The Care Quality Commission (CQC) has published a report following an inspection of acute wards for adults of working age and psychiatric intensive care units at Midlands Partnership NHS Foundation Trust, in November.
An unannounced focused inspection of the service was carried out following notifications received about serious incidents during September and October 2022. Inspectors looked at the areas of safe and well-led only.
The trust provides acute inpatient wards for adults of working age and psychiatric intensive care units at two locations, St George’s Hospital in Stafford, and The Redwoods Centre in Shrewsbury.
Following the inspection, the overall rating for the acute wards for adults of working age and psychiatric intensive care units, as well as the ratings for how safe and well-led the service is, went down from good to inadequate.
After the inspection, the trust provided a comprehensive action plan with evidence addressing how they would respond or had already responded to the concerns raised.
Andy Brand, CQC’s deputy director of operations in the midlands, said:
“When we inspected this service, improvements were needed to ensure people were receiving appropriate care in a safe environment, and staff were fully being supported to carry out their roles properly.
“Managers needed to do more to mitigate the impact of staff shortages as understaffing was negatively affecting the quality of care being provided, with many staff reporting they felt unable to meet the needs of people due to these challenges.
“We also found environmental issues that needed addressing. For example, ligature risk assessments to identify any risk areas hadn’t been completed effectively meaning people could be placed at risk of harm. The trust responded to these issues following the inspection and submitted an action plan detailing how they’d make improvements.
“We did also see some positive areas of care. For example, managers debriefed and fully supported staff after any serious incident, including psychological support if needed.
“We also noted there was a dedicated safeguarding team in place to support staff. The team linked with external agencies to ensure staff followed correct procedures should a safeguarding issue occur.
“We will continue to monitor the trust, including through future inspections, to ensure the necessary improvements are made so people can receive safe and appropriate care.”
Inspectors found the following during this inspection:
- The trust failed to demonstrate how staff always safely managed items of potential risk as part of people’s personal property. This had resulted in incidents of avoidable harm
- Our inspection identified operational inconsistencies at site level and at ward level within the trust’s acute mental health wards for working age adults and the psychiatric intensive care units
- Records failed to demonstrate that staff always assessed people’s mental states at the point of taking leave and recorded these discussions and decisions
- There was a significant increase in mixed sex accommodation breaches since our previous inspection and there were concerns about the implications of mixed sex ward environments contributing to sexual safety incidents
- Environmental assessments, including ligature risk assessments and fire safety assessments, were not always sufficient to ensure safety and failed to identify all areas of potential risk.
However:
- Ward areas were clean, well maintained, well-furnished and fit for purpose
- Staff competency in completing observations was regularly checked and they felt confident to undertake these
- Staff carried alarms and there were nurse call points in bedrooms and bathrooms. Staff checked these regularly to ensure they remained in working order
- Staff reported they updated risk assessments regularly, including after significant incidents
- Physical interventions were avoided by using de-escalation techniques and were only used when necessary to keep people safe.