Northamptonshire Healthcare NHS Foundation Trust is rated as Requires Improvement by the Care Quality Commission

England's Chief Inspector of Hospitals has told Northamptonshire Healthcare NHS Foundation Trust that it must make improvements following an inspection by the Care Quality Commission.

CQC has rated the trust as ‘requires improvement’ overall. It was rated as ‘good’ for whether services are caring and ‘requires improvement’ for whether services are safe, effective, responsive and well-led.

Northamptonshire Healthcare NHS Foundation Trust provides community health and mental health services to a population of 629,000 people across Northamptonshire, covering the city of Northampton together with the towns of Kettering, Corby, Wellingborough and Rushden.

A team of CQC inspectors, expert specialist advisors and people who have experience of using services or caring for someone who uses services spent four days at the trust in February. CQC has published 17 separate reports on the services provided by the trust in hospitals, in clinics, and in the community.

Full reports including ratings for all core services are available at: www.cqc.org.uk/provider/RP1. 

The inspectors found a marked contrast in the quality of the trust’s services. While two of the mental health core services were ‘outstanding’, all community health services were in need of improvement.

The trust had 12% of staff posts vacant at the time of the inspection. There were particular shortages of community nursing staff and therapists. The trust had taken some steps to limit the impact of these staff shortages and was in the process of recruiting more staff.

Inspectors found that some of the ward environments were not safe. We concluded that patients at risk might not always be fully protected at the Quayside rehabilitation unit, on both child and adolescent mental health wards and in the gardens at St Mary’s Hospital. Three seclusion rooms did not fully meet current standards.

Across the trust, inspectors heard positive feedback from patients and carers. Treatment was delivered in a sensitive and dignified manner and staff were dedicated and kind. The older people’s mental health inpatient service at the Forest Centre was commended by inspectors due to its state of the art facilities, excellent use of therapeutic tools and the involvement of patients with their own care.

Despite the problems it found, the inspection team concluded that the executive team individually and collectively demonstrated a determination to improve the quality of care provided to those who use the trust’s services.

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

“The quality of the services provided by Northamptonshire Healthcare NHS Foundation Trust was patchy. We rated a lot of its service, particularly the community health services, as ‘requires improvement’. On the other hand we found that the wards at the Forest Centre for older people with mental health problems and the substance misuse service were ‘outstanding’. Overall, we found a committed and caring workforce and we heard a lot of positive feedback from patients and carers.

We have told the trust that it must make a number improvements to bring its services overall up to a level that would earn a rating of ‘good’. In particular, the trust was not providing sufficient training for its staff and not ensuring that all staff received regular supervision. Also clinical staff were not always maintaining high quality patient records, including recording the fact that patients have given consent to treatment,. We were also concerned at lapses in medicines management at Quayside Ward, a long stay mental health rehabilitation service at Berrywood Hospital.

“This report presents the detail of our findings, our ratings and our recommendations. We met with the trust’s senior managers to pass on our preliminary findings at the time of the inspection. We also held a quality summit held on 21 August at which we heard what the trust leadership has already done to bring about improvement and their future plans. Our inspectors will return at a later date to check that progress continues to be made.”

CQC has identified a number of specific areas where the trust must improve. As a first step, the trust must provide a plan setting out how it will address each requirement.

• The trust must review their existing ligature risk assessment audits and address the areas of concern.
• The trust must review all of their seclusion rooms and ensure that these comply with the Mental Health Act code of practice.
• The trust must comply with the Department of Health guidance on same sex accommodation.
• Care and treatment records must capture the involvement of patients in the treatment they received.
• There must always be sufficient numbers of suitably qualified, skilled and experienced staff in the community inpatient wards to ensure patients are safe and their health and welfare needs are met.
• The trust must ensure that staff are able to attend mandatory training opportunities, to enable them to care and treat patients effectively.
• Policies and procedures for safeguarding children must be fully understood and implemented by staff to ensure that all children and young people are protected from the risk of abuse.

The CQC inspection team found several areas of good practice, including:

• The trust commissioned specialist mental health therapies for people living with dementia from external providers including: Alzheimer’s Society’s “singing for the rain” initiative, drama therapy and pet therapy.
• The trust’s daily open clinic slot provided rapid access to treatment for people with substance misuse issues. This had been developed to reduce drug related deaths.
• A peer mentor service had been developed in the substance misuse service which enabled people who were in recovery to play a role in supporting others.
• The care assessment treatment for the children at home team worked closely with GPs to prevent hospital attendance and admission. The team offered home visits and telephone advice to parents.
• Team 63 were receiving training around a new psychological therapy, mentalisation based treatment; a treatment designed to help people with relationships and the ability to manage their own emotions.

The Care Quality Commission has already presented 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.

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