CQC inspectors rate services provided by 2gether NHS Foundation Trust as Good

England’s Chief Inspector of Hospitals has rated the services provided by 2gether NHS Foundation Trust as Good following its first comprehensive inspection by the Care Quality Commission.

The trust provides a range of mental health, learning disability and substance misuse services to a population of 761,000 people across the counties of Gloucestershire and Herefordshire.

A team of inspectors reviewed 10 core service areas against five key questions relating to whether services were safe, caring, effective, responsive and well led. Inspectors found that overall the trust’s services were Good for being caring, effective, responsive, and well led, and as Requires Improvement for being safe. Individual service inspections found that acute wards for adults of working age and mental health crisis services were both rated Outstanding overall.

Full reports including ratings for all of the provider’s core services are available at: www.cqc.org.uk/provider/RTQ.

The inspectors, who included a variety of specialists and experts by experience, visited hospital wards and community based mental health services over a period of five days during October. In addition, they made unannounced visits as part of the inspection.

Inspectors found that care and treatment was effective with people using the services at the centre of everything the trust did. Staff fully supported patients with wider needs including physical health, emotional wellbeing and social needs, treating them with kindness and respect while involving them in their care and treatment. Inspectors found that there were some aspects of care and treatment in some services that needed improvements to be made to ensure patients were kept safe.

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

“2gether NHS Foundation Trust has much to be proud of. The trust has a committed senior leadership team, and there are many skilled and enthusiastic staff throughout the organisation working hard to manage day to day care, while always trying to improve services to meet the needs of their patients.

“We found the crisis and health-based place of safety service and acute inpatient services for adults were outstanding. Both of these services were able to demonstrate excellent practice and innovation which went above the standards which are expected.

“We did find some pockets of poor practice but the trust took immediate action to address some issues and have told us they have taken on board the findings of our inspection. We are confident that the trust will work to deliver those improvements on behalf of all of their patients.”

In the acute inpatient services, inspectors found that there was an underlying philosophy to provide care in partnership with patients and to tailor treatment to meet their individual needs. An open door policy on the wards allowed patients to come and go as they wished but at the same time ensured the clear and positive management of patients who were detained under the Mental Health Act. Instead of using traditional seclusion, staff worked with patients to effectively manage challenging behaviour.

The crisis and health based place of safety services were well managed. The crisis teams saw patients quickly and patients had thorough risk assessments and care plans. They ensured patients only had to go into hospital if it was absolutely necessary, with every effort being made by the team to support patients in their own homes.

The reports highlight several areas of good practice, including:

• The recovery colleges provided patients with opportunities to socialise, learn, develop their self-confidence and acquire skills to help prevent a relapse. They also gave patients the opportunity to become trainers themselves.
• The managing memory team ran a dementia training and education programme. They had recently won a community dementia link award after training 400 firefighters about aspects of supporting people with dementia. The team had written a play using their links with schools which sent a strong message about living with dementia.
• The children and young people’s team in Gloucester provided a project that supported the safe return of children and young people in care back to their families using a number of agencies.

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

• The trust must ensure patients are aware of any contingency plans put into place for their support when they are on Section 17 leave, including what they should do if they think they need to return to hospital early.
• On the wards for people with a learning disability, the trust must ensure staff fully understand the policies and procedures relating to seclusion, that patients have a robust care plan in place for using the seclusion room and are aware of their rights and that up to date and accurate records are kept when using the seclusion room for non-seclusion purposes.
• The trust must ensure patients have copies of their care plans in a format they can understand, and keep a record of reasons if the patient does not have a copy.

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.

Ends

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