CQC finds improvements at Tees, Esk and Wear Valleys NHS Foundation Trust but more needs to be done
The following is direct from CQC.
CQC carried out unannounced inspections of four inpatient mental health services, and a short notice announced inspection of two community mental health services. Inspectors also looked at how well-led the trust is overall.
These inspections were carried out due to concerns regarding the quality of care being provided to people following serious incidents which had occurred in some services. Also, to check on the progress of improvement the trust were told to make by CQC at their previous inspection, when some services were rated inadequate, and due to the potential high-risk nature of some of the services.
Following this inspection:
- Acute wards for adults of working age and psychiatric intensive care units - the overall rating has again been rated as requires improvement, as has how safe and well-led it is. Effective, responsive and caring have again been rated as good.
- Wards for people with a learning disability or autism – the overall rating has improved from inadequate to requires improvement, as has safe, effective and well-led. Responsive has again been rated as requires improvement and caring has improved from requires improvement to good.
- Forensic inpatient and secure services – the overall rating and for being effective, caring and well-led have all improved from inadequate to good. Being responsive has improved from requires improvement to good, and safe has improved from inadequate to requires improvement.
- Wards for older people with mental health problems – the overall rating and for being well-led has improved from requires improvement to good. Effective, caring and responsive have again been rated as good and safe has again been rated as requires improvement.
- Community mental health services for people with a learning disability or autism – the rating overall and for being well-led and responsive have again been rated as good. Effective has improved from requires improvement to good, safe has dropped from good to requires improvement and being caring has dropped from outstanding to good.
- Community based mental health services for adults of working age – it has again been rated requires improvement overall and for being responsive. Safe has declined from good to requires improvement, well-led has improved from requires improvement to good, and effective and caring have again been rated as good.
Overall, the trust has again been rated as requires improvement as well as the ratings for being safe, responsive and well-led. Effective and caring have again been rated as good.
Sarah Dronsfield, CQC deputy director of operations in the north, said:
“When we inspected Tees, Esk and Wear Valleys NHS Foundation Trust, there had been a number of positive changes in the senior leadership team since our last inspection, and we were pleased to find the culture had improved and it was more open and transparent.
“These positive changes had impacted on the quality of care, and none of the services we inspected are now rated as inadequate. Also, staff were receiving the support they needed to manage their wellbeing.
“However, we did find areas where improvements still need to be made. For example, the trust had a backlog of around 100 serious incidents which required investigation, which needed to be reviewed. This backlog delays opportunities for the trust to learn lessons and make improvements to prevent incidents recurring. Although, the trust is receiving some external support to manage this backlog.
“Additionally, people continued to wait too long to access some services. There were significant waiting times in child and adolescent mental health services and for neurodevelopmental assessments which is an issue nationally. We fed this back to the trust who must improve these waiting times so people can receive the help they need in a timely way to keep them safe.
“We did find some outstanding practice in wards for older people with mental health problems. Staff were involved in a pilot enabling them to develop better communication with people who lived with dementia. Everyone involved should be proud of their hard work and commitment in helping people living with this condition receive a high standard of care.
“We'll continue to monitor these services, including through further inspections, to ensure people are receiving safe care and support the trust to continue building on the improvements made so far.”
Inspectors found:
- The trust no longer had any services which were rated inadequate.
- Three of the six services inspected were rated as requires improvement overall and three were rated as good.
- Leaders were experienced, visible and approachable. Leaders at all levels had ensured that improvements were made since the last inspection.
- Executives and non-executives were passionate about the trust’s delivery of safe, high-quality care and were aware of most of the trust’s challenges, risks, and issues.
- Staff felt supported and valued and had confidence in the trust’s freedom to speak up process. The trust had undertaken work to understand the risks of closed cultures across the services it provided.
- There continued to be good and improved engagement with staff, stakeholders, and partners.
- The trust had received feedback on its governance processes and had made significant changes which had made it easier for services to escalate risks to the board.
However:
- Where there had been incidents or treatment which caused harm to people, the trust’s approach had not always ensured staff and leaders reached out to people involved. The trust missed opportunities and were reluctant to consistently engage with people who used services, staff and others who had negative experiences or had been involved in incidents to gain feedback to help make improvements.
- The trust did not always have enough suitably trained staff to deliver safe care in all services. This was due to high vacancy rates, high sickness rates and significant reliance on temporary staff in some services.
- Staff didn’t always take appropriate action to reduce risks to people. In some services people were able to leave the wards without appropriate risk assessments.
- There was low compliance with specific modules of mandatory training.
- The trust did not always act in accordance with the requirements of the duty of candour by failing to make an apology without delay for incidents resulting in harm.
- Seclusion facilities were not always fit for purpose, and some wards had blind spots which had not been addressed. Some improvements to these were made during the inspection.
The report will be published on CQC’s website.
About the Care Quality Commission
The Care Quality Commission (CQC) is the independent regulator of health and social care in England. They make sure health and social care services provide people with safe, effective, caring, well-led and responsive care, and they encourage care services to improve. They monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety and they publish what they find to help people choose care.
