The Care Quality Commission (CQC) has published a report following an inspection at Avon and Wiltshire Mental Health Partnership NHS Trust.
Inspectors visited the trust between July and September to assess two core services: wards for older people with mental health problems and specialist community mental health services for children and young people*. CQC also looked specifically at management and leadership of the trust to answer the key question - is the trust well led?
Following this inspection, the overall rating for both services move down from good to requires improvement but, rated the key question, ‘is the trust well led’ as good – an improvement from the last inspection. However, the overall rating for the trust remains requires improvement. Overall, it remains requires improvement for being safe and responsive to people’s needs, and good for being caring and effective.
The wards for older people with mental health problems have had their caring and well-led ratings moved down from good to requires improvement. The rating for safe remains requires improvement, while the ratings for effective and responsive remain good.
In the specialist community mental health services for children and young people, the safe and responsive ratings have moved from good to requires improvement, while effective, caring and well-led retain their good rating.
Karen Bennett-Wilson, CQC’s head of inspection for mental health, said:
“Since our last inspection of Avon and Wiltshire Partnership NHS Trust, the leadership team has demonstrated a higher level of awareness of the priorities and challenges facing the trust and they responded quickly to take action to keep staff and patients safe during the COVID-19 pandemic. However, despite plans being in place to address challenges, actions did not always happen at pace.
“For example, there is work to do to manage environmental risks including known ligature points that people may use to hurt themselves, on the wards for older adults. Plans have been created but not fully implemented which puts people at risk.
“Most staff we spoke with told us that their immediate managers were visible and supportive. However, staff did not always feel that senior leaders, outside of their local areas, were approachable or had a good understanding of the services. It was also concerning that staff did not always feel able to raise concerns without fear of retribution.
“In April 2020 the trust took over Weston Area Health Children’s and Adolescent Mental Health Community services. These services were originally rated inadequate under the previous provider, but the local team have worked hard, and this rating is now requires improvement. Whilst there is work to be done, the trust and the staff team delivering these services should be pleased with the improvements made and the direction the service is headed in.
“We will continue to monitor the trust closely to ensure it continues to make improvements and embeds them fully in areas where progress has already been made.”
In specialist community mental health services for children and young people inspectors found:
- Some of the areas where young people received care were not safe, clean or well equipped. Assessments were not always thorough enough to remove potential risks. However, in the trust’s South Gloucestershire service, staff were carrying out a full range of environmental risk assessments
- Some staff found their caseloads were too high to give each young person the time they needed and there wasn’t always enough staff in all areas who knew the young people well
- Staff did not always assess and treat young people quickly enough however, if a young person missed an appointment staff did follow this up
- Young people’s safety incidents were managed well. Staff could identify incidents and reported them appropriately. Managers investigated incidents and shared any lessons learned with the service. When things went wrong, staff apologised and gave young people honest information and suitable support
- There was a dedicated mental health crisis service which was available 24-hours a day and was easy to access.
In the wards for older people with mental health problems, inspectors found:
- Staff knew about risks to each patient and acted to prevent or reduce these. But staff had not included references to environmental risks, such as ligature points and blind spots when developing risk management plans for patients who could be a risk to themselves on five of the wards inspected
- On most of the wards, inspectors saw examples of staff providing good care. However, there were examples of staff entering patient’s bedrooms without knocking on their door or asking for permission to enter. Inspectors had to prompt some staff to ask for the patient’s consent for inspectors to enter bedrooms during inspection. Staff said some patients did not have the capacity to consent to inspectors entering their bedrooms, but, they did not attempt to discuss this with the patient. There were also examples of staff not interacting with patients when already in their room
- Some staff did not feel involved in the development of the future plans of their wards and said they felt uninvolved with the changes being proposed
- Some wards were being used as admission areas during the COVID-19 pandemic. Staff said that they felt the workload created by high level of transfers to and from these wards could not be sustained in the long term
- Ward managers and senior nurses completed audits of care records. Inspectors found that some ward managers were using the audits effectively. However, others were unsure on the processes for these or were unaware of their existence meaning patients weren’t benefitting from improved care
- Managers worked closely with the local healthcare community to make sure that a well-integrated health and social care system was in place to meet the needs of the local population.
Full details of the inspection are given in the report published on our website.
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