England's Chief Inspector of Hospitals has rated Humber NHS Foundation Trust as Requires Improvement following an inspection by the Care Quality Commission.
The trust has been rated as Inadequate for providing services that were safe, Requires Improvement for effective, responsive and well-led and Good for caring,
The full report of the inspection that took place in April 2016 is available.
Some clinical teams had high vacancy rates and a number of teams were operating below the staffing levels that the trust had determined as being necessary. This was a particular problem in mental health crisis services, the health-based places of safety, the five district nursing teams and seven community health services neighbourhood care teams.
The trust was failing to provide sufficient training opportunities in that it did not ensure that its staff undertook basic training or received support for personal development. Staff compliance with training, that the trust had deemed mandatory, was only 61%; well below the trust’s target of 75%. Fifty percent of staff had not received recent training in the Mental Capacity Act
Inspectors were not assured that the trust’s mechanism for assuring and improving the quality of care was consistent at team, service and trust board levels. The trust must take significant steps to improve the quality of its services. The CQC served a warning notice giving the trust until 14 June to produce an action plan describing how it would improve services. The trust produced the plan before the deadline.
Although the trust had made significant progress since our previous comprehensive inspection in addressing concerns about services for children, young people and families and in community health services, they had failed to make the same progress in mental health services.
Dr Paul Lelliott, the Deputy Chief Inspector of Hospitals (and CQC lead for mental health), said:
“Humber NHS Foundation Trust has a number of issues it has to address. They have been rated as Inadequate for safety and a great deal of what we saw demonstrates that the trust had not learnt all the lessons from our last comprehensive inspection. The trust will be disappointed with the outcome.
“In some services, people waited a long time to receive the care that they needed. Some of the trust’s facilities did not promote recovery. In mental health acute wards, patients’ bedrooms were locked and in forensic inpatient and secure wards, patients had limited access to meaningful activity to support their recovery. The wards had facilities to provide activities but shortages of staff often meant they did not take place.
“The serving of the warning notice was necessary to ensure that the trust addressed poor practice in respect of seclusion and long-term segregation, rapid tranquilisation and the inappropriate supervision of patients while opening mail. This represented very poor practice, especially as we had previously advised the trust against this practice.
“The trust must focus on the many areas for improvement. We have received their action plan, which will form the basis and plan for our next follow up inspection when I hope to be able to report improvement”
This report identifies a number of areas where the trust must improve, including:
- The trust must ensure that the withholding of patients’ mail in secure/forensic services is stopped. They must also maintain accurate, complete and contemporaneous record in respect of each patient and document when they had administered medication to patients.
- The trust must ensure that it trains all qualified staff in immediate life support, so they know what action to take should a patient have an adverse effect from rapid tranquilisation including the use of emergency medication.
- The trust must ensure that all staff are trained in the use of seclusion and make sure that adherence to trust and national guidance addresses how, when and by whom the clinical reviews are undertaken, in addition they must also ensure that physical health monitoring of patients is undertaken while patients are in seclusion.
- The trust must urgently review the geographical issues with the substance misuse care pathways and review the high waiting times and high unplanned exits resulting from the substance misuse service
During the inspection, inspectors did note and comment on an example of good practice by staff in the learning disability inpatient service where several patients had tablet computers provided by the trust. These incorporated an application called ‘my health guide app’.
The app helped patients to own their information and take a role in their own health care. Patients could customise the app so that it was personal to them. Information could be recorded in a number of ways such as text, audio, video and images.
Within Child and Adolescent Mental Health Services (CAMHS) community services a member of staff had been recognised nationally for a peer support group for patients with attention deficit hyperactivity disorder. The group was called #.H.A.S.H.T.A.G. They won a £1000 grant to help with the group.
The Care Quality Commission will present 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.
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We have received their action plan, which will form the basis and plan for our next follow up inspection when I hope to be able to report improvement.
Dr Paul Lelliott, Deputy Chief Inspector of Hospitals (CQC lead for mental health