Archived: Solent NHS Trust

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We assessed all the quality statements from this key question to assess the quality of the care. We found that the service had systems in place so that staff could learn from incidents from across the trust. There were good admission and discharge pathways in place so that staff could assess patients’ suitability for admission. The staff team had training in safeguarding and knew how to respond to safeguarding risks. Staff involved patients in managing their identified risks. There were appropriate numbers of skilled staff employed to work on the ward. The ward environment was well-maintained and suitable for caring for the identified patient group and there were good infection control processes in place. The trust had good systems in place to ensure medication was managed safely and staff understood their role in this process.

Staff morale was sometimes low on the ward as it was becoming harder to transfer patients whose mental health required higher levels of security to be treated safely.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The trust had processes in place to ensure they learnt from incidents.

Staff told us that the trust is always looking to improve by learning from incidents. Following any serious incidents there is a serious incident review and learning is shared with the team and across the trust.

The provider had a reducing restrictive practice programme that is always reviewing restrictions on the wards.

Staff gave us examples of how the trust had improved the service from reviewing risk and making changes where necessary. Ward staff had reviewed how they managed the restricted items list and started assessing patients individually to see if they could have access to more items. For example, patients have been risk assessed to have a phone charger in their bedrooms while others could not have them.

The management and staff engage in improvement programmes to make sure they learn from any incidents on the wards. This includes the safe wards programme, a nationally recognised model to improve the quality of care by reducing conflict and containment on the wards.

There were good pathways in place for admission and discharge of patients. The ward had an admission criteria. Staff assessed risk prior to admission and could refuse to admit patients that did not meet the admission criteria.

However, staff told us that they found it harder to find placements for patients who needed a higher-level of security if their mental health had deteriorated after they were admitted. This meant staff had to manage patients who were no longer suitable for their service. Staff told us the higher level of risk they needed to manage had an impact on their morale. Senior managers in the trust were aware of these concerns and were working with local and national partners to address this issue.

The ward team worked to ensure patients were cared for in an environment where they felt safe. When patients alerted them to concerns the staff team addressed this quickly and worked with patients to ensure their rights were protected.

Staff had received appropriate safeguarding training relevant to their role. Staff we spoke to told us they understood what needed to be reported as a safeguarding issue and how they should report this. There was a safeguarding lead for the ward. Staff told us they could get advice from senior managers if they were unsure if an issue was safeguarding.

Staff encourage patients to help develop their risk management plans by involving them in identifying their risks. Staff worked with patients to develop risk management plans so they can find practical ways for them to manage their identified risks. Staff told us that it is not always possible to involve patients in their risk management, as some patients refuse to be involved and some patients were too unwell to actively contribute.

Staff offer all patients copies of their risk management plans. When patients have not been involved in developing their risk management plans, staff still offer them copies of the plans and spend time explaining the plans to them. Staff regularly invite all patients to review risk management plans with them.

Maple ward was an appropriate environment to offer care and treatment to patients with mental health needs. The ward was clean, tidy and in a good state of repair.

The trust had restructured the ward since our last visit. The redesign of the ward had included moving the main ward office so that it was now more centrally located and gave staff a clearer view of the ward. There was a large outside area available to patients which they could access 24 hours a day. There was adequate space available to the patients and rooms available for 1 -1 sessions when needed.

There were enough staff employed to work at the service to ensure they provide safe care. Staff told us that senior managers had reduced staff numbers due to having less patients, but the managers had agreed to increased staff numbers after they reported that they felt unsafe. Bank and agency staff filled any gaps in the rota. The provider tried to use temporary staff that were familiar with the ward, so that they were familiar with the patients and any identified risk.

Staff received appropriate training for their role. At the time of our visit the ward manager was in the process of providing additional training for the whole staff team.

The trust has an Infection Prevention and Control policy in place that follows national guidance. Staff use the policy in conjunction with specific policies that covered areas including hand hygiene, decontamination, hospital acquired infections and sharps safety. Staff received appropriate training for their roles and responsibilities.

The trust carries out regular audits to ensure policies are followed and to measure how effective they are. There is an annual schedule of audits that includes hand hygiene, mattresses, clinical environment and sharps.

The trust monitors any infection outbreaks, take appropriate action to prevent further spread and record the outcome so they can learn from the incident.

The trust involved people in decisions about their medication when it was appropriate. Staff ensured medicines were stored and administered safely.

Staff told us that medication is discussed with patients as part of their MDT meeting.

The trust uses an electronic medication system. We reviewed four medication records. We saw that staff reconciled patients’ medicines on admission. There were monitoring processes in place for high dose anti-psychotic medication and nursing staff understood their responsibilities to ensure they monitored physical health in line with the trust policies. Staff reviewed as required medication (sometimes called PRN) regularly to ensure it was being used appropriately.

The treatment room was clean, tidy and well maintained. Staff completed regular checks to make sure medication was stored safely. For example, room and fridge temperatures were recorded and action taken if they were too high or low. Medical devices were clean and maintained appropriately.