The new Ofsted-style inspections of health services are now in full flow. Health reporter Priya Mistry takes a look at the Care Quality Commission report into community care providers Southern Health NHS Trust.
There has been one of the biggest health inspection shake-ups of recent years and a trust that provides community and mental health services for Hampshire has been one of the first to get checked out.
Southern Health NHS Foundation Trust runs services such as the secure mental health unit Ravenswood House, in Knowle, and Gosport War Memorial Hospital.
Its catchment area is huge – as well as south-east Hampshire, the trust also provides services for the rest of the county, Oxfordshire, Buckinghamshire and Wiltshire.
In October, more 100 inspectors from the Care Quality Commission (CQC) spent a week looking at 120 sites across the trust’s patch.
There are four ratings the CQC can give – outstanding, good, requires improvement and inadequate. Overall the trust got a rating of ‘requires improvement’.
More than two -thirds of individual services were rated as good and the trust’s perinatal unit, based in Winchester but used by women across the region, received outstanding in each area.
Southern Health’s chief executive Katrina Percy says: ‘We welcome this report from the CQC, which is an invaluable opportunity for us to reflect on detailed feedback on our services.
‘In every part of the report, the recurring theme is the caring and responsive approach of staff towards patients.
‘This is something I see in our staff every day, and it’s reassuring and affirming to see this care recognised by the CQC.
‘There were a number of areas of practice highlighted as good within the report, and also areas of best practice and innovation, such as the peer review programme that is active throughout the trust, and I am delighted to see staff recognised for their efforts here.
‘The report also highlighted a number of areas for improvement, which we have already begun to address.
‘We know that there will always be things we can learn from and ways we can make our services better, and we are working closely with staff, commissioners and partners to make progress.
‘This is a challenging time for the health service nationally, and our work with colleagues in primary and social care will transform traditional care services for the future.’
Overall the CQC identified a number of specific areas where the trust must improve:
- On the adolescent mental health wards and forensic services, the trust must ensure there’s an appropriate policy for the use of restraint and that it’s recorded correctly.
- The trust needs to have better measures to stop ligature risks – a ligature is any piece of clothing or cord or any item that can be tied and used for self-harm – in Ravenswood House, Knowle, and Southfield, in Calmore.
- On wards for people with learning disabilities or autism, the trust must ensure all staff are aware of previous incidents that have had a negative effect and learn from them.
- There needs to be more suitably qualified, skilled and experienced staff to provide end-of-life care to all patients that need it.
The inspectors also found a lack of consistency across the trust – while some community health and mental health services were good, there was significant variation in the quality of services.
Despite these problems, in all of the services visited, inspectors found kind, sensitive and caring staff who were passionate about their work and committed to delivering high quality care.
Patients and families were positive about the way staff communicated with them, the time staff took to listen, and their caring nature.
The mother and baby unit in Melbury Lodge, in Winchester, which is used by mums from the Portsmouth area, was praised highly.
The inspectors based their ratings of each service or team visited, on five key questions – whether the service is safe, is effective, is responsive, is caring and if it’s well led.
Both Gosport War Memorial Hospital (GWMH) and Petersfield Hospital received a rating of good.
The inspectors found that in GWMH, although a thermometer measured the temperature in the medicine room, this was not recorded, nor was the area properly secured.
However they found that in the Sultan ward nurses liaised with their colleagues on the adjoining older persons mental health wards for support and guidance in caring for patients living with dementia or who had specific mental health needs.
In Petersfield, inspectors found there was some restriction for patients to move around the hospital freely due to locked doors that could only be opened with a staff pass, but that staff were good at recognising the distress and anxiety of a patient.
Gethin Hughes, director of integrated services, says: ‘During the inspection of those services, the CQC spoke to 68 patients and relatives who were all positive about their care and support.
‘The CQC highlighted Petersfield Hospital staff’s holistic approach to care and support to patients and their families as good practice.
‘Patients told the CQC their privacy and dignity was “always considered,” they were “welcomed and provided with information when they were admitted onto wards” and doctors were “very approachable”.
He adds: ‘At Gosport War Memorial Hospital the inspectors identified some minor areas for improvement, including around the storage of medication, which have since been addressed.’
The overall rating for Elmleigh Hospital in Havant was ‘requires improvement’.
The report found that there were gaps in staff training, staffing levels were inadequate and there was not enough one-on-one time with patients.
Elmleigh is a psychiatric intensive care unit which has 20 beds and 14 high-dependency beds.
There were long waits for assessments and when they did happen there wasn’t always a doctor present, which meant some people who did not have a mental health problem were kept in when they should have been allowed to leave.
Lesley Stevens, director of mental health and learning disabilities for the trust, said: ‘A number of actions have already been planned and implemented, resulting in improvements within the service. In order to ensure adequate training is provided for all staff, sessions to improve their knowledge and skills where gaps were identified are taking place, and training reports are checked and regularly monitored by managers.
‘This includes additional training in supporting patients in crisis.
‘New staff have also been recruited which means both the patients and existing staff members are better supported.’
IN TOTAL £1.7m is being spent on making a mental health unit safe for patients.
The Care Quality Commission gave an overall rating of ‘requires improvement’ for Ravenswood House, in Knowle.
Patients have been moved out of the secure unit, which has 16 patients living there, to Woodhaven Hospital, in Calmore, for work to be done.
Work is expected to last for up to nine months and will include improvements to safety, security and environment for patients.
The report said: ‘Ravenswood House was not fit for the purpose for which it was being used.
‘The environment posed a number of risks to patients, particularly in relation to ligature risks.
‘The provider had approved plans to renovate wards in the short term.
‘In the longer term, the service was to be moved to a new building and plans
for this were being considered at the time of the inspection.’
This is something Southern Health NHS Foundation Trust has started to carry out.
The report found the trust was inadequate for ‘are services safe’, good for three categories and requires improvement for one.