The Care Quality Commission (CQC) has told Birmingham and Solihull Mental Health NHS Foundation Trust they must make improvements at their forensic inpatient and secure wards following a Care Quality Commission (CQC) inspection in June and August. CQC also looked at the community-based mental health services for adults of working age, which have improved from requires improvement to good.
Forensic inpatient and secure wards:
- The inspection was prompted in part due to concerns from whistleblowers about safety on the wards, staffing and leadership of Reaside Clinic, a medium secure clinic for men with severe mental health problems who have committed a criminal offence or who have shown seriously aggressive or threatening behaviour.
- As well as the service remaining rated requires improvement overall, so do the ratings for being safe and well-led. How caring the service was, has dropped from good to requires improvement. On this occasion, CQC did not inspect how effective or responsive the service was, as it focused on the specific areas of concern. Therefore, it remains rated requires improvement for being effective and rated good for being responsive from the previous inspection.
- CQC have issued a warning notice and two regulation notices due to three regulations breaches found during the inspection in relation to good governance, treating people with dignity and respect and staffing. This will help to focus the trust’s attention on the areas where significant and immediate improvements are needed and report on their progress to CQC.
Community-based mental health services for adults of working age services:
- This inspection was carried out to review progress following two warning notices issued to the trust after a previous inspection. Following this most recent inspection, CQC found that the trust had taken action and met the requirements of the warning notices
- As well as the overall rating for the service improving from requires improvement to good, as have the ratings for being safe, effective and well-led. Caring and responsive were not included in this inspection and remain rated as good.
The overall rating for Birmingham and Solihull Mental Health NHS Foundation Trust wasn’t affected by this inspection and remains rated as requires improvement.
Amanda Lyndon, CQC deputy director of operations in the midlands, said:
“We found a mixed picture when we inspected the care being provided by these services following our inspections at Birmingham and Solihull Mental Health NHS Foundation Trust.
“One of our main concerns was the environment at forensic inpatient and secure wards. We saw damaged furniture, dirty toilets with urine on the floor, mould around showers and sinks and graffiti which hadn’t been removed. When we spoke to staff and people using the service, they said repairs and cleaning didn’t happen quickly enough. This has potential infection control risks as well as being undignified for people who were using the service. This breached two regulations, so we issued a warning notice to the trust to make sure significant change is made as a priority.
“However, we did find staff working hard to support people and keep them safe without the overuse of restraints. Staff demonstrated a good understanding of safeguarding and how to take appropriate action if they witnessed or suspected abuse. They also spent time with people to build their trust and explain safeguarding processes.
"We have told leaders where we expect to see the rapid improvements highlighted in the warning notice and will continue to monitor their progress on this.
“Since our previous inspection, staff in the community-based mental health services were now making sure people were receiving their medicines safely and quickly. People told us that staff discussed their medicines with them, and they knew why and what medicines they were taking, as well as any potential side effects.
“Additionally, leaders encouraged people using the service and staff to raise concerns so any necessary changes could be made to keep people from safe. It was also good to hear that people knew they would be treated with compassion and understanding when they did speak up.
“We’ll continue to monitor the trust, including through future inspections, to ensure it builds on the improvements it has already made, and to ensure further necessary changes are made and embedded.”
Forensic inpatient and secure wards:
Inspectors found:
- Some people did not always feel safe because of the aggressive behaviour shown by some of the other people using the service.
- Staff weren’t always treating people with compassion and kindness.
- People said the service didn’t support them to follow their religious beliefs or respect their cultural background.
- Staff and people were not always enough staff which affected their leave and activities.
- Staff were not all trained in immediate and emergency life support although this was being arranged.
- Some people said staff did not always listen to them or respond immediately when needed.
However:
- People said that most staff were kind and friendly
- Staff spent time with people and spoke to them with kindness and compassion
- People were supported to keep in contact with their families
- Staff responded to people’s requests even when they were busy doing other tasks
- Staff said that ward managers were visible and approachable.
Community-based mental health services for adults of working age services:
Inspectors found:
- People were involved in their care plans and risk assessments and staff empowered them to make decisions about their care
- Staff updates risk assessments every year or when there had been incidents or a change in circumstances around someone’s personal risk
- Staff understood safeguarding and when and how they needed to take appropriate action to keep people safe
- People were encouraged and supported to make healthier choices to help promote and maintain their health and wellbeing
- Staff worked in partnership with other services. They shared information and learning with partners and collaborated for improvement.
However:
- Some people felt that it was difficult to access the services they needed when they were experiencing a crisis in their mental health.
The full report will be published on CQC’s website in the next few days.