Chief Inspector of Hospitals rates Mersey Care NHS Trust as Good

England’s Chief Inspector of Hospitals has rated the services provided by Mersey Care NHS Trust as Good following an inspection by the Care Quality Commission in June 2015.

Services were rated as Good for being effective, caring, responsive, and well led, and as Requires Improvement for being safe. Forensic inpatient services were rated Good across the board as was adult and older people's community services and health based places of safety.

The trust provides a range of mental health, learning disability and substance misuse services to a population of 840,000 people across Merseyside, parts of Cheshire, the West Midlands and Wales.

A team of inspectors, which included a variety of specialists and experts by experience, visited hospital wards and community based mental health services over a period of four days. In addition they also made unannounced visits as part of the inspection. Full reports including ratings for all of the provider’s core services are available on the CQC website.

Inspectors judged the care provided by staff to be good across the majority of core services rather than good across all the majority. Staff fully supported patients, treated them with kindness and respect and involved them in their care and treatment.

Dr Paul Lelliott, CQC’s Deputy Chief Inspector of Hospitals, said:

“People are entitled to services which provide safe, effective, compassionate and high quality care. Mersey Care NHS Trust provides good services to its patient population. We found a caring and committed workforce that was working hard to meet the needs of its patients.

“We saw that staff took great pride in their work, and that they felt the leadership team were approachable. Teams communicated well with each other, and we saw some good examples of collaborative working to improve the treatment and care people received.”

“While our overall finding is that the trust provides a Good service, we did find some areas for improvement. The trust has told us they have listened to our inspectors’ findings and we are confident that the executive team, with the support of their staff, will work to deliver those improvements on behalf of all of their patients. We will return in due course to check that the improvements have been made.”

CQC found that the trust had a strong leadership team that promoted the delivery of good quality care with a clear statement of vision and values. The team was leading by example in focusing on quality and safety.

Staff had a sound understanding of their role and responsibilities in relation to safeguarding incidents and could demonstrate what action to take if they were concerned about a patient. Inspectors found that medicines were managed safely across trust sites, and inspectors observed good practice in relation to hygiene and infection control.

There were strong systems in place for multidisciplinary working between the staff and with other professional groups. Local commissioners were positive about the open and honest relationship they had with the trust.

The trust’s senior leadership team had a good understanding of what was happening on the frontline and responded quickly to areas of concern. For example, a weekly surveillance meeting led by the chief executive sought to identify “hotspots” or areas of risk. Action plans were subsequently implemented to tackle the issues and share learning to prevent recurrence. The trust had systems in place to manage, investigate and learn from incidents and complaints.

However, inspectors were concerned about the safety on some wards. On the trust’s Rathbone unit, risks associated with ligature points in the garden had not been identified or dealt with. The older people’s inpatients services did not always meet national guidance regarding same sex accommodation which requires there to be separate facilities for men and women. On Irwell ward inspectors found that patients were not always treated with dignity and their autonomy was not always respected.

The trust had the appropriate policies in place to support staff in their work. However, on the trust’s Rathbone unit, staff had not completed all mandatory training, and were not always receiving regular supervision and appraisals.

The reports highlight several areas of good practice, including:

• Staff on Windsor ward were piloting a “restrain yourself” project, in conjunction with a local university. This was for patients who had experienced trauma and provided them with the option of going to a quiet room with adjustable mood lighting when they felt distressed.
• Acorn ward, led by the unit’s dementia lead, were trialling a human rights based approach to assessing and planning for the needs of older patients with dementia. The approach would provide a more person centred and user friendly framework for detailing how the service will provide care and treatment for older people. It would also ensure that the trust met its legal obligations in relation to human rights legislation.
• The trust had a well embedded falls management system in place. Inspectors considered that the multidisciplinary approach and staff commitment to fall prevention, which was in evidence on Acorn ward and Hayes Court was outstanding.
• The trust had launched an ambitious strategy to reduce suicide by 2020. The strategy was called zero tolerance to suicide.
• Ashworth research centre was the only dedicated research centre based in a high secure hospital. It develops research that enriches the quality of care in forensic mental health.
• The trust’s learning disability advisory group, (FREDA), was active in promoting service user involvement in service development within the learning disabilities teams. The service and group used the principles of the Human Rights Act: FREDA stands for fairness, respect, equality, dignity and autonomy. The group has produced the first booklet about human rights by people with learning disabilities, for people with learning disabilities.

Inspectors said that the trust must improve in some areas, including:

• The trust must ensure staff receive the appropriate support, supervision, appraisal and training and professional development necessary to enable them to carry out the duties they are employed to perform.
• The trust must ensure that all staff have a good understanding of the Mental Capacity Act 2005 and how it is applied in practice for the patients in their care. This is particularly necessary for older people’s inpatient services and learning disability inpatient services.
• The trust must ensure that Irwell ward provides a safe environment that meets the needs of older patients with dementia and must comply with the guidance on same sex accommodation.

Ends

For further information please contact CQC Regional Engagement Manager Kirstin Hannaford on 0191 233 3629.

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