Chief Inspector of Hospitals rates Sheffield Health and Social Care NHS Foundation Trust as Requires Improvement

England’s Chief Inspector of Hospitals has rated the services provided by Sheffield Health and Social Care NHS Foundation Trust as Requires Improvement following an inspection by the Care Quality Commission.

The trust provides mental health, learning disability, substance misuse, community rehabilitation, and a range of primary care and specialist services to people in and around the city of Sheffield.

A team of inspectors, which included a variety of specialists and experts by experience, visited hospital wards and community-based services over a period of three days. They also visited six adult social care services run by the trust and made some additional unannounced visits as part of the inspection. Full reports including ratings for all of the provider’s core services are available at: www.cqc.org.uk/provider/TAH.

The trust’s forensic inpatient services were rated as Outstanding and the trust’s mental health crisis services, wards for older people with mental health problems and community mental health services for older people were rated as Good. However, the services provided on the trust’s psychiatric intensive care unit (PICU), long stay rehabilitation wards, and community mental health services for adults of working age were rated as Requires Improvement.

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

“We have found significant variation in the quality of the services provided by Sheffield Health and Social Care NHS Foundation Trust

“While there were examples of good practice and innovation in some of the services, we also saw other services where more needed to be done to make sure that care and treatment consistently met the required standard. Staff shortages in some services posed a risk that patients’ needs would not always be met in a timely maner and concerns were also raised regarding medicines management. These issues require urgent attention to bring them up to acceptable standards.

“The trust’s forensic mental health services proactively promoted patient’s recovery from admission through to discharge and staff took all practical steps to minimise restrictions on patients.

“People are entitled to services which are consistently safe, effective, caring and responsive to their needs. The trust has told us they have listened to our inspectors’ findings and have begun to take action where it is required. The trust has a clear governance structure with effective communication between the senior management and frontline staff therefore I expect the trust’s leadership team to drive improvements to address all areas of concern. We will return in due course to check that the improvements have been made.”

Overall the trust was providing a caring service for its patients. Inspectors saw examples of staff treating people with kindness, dignity and compassion and patients commented favourably on the quality of care and support they received. The majority of patients who met inspectors said that they felt involved in decisions about their care and inspectors found that staff were knowledgeable about patients’ needs.

On the trust’s forensic inpatient wards staff effectively assessed and monitored individual patient risks to help keep patients and staff safe and this was reflected in the relatively low use of restraint and seclusion. Patients on these wards were supported to maintain contact with their relatives through use of digital communications and were provided with a range of recreational and therapeutic activities to help support their recovery.

However inspectors identified a number of safety concerns regarding the seclusion rooms on some of the trust’s acute wards and they also found potential risks from fixtures that could be used by patients to harm themselves, although they had not been identified by staff. There were insufficient numbers of qualified staff to provide full cover on all the rehabilitation wards at Forest Close, and a shortage of staff to manage the trust’s out of hours services at night time.

At the time of the inspection, inspectors also raised concerns about the management of medicines. In some treatment rooms on the acute adult and older people’s wards refrigerators were not always properly monitored to make sure that medicines were being stored at the correct temperature and medicines administration records were not always completed by staff to show that patients had received their medicines as prescribed.

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

• The trust must take action to remove ligature points in the acute admission and PICU wards that could endanger people at risk of suicide.
• The trust must ensure there are consistent qualified staffing levels at Forest Close and adequate staffing at night time to manage the out of hours and crisis demands.
• The trust must ensure medicines management is effective in the acute adult wards, older people’s wards and Community Mental Health Teams.
• The trust must ensure that all patients are invited and encouraged to be involved in their multi-disciplinary meetings, Care Planning Assessment (CPA) meetings or ward rounds and this is documented.
• The trust must ensure that all services adhere to the Mental Health Act Code of Practice in relation to documentation and capacity to consent.

The reports highlight several areas of good practice, including:

• Patients on Stanage ward had access to innovative touch screen technology providing information on a range of subjects including the ward services, Mental Health Act rights, medication information and services available to the patients in hospital and in the community.
• There were innovative initiatives to enable patients to comment on community mental health services, including the employment of peer workers, people involved in interviewing community staff and other initiatives.
• There was integrated health and social care working within the community teams including nurses acting as Approved Mental Health Professionals and community psychiatric nurses providing social circumstance reports.
• In forensic services, wards had a fast track complaints system in place which enabled patients or visitors to raise an informal complaint if they did not wish to raise their concerns formally.

The report which CQC publishes today is based on a combination of its inspection findings, information from CQC’s Intelligent Monitoring system, and information provided by patients, the public and other organisations. CQC inspectors will return to the service in due course to check that the required improvements have been made.

Ends

For further information contact David Fryer on 0790 151 4220 or Kirstin Hannaford on 0191 2333629. For media enquiries about the Care Quality Commission, please call the press office on 020 7448 9401 during office hours. Journalists wishing to speak to the press office outside of office hours can find out how to contact the team at www.cqc.org.uk/media/our-media-office. (Please note: the duty press officer is unable to advise members of the public on health or social care matters).

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