The Chief Inspector of Hospitals has told Avon and Wiltshire Mental Health Partnership NHS Trust that it must continue to make improvements following its latest comprehensive inspection by the Care Quality Commission.
Inspectors found there had been major improvements in community mental health services in Bristol. But, there were significant failings in the delivery of health based places of safety. Overall the trust has been rated Requires Improvement. Full reports on all core services are available at www.cqc.org.uk/provider/RVN
Avon and Wiltshire Mental Health Partnership provides mental health services across Bath and North East Somerset, Bristol, North Somerset, South Gloucestershire, Swindon and Wiltshire. The trust also provides specialist mental health services for a wider catchment extending throughout the south west.
Following the inspection, in May 2016, CQC issued a Warning Notice requiring the trust to make urgent improvements to the health based places of safety services.
Inspectors found that in some cases, vulnerable patients were detained in police cells because there were no beds available in the trust’s designated places of safety. Patients were regularly waiting over twelve hours for a Mental Health Act assessment and then had to wait again for admission to a suitable ward. Inspectors had further concerns about the safety of the environments of some places of safety.
Dr Paul Lelliott, Deputy Chief Inspector of Hospitals (and lead for mental health), said:
“When a person in a crisis who requires mental health care is detained by the police, they should be taken immediately to a properly staffed place of safety where they can be assessed by a mental healthcare professional. They should be taken to a police cell only in exceptional circumstances. We found that too often the designated places of safety managed by AWP were not available when needed. This must be addressed as a priority and I know the trust is already working closely with the police to tackle this problem.
“Despite these specific concerns, we found that Avon and Wiltshire Mental Health Partnership NHS Trust has a committed and caring workforce that is trying to meet the needs of all people who use the services safely and effectively. Almost without exception, patients and carers spoke positively about the care they received and patients. They described staff as being caring, enthusiastic and committed to delivering high quality care and treating patients and carers with dignity and respect.
“The trust has responded well to make the improvements that we required following previous inspections. However, there is still a significant amount of work to be done to improve quality and consistency of services and effectiveness of working practices across the trust.”
After the trust’s last inspection in December 2015, CQC served a Warning Notice because of significant concerns about the Bristol crisis, assessment and recovery services for adults of working age. People needing urgent community-based mental health services were waiting several months for assessment. At the time, inspectors found that the trust did not have effective governance arrangements in place to enable it to assess, monitor and improve the quality of services. When we inspected again in May 2016, we found that the trust had made major improvements to the community mental health services in Bristol. However, there is still more work to be done; particularly to the north Bristol community mental health services.
Inspectors also found there had been considerable improvements since the trust’s last comprehensive inspection in 2014. A service manager had been appointed to cover all three Bristol teams and there had been an increase in staffing.
The report highlights areas of good practice including:
- Staff throughout the trust were committed to continuous improvement with many involved in a wide variety of local initiatives. On Alder ward (rehabilitation)staff and patients worked together to raise funding to buy musical instruments and bikes for the patients.
- The trust had participated in a number of quality improvement programmes or accreditation schemes covering ECT, inpatient wards, home treatment, memory services, forensic mental health services, eating disorder services and perinatal services.
- The trust was committed to participation in research and viewed it as a core activity. It had developed good collaborations with three universities of Bristol, West of England and Bath.
- Staff were actively encouraged to publish papers describing their achievements or innovations. For example, a consultant at the Victoria Centre in Swindon had recently published a paper on the management of aggression in patients with dementia.
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