BOSSES at a health trust have been told to make ‘significant improvements’ to protect vulnerable patients in their care.
Inspectors from the Care Quality Commission issued a warning to Southern Health NHS Foundation Trust to improve its practices to ensure ‘robust investigation’ and learning from incidents and deaths.
We found long-standing risks to patients, arising from the physical environment, that had not been dealt with effectively.
The CQC carried out an inspection in January in light of a report commissioned by NHS England that highlighted the trust’s failure to investigate and learn from the deaths of patients; particularly those receiving care in its older people’s, learning disability and mental health services.
Inspectors found it had failed to mitigate against significant risks posed by some of the environments where it ran mental health and learning disability services.
It was also found not to operate ‘effective governance arrangements’ to ensure robust investigation of incidents, including deaths. And it did not ensure it learned from incidents to reduce future risks to patients.
Inspectors found the trust did not effectively respond to concerns about safety raised by patients, carers and staff, or respond to concerns raised by trust staff about the ability to carry out their roles effectively.
Southern Health admitted it has not acted ‘swiftly enough’ in some areas and there is still ‘a lot of work to do’.
Dr Paul Lelliott, CQC deputy chief inspector of hospitals and lead for mental health, said: ‘We have made it clear that the safety of patients with mental ill health and or learning disabilities, provided by Southern Health requires significant improvement.
‘We found long-standing risks to patients, arising from the physical environment, that had not been dealt with effectively. The trust’s internal governance arrangements to learn from serious incidents or investigations were not good enough, meaning that opportunities to minimise further risks to patients were lost.
‘It is only now, following our latest inspection, and in response to the warning notice, that the trust has taken action and has identified further action that it will take to improve safety at Kingsley ward, Melbury Lodge in Buckinghamshire and Evenlode in Oxfordshire.’
‘The trust must also continue to make improvements to its governance arrangements for reporting, monitoring, investigating and learning from incidents and deaths.
‘CQC will be monitoring this trust very closely and will return to check on improvements and progress in the near future.’
Katrina Percy, Southern Health chief executive said: ‘I have been very clear and open that we have a lot of work to do to fully address recent concerns raised about the trust.
‘Good progress has been made, however we accept that the CQC feels that in some areas we have not acted swiftly enough.
‘We take the CQC’s concerns extremely seriously and have taken a number of further actions. The full CQC inspection report, which we expect to receive later this month, will allow us to consider their findings in full.
‘In addition, our regulator NHS Improvement has announced that it intends to take action to allow it to make management changes if progress isn’t made on fixing the concerns raised.’
The trust covers Hampshire, Dorset, Wiltshire, Oxfordshire and Buckinghamshire.
Meon Valley MP George Hollingbery said: ‘Southern Health is working hard to improve its services and this CQC warning notice should allow its new leadership to focus on where progress needs to be quickly made to ensure patient safety.’