CQC inspectors rate Cheshire and Wirral Partnership NHS Foundation Trust as Good

England's Chief Inspector of Hospitals has found the quality of services provided by Cheshire and Wirral Partnership NHS Foundation Trust to be Good following an inspection by the Care Quality Commission.

Overall the trust has been rated as Outstanding for providing services that are caring, Good for providing services that are effective, responsive and well led, and Requires Improvement for providing services that are safe.

A team of CQC inspectors and specialist advisors spent four days in June inspecting the services provided by the trust. The team inspected the mental health wards for children and young people, working age adults and older people, forensic services, including the low secure service, and both physical and mental health community services for people of all ages.

Full reports of the inspection including ratings for all core services will be available on CQC’s website from 00:01 on Thursday 3 December at: www.cqc.org.uk/provider/RXA.

Inspectors found that the trust was committed to improving the quality of services and had governance structures to support that aim. Morale was good across all services, and staff teams were motivated and committed to providing high quality care and treatment to patients in line with the trust’s vision and values.

There were systems in place to report when things go wrong and a positive culture of learning and continuous improvement that was shared by staff in the trust’s hospitals and in the community.

The trust had worked hard to improve staffing levels significantly over the six months immediately prior to the inspection. The trust continued to face staffing challenges on some wards. However, overall staffing levels were safe and caseloads across the community teams were in line with current guidance.

Most patients said they received good care. Inspectors found staff providing skilled interventions in a caring and respectful way across all the core services, and saw numerous examples of staff teams having ‘gone the extra mile’ to ensure patients’ needs were being met.

Inspectors noted a number of areas of good practice - a panel of patients was involved in the recruitment and selection of new staff. If the panel did not approve of a potential member of staff then they were not appointed.

Working with Cheshire Police, the trust had a street triage approach to policing incidents involving people who may have mental ill-health. The service had shown a to 92 per cent reduction in the number of people detained under section 136 of the Mental Health Act.

However, inspectors were concerned about the safety of some of the wards. Staff were not always aware of the risks posed by fixtures and fittings that could be used as ligature points by patients who were at risk of harm. Trust policy and national guidance in relation to the use of seclusion rooms was not always followed, and some of the trust’s acute mental health wards did not fully meet national guidance regarding same sex accommodation, which requires there to be segregated facilities for men and women.

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

"Overall we have found that the services provided by Cheshire and Wirral Partnership are Good, and in some places Outstanding. Most people we met, either as patients or carers, spoke very highly of the care and that is reflected in these ratings.

"We saw dedicated and compassionate staff using innovative approaches to communicate effectively with patients.

“The trust board and those senior managers we spoke with were open and transparent and committed reducing restrictive practices in line with their trust-wide campaign ‘zero harm’.

“While our overall finding is that the trust provides a Good service, we did find some areas for improvement in relation to the safety of some services.

"The trust is well led. We have seen there are systems in place which ensure that the senior management is aware of the strengths and weaknesses of their services. We are confident that they will address the issues we have identified in this report. We will return in due course to check on their progress."

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

• Young people who had used the trust’s community mental health services helped to run training for professionals on topics including self-harm.
• The education provision for young people receiving inpatient services on Maple ward and at Pine Lodge had been rated by Ofsted as outstanding. Inspectors observed individually tailored education during our inspection.
• Adults of working age using the trust’s community-based mental health services were encouraged to act as peer supporters for other people attending the wellbeing group and acted as a point of contact before the group, providing refreshments and welcoming group members.
• The community end of life care team worked to ensure that patients received all the emotional and practical advice and support they needed. Inspectors saw good examples of team members going the extra mile to try to ensure that patients were able to end their days in the place they chose.
• In November 2014, the trust’s mental health crisis and health-based places of safety team worked with Cheshire Police in a new approach to policing incidents involving people with mental ill-health. The service had shown an up to 92% reduction in the number of people detained under section 136 of the Mental Health Act.
• The care being provided in the learning disability service was outstanding patients, families and carers were involved in decisions about care. Care plans were developed collaboratively with a person centred focus.
• In the End of Life service, the team as a whole, worked to ensure that patients received all the emotional and practical advice and support they needed. We saw some outstanding examples of team members going the extra mile to try and ensure that patients’ needs and wishes were met.

The inspection also identified a number of areas where the trust must improve:

• The trust must ensure that all young people using community mental health services have a comprehensive individual risk assessment.
• On the acute wards for adults of working age and the psychiatric intensive care units, the trust must review ward composition and practices to ensure they comply with the Department of Health required guidance on Same-sex accommodation.
• On the secure inpatient wards the trust must ensure that patients are cared on the secure inpatient wards for in the least restrictive manner and that staff are aware of environmental risks and that actions are taken to mitigate them as far as possible. The trust must ensure that there are enough suitably qualified, skilled and experienced nursing and other staff working in adult community services.
• Staff working in community health services for children must ensure that medical records are kept in a way that allows professionals to access accurate, complete records for each child easily when required.

The Care Quality Commission has already presented its findings to a local quality summit, including NHS commissioners, providers, regulators and other public bodies. The purpose of the quality summit is to develop a plan of action and recommendations based on the inspection team's findings

Ends

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