The Care Quality Commission (CQC) has told Herefordshire and Worcestershire Health and Care NHS Trust it must make improvements, after concerns were found at an inspection carried out between February and June last year.
The inspection covered three mental health services, a community health service and how well led the trust was overall. This inspection sees the overall rating of the trust drop from good to requires improvement.
CQC carried out the unannounced inspection of the mental health and community health services provided by this trust, in part due to information they had received around the trust’s acute wards which raised concerns. They also inspected as the trust had taken on responsibility for providing more mental health services since the previous inspection.
Following the inspection, the services were rated:
- Acute wards for adults of working age and psychiatric intensive care units – the overall rating, as well as well-led, have improved from inadequate to requires improvement. Effective, caring and responsive have dropped from good to requires improvement. It was again rated inadequate for being safe
- Community-based mental health services of adults of working age – overall, together with safe and well-led have improved from inadequate to requires improvement. The ratings for effective and caring has improved from requires improvement to good. Responsive has again been rated requires improvement
- Mental health crisis services and health-based places of safety – the overall rating has dropped from good to requires improvement, which is the same for safe and well-led. Effective, caring and responsive were again rated good
- Community health services for adults - the overall rating has dropped from good to requires improvement, which is the same for safe, effective and well-led. Caring and responsive were again rated good.
As well as the overall rating for Herefordshire and Worcestershire Health and Care NHS Trust going down from good to requires improvement overall, so has how safe, effective and well-led the trust is overall. Caring and responsive were again rated good.
Craig Howarth, CQC deputy director of operations in the midlands, said:
“When we visited Herefordshire and Worcestershire Health and Care NHS Trust we found leaders had the experience, knowledge and capability to carry out their roles. However, they didn’t always work collaboratively, which filtered down to front line staff, having further reaching impact across the trust. We also heard how newer members of the executive team were more proactive than those who’d been there for many years.
“We found evidence of a closed culture within the trust as leaders weren’t making enough effort to address equality, diversity and inclusion issues felt by staff. Since the inspection, the trust have started to address some of the cultural concerns within the organisation.
“We were concerned about sexual safety issues in two of the mental health services. The mixed sex wards weren’t always laid out, used, and monitored in a way that ensured people were safe from the risk of sexual safety incidents. Incidents weren’t always recorded effectively. For example, it took staff two months to update records for a person who’d been involved in a sexual safety incident.
“Also, inspectors found staff treated people with compassion and kindness. They understood individual needs and supported people to understand and manage their care, treatment, or condition.
“Following the inspection, we have told the trust where they need to improve and where they are making good progress. We will continue to monitor the service closely, so we can be sure people using the service receive the care they have a right to expect.”
Inspectors found:
- There were environmental risks around accommodation which resulted in sexual safety incidents and ligature risk assessments weren’t up to date and identified risks were not effectively mitigated
- Staff did not manage sexual safety incidents well and not all these incidents were escalated or reported
- Safety was not a sufficient priority in all services
- The systems and processes used to manage risks in the trust were not effectively managed
- Psychology waiting times prevented people from receiving care in a timely manner
- Some systems and processes did not effectively provide managers with oversight or assurance of how services were delivered. Managers did not always have systems to be able to assess, monitor and review the quality of the service
- While members of the board had the skills, knowledge and experience required, they did not always work in a cohesive and collaborative way to address areas of risk or concern. Leaders at all levels were not always visible
- Not all staff had completed their mandatory training, this included training in basic life support, fire safety training and Mental Health Act training. The trust didn’t have effective systems and processes to monitor this.
However:
- The trust had a clear vision with values which were understood by all staff
- In two of the services inspected, staff completed and updated risk assessments for each person using the service and removed or minimised risks. Staff identified and quickly acted upon risk of deterioration
- Trust safeguarding systems and processes were well managed and risks were mitigated. Staff in the trust were up to date with safeguarding training and knew how to recognise abuse and when to report it
- Across services, medicines management was managed well. Physical healthcare was managed effectively, and staff encouraged people to live healthier lives
- Staff from different disciplines worked together as a team to benefit people using the service. They supported each other to make sure there were no gaps in care and had effective working relationships with other relevant teams both within and outside the organisation.