England’s Chief Inspector of Hospitals has told Lancashire Care NHS Foundation Trust that it must make improvements following an inspection by the Care Quality Commission.
Lancashire Care NHS Foundation Trust is a provider of mental health, community health, adult social care, primary care, community dental services, community health inpatient services and prison healthcare. Inspectors visited the trust between January 8 and February 21, 2018.
The trust’s overall rating has fallen from Good to Requires Improvement since its last inspection in September 2016. At this inspection, CQC rated safety, effectiveness and well-led as Requires Improvement. Responsiveness and caring were rated as Good.
The five core services that CQC inspected as part of their regular checks on the safety and quality of healthcare services were: acute wards for adults of working age and psychiatric intensive care units; forensic inpatient / secure wards; child and adolescent mental health wards; mental health crisis services and health based places of safety; and community health inpatient services.
Inspectors have rated the trust Requires Improvement for safety. The recruitment and retention of staff remained a challenge and there was an over reliance on the use of agency and bank staff to ensure patients were kept safe.
The rating for the well-led key question has gone down to Requires Improvement. Inspectors noted staff on the child and adolescent ward had felt disconnected and unsupported by senior managers within the trust during the transition to the new location and staff morale remained low. The senior management team had not taken effective action to ensure the proper use of the crisis support units.
Community health inpatient services had improved from Requires Improvement to Good. It was clear that staff knew how to report incidents and these were discussed at monthly team meetings. Staffing levels had improved since the last inspection as had infection control and prevention audits. Staff delivered patient centred care based on best practice guidance.
Within mental health services, the rating fell from Good to Requires Improvement.
In acute wards for adults of working age and psychiatric intensive care units. Staff compliance with essential training was low and some staff were not appropriately monitoring patients after the administration of rapid tranquilisation. There were gaps in the required observations and incomplete records.
In the mental health crisis services and health based places of safety, patients detained by police as requiring assessment under the Mental Health Act would be kept in specialist suites known as health based places of safety. Inspectors were concerned to see that it was not unusual for patients to be held in this accommodation for longer than the 24-hour time limit set down in legislation.
On the child and adolescent mental health wards, the service was under pressure due to the acuity of the patients, staffing issues and the high levels of observation required. Staff spent the majority of their time on observations for certain patients.
The rating for forensic inpatient and secure wards remained unchanged at Good.
Dr Paul Lelliott the Deputy Chief Inspector of Hospitals (and lead for mental health), said:
“It is disappointing to report that our overall rating for Lancashire Care NHS Foundation Trust has declined since our last inspection.
“The trust has been under pressure notably in mental health crisis services and the child and adolescent mental health wards. The board and senior management team did not have sufficient oversight of staff supervision; particularly in some core services, where rates of ongoing appraisal and supervision were too low and have not improved since our last inspection.
“However, patients and carers have told us that staff were compassionate, committed and interested in them as individuals. Inspectors could see that staff ensured that patients’ cultural, religious and dietary needs were being met and services were equipped to meet the needs of patients with physical disabilities.
“Encouragingly there were areas where the trust had improved such as community health inpatient services but the trust needs to address those areas where we have identified the need for improvement. We will continue to monitor the service closely and return at some time in the future to check on progress.”
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It is disappointing to report that our overall rating for Lancashire Care NHS Foundation Trust has declined since our last inspection
Dr Paul Lelliott, Deputy Chief Inspector of Hospitals (and lead for mental health)