The Care Quality Commission has again rated Southern Health NHS Foundation Trust’s acute wards for adults of working age and psychiatric intensive care units (PICU) requires improvement following an inspection in October.
CQC inspectors conducted this unannounced, focused inspection mainly at Antelope House, Parklands Hospital and Elmleigh to follow up on the progress of improvements they were told to make following an inspection in October 2021.
Following the latest inspection, the overall rating for the service has again been rated as requires improvement, as have the ratings for safe, responsive and well-led. Caring and effective remained rated as good.
Serena Coleman, CQC deputy director of operations in the south of England, said:
“During our inspection of these services, we found some areas where we told Southern Health NHS Foundation Trust to improve at the last inspection still hadn’t been fully addressed. The trust needs to make more effective use of their governance systems in order to identify and address issues and ensure learning is shared across the organisation.
“Leaders have been unable to embed and sustain some of the improvements they had planned to make following our last inspection. For example some of the actions put people at risk of unsafe care including staff not following the controlled drugs management processes effectively at Parklands hospital.
“People didn’t always have the freedom to allow themselves some comfort, privacy and dignity. This included people not being able to lock their bedroom doors, not having access to their own private lockable space, not being able to control the viewing panels in their bedroom doors and sometimes relying on staff to locate cups for them to access drinking water at Elmleigh.
“At Antelope House people’s physical health was not monitored as frequently as it should have been. We did report this to senior leaders who took immediate action to ensure staff understood their responsibilities to monitor the physical health of people.
“The trust faced significant challenge in terms of demand for beds including PICU provision. This meant that staff were struggling to manage people who were acutely mentally unwell in an acute ward setting. We had identified this challenge previously and this has continued for the trust.
“Southern Health must continue to advance improvements and ensure that any changes are sustainable. In the meantime, we will continue to monitor the service closely to ensure improvements are made. If improvements are not forthcoming, we will not hesitate to take steps to protect the people who are using this service.”
Inspectors found:
- At Elmleigh people were not always reviewed by a doctor on admission to the service and did not always have timely access to their required medicines. This meant there was a risk people could miss doses
- Although there had been progress made in relation to staff recruitment since the last inspection, there were still a number of vacant posts that needed to be recruited
- At Elmleigh staff did not always complete the necessary enhanced observations
- Staff sickness rates at Elmleigh were increasing and staff turnover was high at Antelope House. This meant that people were less likely to receive continuous care from staff who knew them and understood their needs
- Improvements were needed to ensure staff had received the necessary mandatory training to safely fulfil their roles. At Elmleigh, most staff had not recently completed training in prevention and management of incidents of violence and aggression, during which they learn how to use safe restraint techniques
- Staff did not always receive regular supervision. This posed a risk that staff would not receive the support they needed to fulfil their roles safely and confidently. However, a new project group had been set up to improve supervision compliance and review the style of staff supervision.
However, Inspectors also found:
- The trust had improved the process for monitoring the physical health of people receiving high doses of antipsychotic medicines
- Staff knew about the potential ligature anchor points on each ward and proactively managed these risks to keep patients safe
- Staff now managed safety incidents well and staff received appropriate support if they were involved in an incident
- Staff felt more able to speak up about their concerns without fear of retribution
- Staff also knew how to escalate concerns and they had used the trust’s freedom to speak up guardian.