CQC recommends that Isle of Wight NHS Trust is placed into special measures

England's Chief Inspector of Hospitals has recommended that Isle of Wight NHS Trust should be placed into special measures after an inspection by the Care Quality Commission.  

The Isle of Wight NHS Trust provides acute, ambulance, community and mental health services to a population of 140,000 people. 

Overall, CQC has rated the trust as Inadequate. Acute services provided at St Mary's Hospital and Community Health services, were rated as Requires Improvement. Ambulance Services and Mental Health services were rated as Inadequate 

CQC carried out the inspection over five days in November and January to check on the trust’s progress since its last inspection and to follow up new areas of concern that had been identified from ongoing monitoring of the service. 

Immediately after the inspection, CQC placed conditions on the registration of the trust to minimise the risk of patients being exposed to harm. CQC told the trust that it must operate an effective system to prioritise patients who urgently need access to community mental health services. The trust was also required to carry out an urgent assessment of the physical environment on the mental health wards at St Mary’s Hospital, with a comprehensive assessment of ligature points and a plan to deal with the risks.

CQC's Chief Inspector of Hospitals, Professor Sir Mike Richards, said:

“The Isle of Wight NHS Trust is unique in England as an integrated provider of acute, ambulance, community and mental health services."

“Since our last inspection in June 2014 we have found a number of significant concerns particularly in the mental health and ambulance services, which is why I have made a recommendation to NHS Improvement that the trust should be placed into special measures."

“My inspectors found people were exposed to unacceptable risk of harm. On the mental health wards staff did not always report safeguarding incidents to their local teams and wards were not holding local records of ongoing safeguarding concern. There was poor communication of safeguarding concerns when patients were transferred between services."

“Since this latest inspection we have been assured by the trust that there have been changes to their safeguarding procedures to ensure that incidents are properly reported and investigated."

“I am aware that since the inspection NHS Improvement have been working with the trust to make sure that our concerns are appropriately addressed and that progress is monitored."

“We will return in due course to undertake further inspections, including unannounced visits, to check that the necessary improvements have been made." 

Inspectors found, that despite the pressures, there were many areas where staff were dedicated and committed to patient care. Staff did their upmost to provide care that was compassionate, involved patients in decision making and provided good emotional support to patients and those close to them.

But leadership was Inadequate. The vision for the trust was not clearly articulated by the senior team and staff. The executive team did not always have the necessary experience, or capability to lead effectively. It was a matter of concern that there was no representation of mental health services at board level. 

Staffing shortages within the ambulance service were affecting staff morale and the service’s ability to provide a safe service and meet response times. Inspectors found throughout the trust a culture of subtle bullying from staff working in old fashioned ways and holding up barriers to change. Staff said morale was low, with people leaving and sickness rates going up.

The ambulance station was not found to be secure. The mobile data terminal used to provide staff with patient information and navigation was unreliable. Confidential information, medicines and cleaning products were not always securely stored in the urgent and emergency care service. 

Inspectors found the trust's mental health and community services were facing serious challenges and were unable to safely meet the needs of patients. This meant that the service was unable to respond consistently and effectively.

Not all staff had the skills and knowledge required to undertake their role. Some nursing staff in acute medicine services did not have key competencies to care for patients. 

The inspection has identified a number of areas where the trust must improve, including:

• The trust must ensure that leadership improves at all levels from board to service level.
• The trust must ensure that there are arrangements in place for identifying, assessing and managing risk at all levels and that staff are appropriately trained in this.
• Improvements must be made to partnership working with the local hospice and local authority, to improve patient flow and access to services as they need them. 
• The trust must put in place effective staff engagement and work to progress organisational development and culture change, so that candour, openness and challenges to poor practice are improved.
• The trust must agree a comprehensive community mental health services improvement plan. There should be the necessary external advice and agreement for this improvement plan. The plan should ensure demands on the service are appropriately escalated, assessed and managed.
• The trust must operate an effective escalation protocol in community mental health services. This escalation protocol will need to ensure patients are prioritised appropriately in response to service demands and pressures. 
• The trust must ensure there are sufficient numbers of suitable qualified and competent staff, and managers, to provide a safe, effective and responsive ambulance service. 
• The trust must implement actions in response to the investigation reports and improve the ambulance service culture.

Inspectors also found an area of Outstanding practice, including:

• A new initiative in place ‘Post discharge medicines optimisation support to reduce readmission’, known as MOTIVE, resulted in a significant reduction in readmissions. 

An inspection team, including doctors, nurses, midwives, trained members of the public, a variety of specialists, CQC inspectors and analysts visited relevant wards and departments at the main site Newport as well as clinics and teams across the Island 22--24 November 2016, and an additional visit to mental health services 18-19 January 2017.  

The reports are available in full on our website.

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