The Care Quality Commission (CQC) has rated the services provided by Tees, Esk and Wear Valleys NHS Foundation Trust as Requires Improvement following its latest inspection.
A team of inspectors visited the trust from 24 September to 6 November 2019 and found a number of improvements were needed.
CQC asks five key questions - are services safe, effective, caring, responsive and well-led – and as a result of the latest inspection the trust is rated Good for effective, caring and well-led. It is rated Requires Improvement for whether its services are safe and responsive.
The trust was last inspected in July 2018 and was rated Good overall. At that time the trust was rated as Requires Improvement for whether its services were safe.
In June 2019 the trust’s child and adolescent mental health wards (CAMHS) were inspected which resulted in them being rated Inadequate. In August 2019 CQC imposed conditions on the trust’s registration following which West Lane Hospital closed.
CQC’s Deputy Chief Inspector of Hospitals and lead for mental health, Kevin Cleary, said:
“During our most recent inspection of Tees, Esk and Wear Valleys NHS Foundation Trust we found some services had deteriorated while others had failed to make sufficient improvements.
“Risks to people’s safety were not always well managed and we found issues that could compromise people’s privacy and dignity. We found medicines were not always effectively managed, some parts of the trust’s buildings were not fit for purpose and we remained concerned that disciplinary and grievance processes were not being followed.
“In specialist community mental health services for children and young people we found staffing was poor and the workload too high, resulting in long delays. When we reviewed care records in mental health crisis services and health-based places of safety, the majority lacked individualised detail.
“However, we found that staff treated patients with compassion and kindness. They took concerns and complaints seriously, investigated them, learned lessons and shared any findings. We were encouraged to find a number of areas of outstanding practice at the trust and a leadership team that was visible and approachable, and that provided development opportunities to staff.
“We reported our inspection findings to the trust and will continue to monitor its progress. This will include further inspections.”
The trust has been told it must make a number of improvements, including:
- The trust must ensure actions identified in the environmental risk assessments are implemented to keep patients safe on wards for older people with mental health problems.
- The trust must ensure ligature risk assessments used by the specialist eating disorders service include management plans for each risk or detail contingencies for these risks.
- The trust must ensure that timely assessments are carried out by doctors for patients entering a health-based place of safety.
- The trust must ensure that there are enough staff in each children and young people’s community mental health team to meet the demands of the service.
- The trust must actively monitor children and young people on waiting lists for assessment and treatment for changes in their needs.
- The trust must ensure that staff follow trust policy when using and recording the use of seclusion on wards for older people with mental health problems.
- The trust must ensure that all audits in place are effective in identifying areas of concern on wards for older people with mental health problems.
- The trust must ensure patients on Talbot ward have access to call alarms.
There were a number of outstanding practices reported on, including:
- Staff at Bankfields Court, which cares for people with a learning disability or autism, utilised an eye tracking device that patients used to communicate and interact. This allowed non-verbal patients to use their eyes to respond to questions.
- There was a well embedded culture of wellbeing across community based mental health services for older people. Staff demonstrated mutual respect and value for each other both through their interactions and through the feedback they provided to inspectors.
- The specialist eating disorder service ensured adolescent patients were admitted appropriately into the service and that suitable arrangements were in place to maintain continuity of care.
During the inspection CQC looked at acute wards for adults of working age and psychiatric intensive care units, long-stay or rehabilitation mental health wards for working age adults, forensic inpatient or secure wards, wards for older people with mental health problems, wards for people with a learning disability or autism, mental health crisis services and health-based places of safety, specialist community mental health services for children and young people and community-based mental health services for older people. The specialist eating disorders service was inspected for the first time and inspectors looked specifically at management and leadership to answer the key question ‘is the trust well-led?’ as part of the inspection.
A full report of the inspection will be published on CQC’s website: www.cqc.org.uk/provider/RX3
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For further information please contact CQC Regional Engagement Officer, Mark Humphreys, 0191 201 1675/07384 902 623 or Louise Grifferty Regional Engagement Manager, on 07717 422917.
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