The Care Quality Commission (CQC) has found improvements at Lancashire & South Cumbria NHS Foundation Trust, following inspections carried out in July and October, which sees the overall rating for the trust improve from requires improvement to good.
Unannounced inspections were carried out of acute wards for adults of working age and psychiatric intensive care units (PICU), as well as short notice (24 hour) inspections of the community based mental health services for adults of working age.
These services were inspected as CQC had concerns about waiting times to access community based mental health teams and access to acute wards for adults of working age and PICU beds.
CQC also inspected mental health crisis services and health-based places of safety to ensure the quality of care had improved since the last inspection in 2020.
Inspectors also looked at how well-led the trust was overall.
As well as the overall rating for the trust improving from requires improvement to good, so has how responsive and well-led the trust is. Safe and effective were again rated requires improvement. Caring was re-rated as good.
The services were rated:
- Acute wards for adults of working age and psychiatric intensive care units (PICU) – the overall rating, as well as being safe, effective and well-led have again been rated requires improvement. Caring has been re-rated as good, and responsive has improved from requires improvement to good
- Community based mental health services for adults of working age – this has again been rated requires improvements overall and for being safe, effective, responsive and well-led. Caring has again been rated as good
- Mental health crisis services and health-based places of safety – the overall rating, as well as being effective, caring, responsive and well-led has improved from inadequate to good. Being safe has again been re-rated as requires improvement.
Sheila Grant, CQC deputy director of operations in the north, said:
"When we visited Lancashire & South Cumbria NHS Foundation Trust, we found leaders were passionate about the trust’s delivery of safe, high-quality care, and were aware of the trust’s challenges and risks.
“Staff told us they were proud to work for the trust, and during our well-led inspection, everyone we spoke to was positive about the leadership team. They also described an energy within the trust and said it was a happy place to work.
“In terms of improvements, the trust had implemented an initial response service since our last inspection. This was a 24-hour telephone mental health service to support people in the community, and signpost them to the right care, in the right place, to meet their needs. This had reduced the number of people accessing accident and emergency liaison teams and the home treatment team.
“Additionally, we found the mental health crisis teams had access to a full range of specialists to meet the needs of people under their care. Also, managers made sure staff had the right range of skills needed to provide high quality care to people.
“However, there were areas which needed improvement. For example, current bed capacity meant there were high risk people who needed to be admitted to hospital but were unable to access a bed. There were also significant waiting times in specialist community mental health services for children and young people including access for neurodevelopmental assessments. Although, the trust was aware of these issues and had started looking at improving access to these services.
“We’ll continue to monitor the trust, including through future inspections, to ensure people continue to receive a good standard of care, and necessary improvements have been made in areas highlighted to the leadership team.”
Inspectors found:
- Leaders were experienced, visible and approachable
- The trust had a clear vision and strategy, understood by all staff and driven by the executive team
- The trust had a strong freedom to speak up process which staff spoke about positively
- Staff equality networks had been successfully implemented and supported staff through development initiatives
- A ‘flex’ system had been introduced to enable individuals to work flexibly, this supported staff retention and showed value of the workforce
- The trust had a clear approach to quality improvement which involved staff at all levels.
However:
- People continued to wait too long to access some services. Waiting times for community based mental health services for adults of working age had improved since the last inspection however there was not enough nursing and multidisciplinary staff in some teams
- The capacity in acute wards for adults of working age and PICU was lower than the demand, which had led to higher than expected out of area placements and an increase in demand for community based mental health services for adults of working age.