Chief Inspector of Hospitals rates Surrey and Borders Partnerships NHS Foundation Trust as Requires Improvement

England's Chief Inspector of Hospitals has told Surrey and Borders Partnerships NHS Foundation Trust that it must make improvements to some services following an inspection by the Care Quality Commission.

Overall, the trust has been rated as Requires Improvement for providing safe and well led services, and rated Good for being caring, effective and responsive to people’s needs.

Full reports of the inspection including ratings for all core services are available.

The Deputy Chief Inspector of Hospitals (and CQC’s lead for mental health), Dr Paul Lelliott, said:

“Since our previous inspection two years ago, the trust has carried out a comprehensive review of its inpatient mental health services and health based places of safety. The trust has closed wards and units that were not safe or no longer suitable and has opened new facilities in their place.

“We have rated seven of the nine mental health core services provided by the trust as Good. The trust has improved patients’ access to physical healthcare and is better at monitoring the physical health of people who use its mental health services. It has also improved waiting times for people who use its community mental health services.

“However, the trust board did not have a good enough oversight of incidents which they should be learning from. Also, the trust managers has not ensured that the care homes that it manage provide care that is safe and of a high quality. The CQC has inspected eleven care homes managed by the trust and rated six of these as Requires Improvement.

“We will be working with the trust to agree an action plan to assist them in improving the standards of care and treatment.”

A team of CQC inspectors, specialist advisors visited hospital and community services provided by Surrey and Borders Partnerships Foundation Trust during March 2016.

Surrey and Borders Partnership NHS Foundation Trust has a total of eight registered locations serving mental health and learning disability needs, including four hospital sites. The trust provides community mental health and learning disability services from a range of community sites across Surrey and North East Hampshire. There are also 12 care homes registered which provide residential services to adults with a learning disability and a domiciliary care service for adults and older people in North East Hampshire and North West Surrey.

The trust had carried out a comprehensive review of its inpatient services and health-based places of safety since the last inspection. The trust had closed wards and units that were not safe or no longer suitable for inpatient mental health services and had opened a new purpose built unit for adult acute services, a psychiatric intensive care unit and a health-based place of safety

But, inspectors found the trust’s governance processes did not ensure that incidents were reported or that staff learned from incidents, complaints or patient feedback. It was clear that the board did not have a thorough oversight of incidents and complaints. While the board discussed individual, high profile cases, there was no detailed report to the board which analysed incidents and complaints, or gave them the opportunity to learn from them.

Inspectors found there were weaknesses in the trust’s oversight of its care homes for people with a learning disability. Six of the trust’s care homes have been rated as requires improvement by separate CQC inspections in the past year.

There was inconsistent medicines management practice across the trust. There were controlled drugs discrepancies on two wards and out of date drugs on three wards. On three wards, liquid medicines and creams did not have opened dates recorded.

The trust had set up initiatives to provide training for new staff and newly-qualified staff to help provide them with additional training and support opportunities. For example they had set up apprenticeships for healthcare support workers. The trust was a host employer for trainee clinical psychologists. The education and development team worked with the operational teams to provide placements for pre-registration nursing students. The team had set up a new leadership and management programme which was being rolled out to all supervisory staff.

The inspection has identified a number of areas for improvement including:

• The trust must ensure that it has effective systems for reporting and learning from incidents.
• The board must have a thorough oversight of incidents and complaints.
• Medicine management must be safe throughout the trust.
• The trust must ensure it complies with same sex accommodation guidance.
• The seclusion policy must be updated to reflect the current Mental Health Act Code of Practice guidance.

The report identifies a number of areas of good practice including:

• The specialist community child and adolescent mental health service (CAMHS) had developed an effective partnership with an independent patient-led organisation, the CAMHS Youth Advisors, which provides induction training to help staff understand the experience of patients, provides patient representatives on interview panels, and was consulted on the design of new buildings for children’s services.
• The recent introduction of safe haven services in Aldershot and Woking provided an alternative to traditional out of hours crisis services. The services were set up as cafes, and provided walk-in support between during the evenings for those wishing face to face contact with qualified staff.

Ends

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