Care Quality Commission (CQC) has rated both the acute wards for adults of working age and psychiatric intensive care units (PICU) and the community-based mental health services for adults of working age as good following an inspection in June that found improvement in both services.
Both services are run by Avon and Wiltshire Mental Health Partnership NHS Trust. They service a population of around 1.8 million people across Bath and North East Somerset, Swindon, Wiltshire, Bristol, North Somerset, and South Gloucestershire. They provide both inpatient and community mental health services.
CQC carried out the unannounced inspections to check on the progress of improvements they were told to make at their previous inspection.
At CQC’s previous inspection of the acute and PICU wards, as well as the community services, the trust were issued with a warning notice due to concerns that people weren’t receiving safe care and treatment, and that the service wasn’t being managed well. Although there has been significant improvements, there were still some minor concerns, but these warning notices are now no longer in place for either service.
For the acute and PICU wards, as well as the overall service rating improving from requires improvement to good, so has the rating for how responsive the service is. The rating for safety has improved from inadequate to good. Leadership at the service remains rated as requires improvement. Effective and caring weren’t inspected, and both remain rated as good from their previous inspection.
For the community-based mental health services, the overall rating has improved from requires improvement to good, as has how safe and well-led the service is. How effective, caring and responsive weren’t inspected and all remain rated as good from their previous inspection.
The overall rating for Avon and Wiltshire Mental Health Partnership NHS Trust is unaffected and remains requires improvement overall.
Neil Cox, CQC deputy director of operations in the south, said:
“When we inspected these two services, we were pleased to see the trust had made improvements since our previous inspection. Staff were delivering much safer care across both services and had clearly listened and started to take action on our previous feedback.
“In the acute wards, staff told us new safety measures like more regular environmental checks, and changes to the wards such as additional convex mirrors to cover blind spots were helping them to keep people safer.
“Leaders had also implemented more effective processes to reduce the likelihood of sexual safety incidents which was a problem we identified at our previous inspection. Now there were thorough risk assessments to check whether it was appropriate to admit someone new. Sexually disinhibited people using the service were now automatically admitted or moved to a single sex ward. This had drastically reduced the number of these types of incidents and people using the service told us they felt much safer as a result.
“In community services, we found previous concerns about medicines management had been addressed. Staff now ensured that clinic rooms were clean and organised, and medicines were well managed and stored, as well being safely administered to people.
“Staff across both services spoke positively about the learning and improvement culture that had developed since our last inspection. There were learning away days for staff, and good systems to ensure learning from any incidents or events was shared. This was improving people’s care and reducing the likelihood of similar incidents happening again.
“The majority of people we spoke with across both services understood their care pathways and were included in decisions made about their care. Care plans were written with people and tailored to their individual needs, and also clearly documented how people wanted staff to intervene when they were distressed.
“However, we did identify some areas needing further improvement. Leaders told us they had good relationships with each other but didn’t feel able to challenge decisions from more senior leaders. This resulted in some risks staff had flagged in the ward environment including anti-ligature windows and anti-climb fixings in the garden area, still being on the risk register up to six years after first being flagged.
“The trust should be really pleased with these improvements and their new good ratings and should use them as a foundation to keep building on. We will continue to monitor them and return to see how they’ve done this.”
Inspectors found in the acute wards for adults of working age and PICU:
- Most people spoke positively about their time in hospital, describing staff as supportive, caring and kind.
- Staff assessed and managed risks well, minimising the use of restrictive practices and managed medicines safely.
- Ward leaders had successfully reduced agency staff spend and recruited more permanent staff making people’s care more consistent as staff were better able to build relationships with people.
- People’s requests for Section 17 leave, enabling them to leave the ward had a much safer process, with examinations of people’s mental state being completed prior to leave being granted to ensure their safety. Leave was also very rarely cancelled due to capacity issues
- There were still environmental improvements that needed made. There were no toilet facilities at all in the seclusion suite, and no air conditioning to account for the fact the room was windowless.
Inspectors found in the community-based mental health services for adults of working age:
- Staff demonstrated strong working relationships with local authorities with some teams even sharing offices with them to help them align working arrangements.
- Staff also worked well with other community groups to support people’s recovery journeys and encourage their independence away from formal support.
- Staff knew how to access the trust’s Freedom to Speak Up Guardian and felt able to speak up without fear of retribution which is important as staff can provide important insights to improve care.
- Innovative projects to improve people’s wellbeing were being implemented a 12-week programme covering healthy living and medicines management. People received pedometers and fit watches so that they could keep tracking what they’d learned following graduation from the course.
- Leaders hadn’t created safeguarding policies and procedures that were clear for all staff to understand, which could potentially delay referrals of safeguarding concerns.
- The service weren’t always providing equity in access to some interventions, with it differing by geographical area. For example, there were prolonged wait times in Wiltshire for psychology services compared to other areas due to staff vacancies.
Both reports will be published on CQC’s website in the coming days.