Leeds and York Partnership NHS Foundation Trust rated as Requires Improvement overall by Chief Inspector of Hospitals

Professor Sir Mike Richards, England’s Chief Inspector of Hospitals, has rated the services provided by Leeds and York Partnership NHS Foundation Trust as requires improvement following a Care Quality Commission inspection in October.

CQC found that the trust, which provides mental health and learning disability services to a large population across Leeds, York and North Yorkshire, needed to make a number of improvements in order to make sure that it was consistently delivering care which was safe, effective, caring, responsive to people’s needs, in services which were well led. Many of these improvements related to services in York which had been historically underfunded.

A full report on the trust, and on all the individual services inspected, can be found here.

People using the services run by the trust gave mixed feedback on the treatment and care that they had received.

The majority of patients spoken to during the inspection itself told inspectors that they were happy with the quality of the care and treatment they were receiving and with the approach of the staff, and that they felt involved in decisions about their care. However, some people who attended focus groups arranged by CQC prior to the inspection told inspectors that they had concerns about their care. These related to a number of areas, including access to crisis services, the interface between different services, and the complexity of returning to services after a period away.

Inspectors were concerned about the safety of some of the wards. Staff were not always aware of the risks posed by fixtures and fittings that could be used as ligature points by patients who were at risk of suicide. Some wards in York did not meet national guidance regarding same sex accommodation which requires there to be segregated facilities for men and women. This could pose risks to patients as well as compromising privacy and dignity. Staffing levels were usually maintained at the level set by the trust, but there was limited medical cover in some locations which meant that it could be difficult to get medical assistance in an emergency.

CQC found that, despite significant work having been done to attempt to improve the premises, Bootham Park Hospital was not fit for purpose as a modern mental health ward. Because of the building’s listed status, trust staff could not make safe all potential ligature points nor could nursing staff easily observe all parts of all wards due to the layout of the building. The trust was working to find a solution but as yet this had not been implemented. Inspectors noted that the trust had successfully moved a service that had similar problems to another location.

CQC identified a number of other areas where the trust must make improvements (for full details, see the report).  These included ensuring that:

• Comments and complaints are handled appropriately
• Consent to care and treatment is obtained in line with legislation and guidance including the Mental Capacity Act 2005.
• Rehabilitation wards are both adequately and safely maintained.
• All staff receive their mandatory training, and all appropriate staff receive training in relation to the Mental Capacity Act and Mental Health Act
• All medication charts, observation records and records of Gillick competency and mental capacity assessments are always fully documented.
• Adequate medical cover is available, both within and out of working hours, which meets the needs of the patients across the trust.

Inspectors identified a number of areas of good practice across the trust, including:

• The crisis assessment service in the Becklin Centre, Leeds, which operated a pilot scheme called the Street Triage Team. This had reduced admissions into the 136 suite by 28% since its introduction in April 2014. In addition, the service worked closely with West Yorkshire Police and had provided joint training within the trust.
• In York, the community mental health teams had developed excellent partnership working with York St John University through Converge, which provides support and access to courses specifically designed for people who use mental health services.
• The child and adolescent inpatient ward in York provided mobile phones to young people. This meant young people were able to keep contact with friends and family whilst ensuring the privacy of others on the ward was being protected.
• The rehabilitation wards in Leeds had a “you said, we did” feedback system for patients. If patients had raised a point within their weekly community meetings, the “you said, we did” provided them with communication on what action had been taken.
• Staff within the assertive outreach teams escorted patients to visit their general practitioner if required to ensure they received their annual health check.
• Staff met patients at a community based dementia café to enable patients to access a nurse in a more informal, less stressful environment.
• At Linden House, the team had established a specialist training link with Leeds bereavement forum specifically in relation to dementia.

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

“When we inspected the services run by Leeds and York Partnership NHS Foundation Trust, we saw a great deal of variation in the safety and quality of treatment and care provided.

“We saw some examples of good practice in services which were really going the extra mile to improve the support that they provided to people. However, we saw other services where more needed to be done to make sure that care and treatment consistently met the required standard. This trust also needs to continue to work with stakeholders to improve some of their premises so that they properly meet people’s needs.

“People are entitled to receive treatment and care in services which are consistently safe, effective, caring and responsive to their needs. The trust has told us they have listened to our inspectors’ findings and have begun to take action where it is required. We will return in due course to check that the improvements needed have been made.”

The inspection team, which included consultant psychiatrists, consultant nurses, nurses, mental health social workers, occupational therapists, Mental Health Act reviewers, experts by experience (people with personal experience of using or caring for someone who uses the type of services we were inspecting), student nurses, psychologists, advocates, junior doctors, senior managers and specialist registrars, CQC inspectors and analysts, visited a number of services run by the trust over a period of three days. They also made unannounced visits as part of the inspection.

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