North Staffordshire Combined Healthcare NHS Trust

Updated 1 June 2020

The acute wards for adults of working age provided by North Staffordshire Combined Healthcare NHS Trust are part of the trust’s acute division. Services are provided for patients admitted informally and or detained under the Mental Health Act 1983.

There are three acute wards based at Harplands Hospital:

• Ward 1 is a mixed-sex ward with 14 beds, although at the time of inspection was all male

• Ward 2 is a male ward with 22 beds

• Ward 3 is a female ward with 22 beds.

In addition, a psychiatric intensive care unit (PICU) had opened in October 2018 and provided care for six patients.

During this inspection, we visited all three acute wards and the PICU.

At our last inspection, the wards had one key question (safe) rated as requires improvement and the other key questions (effective, caring, responsive and well led) rated as good.

Our previous inspection between 2 and 4 October 2017 was unannounced (staff did not know we were coming) to enable us to observe routine activity. The report made one requirement on the service to improve the safety of care on the wards:

• The trust must ensure that topical medicines are clearly labelled for the use of a single patient to reduce infection risks and that opening dates of the medicines are monitored.

The provider had subsequently provided written assurances following that inspection that improvements had been made.

Updated 1 June 2020

Our rating of the trust improved. We rated it as outstanding because:

• We rated safe, effective, and well led as good, caring and responsive as outstanding. Following this inspection, one of the trust’s 11 services are rated as requires improvement, seven are rated good and three as outstanding. In rating the trust, we took into account the previous ratings of the eight services not inspected this time.
• The trust had met the requirement notices we set out in our previous report. Medicines safety had improved on the wards for older adults and the community teams. Staff in the community teams now inspected emergency equipment as a matter of routine.
• There was good leadership across the trust from the board to front line managers. Managers had the right skills to undertake their roles. The board had good understanding of performance.
• The trust ensured that risk assessments were completed and updated regularly. Staff updated risk assessments for each patient to understand how to best support them. Staff had good access to patient records and stored them safely. Staff knew how to keep patients safe and reported incidents, including abuse, when necessary. Staff learnt lessons from incidents.
• A range of care and treatment interventions was delivered in line with guidance from the National Institute for Health and Care Excellence (NICE).
• The majority of staff had good knowledge of the Mental Health Act, the Mental Capacity Act and the Deprivation of Liberty Safeguards. Staff were up to date with training in the Mental Health Act and Mental Capacity Act.
• Staff treated patients with compassion and kindness. They respected patients’ privacy and dignity, and supported their individual needs.
• Staff involved patients and those close to them in decisions about their care, treatment and changes to the service. Throughout their recent management of change project, the trust had listened and acted on the feedback of patients, their families and carers.

However:

• The trust had not met its responsibility to make all required notifications to the CQC. There had been no notices made of the outcomes of applications to authorise Deprivation of Liberty Safeguards. We had reminded the trust of this obligation in our last report.
• The stability of the senior leadership of the trust was at risk with changes in the executive team. The new chief executive, chairperson and remaining board members recognised an opportunity to reflect on their structures, processes and external relationships.

• Enhanced reporting on clinical activity in community teams had recently been introduced, which provided assurance to the Board and service managers, but required development to fully establish its reliability and usability

• The trust’s pharmacy team was still developing its strategic plan. The team had made some progress in the last year through development of the team’s capacity and skill base.
• Some community service’s environmental risk management plans lacked detailed mitigation of identified risks.
• There were some omissions in community and crisis services patient care plans related to crisis plans, physical care plans.

Updated 21 February 2017

We rated the child and adolescent mental health service (CAMHS) wards as good because:

• During this most recent inspection, we found that the services had addressed the issues that had caused us to rate wards for children & adolescents with mental health problems as requires improvement following the September 2015 inspection.

• Staffing levels on both wards were sufficient and ensured safe clinical practice and risk assessments were completed and up to date for all patients. Staff also provided therapeutic time for patients who used the service.

• Darwin ward staff had a good understanding of the Mental Capacity Act (MCA) and how it was applied to patients over 16 years of age. All staff on Darwin ward received guidance on the Mental Capacity Act MCA and the trust’s quality assurance manager monitored this.

• Staff on both wards staff knew how to use the trust safeguard system to report incidents and complete incident forms. Staff on Darwin ward received feedback from investigation of incidents from the monthly senior leadership meeting through minutes that went to weekly nurses meeting.

• Risk assessments were positive, collaborative and inclusive of patient’s thoughts and feelings, completed on time and reviewed regularly.

• Physical health was a high priority and delivered by skilled and well-trained staff. This helped to reduce the risk of patient’s mental health problems worsening their physical health problems

Updated 15 February 2018

Our rating of this service improved. We rated it as good.

A summary of our findings about this service appears in the Overall summary.

Updated 21 February 2017

We rated community mental health services for people with learning disabilities as good because:

• We found that services were clean and well maintained. Staff received mandatory training and were able to demonstrate how they met the changing needs of patients. Incidents were reported and, following review, staff met to discuss and learn from outcomes.

• Teams were multidisciplinary and supported patients to meet a wide range of needs. Staff used national institute of health and care excellence guidance to plan and deliver patient care. Treatment records we looked at contained a comprehensive assessment from which care plans were developed and progress reviewed. Staff we spoke with demonstrated an understanding of the Mental Health Act and Mental Capacity Act.

• We saw that staff spoke with patients in a caring, polite and respectful way. Staff communicated and gave patients information in ways that they could understand. Carers we spoke with described staff as helpful, friendly and easy to contact. Service user involvement activities were well established and staff encouraged patients to participate.

• The services had facilities that promoted recovery, comfort, dignity and confidentiality. There was a clear criteria for people referred to the services. Staff contacted referrals in a timely manner and within agreed indicator times. Staff we spoke with demonstrated how they tried to engage people reluctant to use services and made contact with those that had missed appointments. While the service had received no recorded complaints, there were processes in place for staff to discuss and learn from the organisation as a whole.
• The trust had a range of established governance systems to met the needs of community mental health services for people with learning disabilities or autism. This included training, supervisory and whistle-blowing processes. Staff told us that they enjoyed their jobs and felt they were part of a good team. They reported good local management and were familiar with their directorate senior managers. However, some staff felt that above directorate level there was little understanding or value given to the services

Updated 21 February 2017

We have changed the rating for community mental health services for older people with mental health problems from good to outstanding and effective from requires improvement to good because:

• During our inspection in September 2015, we asked the trust to ensure that patients have crisis and contingency plans that reflected patients individual circumstances and that these were easily accessible to staff. At this inspection we found that skilled staff worked within a multidisciplinary approach to ensure they were responsive to urgent referrals or patient crises.
• The teams had developed excellent external links to GPs, care homes, social services and other local agencies, to ensure that patient’s holistic needs were thoroughly care planned.
• During our September 2015 inspection, we asked the trust to ensure that accurate and up to date risk assessments were completed for patients. At our inspection in September 2016 we found that staff had the information they needed to consistently assess and review risks to patients.
• The service used audit and outcome measures to great effect in order to improve patient care whilst evaluating the effectiveness of the service.
• In our inspection in September 2015, we asked the trust to ensure that care plans reflected patient views and were person centred. At this inspection patients received individualised treatment and their care plans were personalised and holistic.
• Innovative ways to improve patients’ health and wellbeing were used that were based on evidence from research and from working with a local university and clinical commissioning group.
• In September 2015, we asked the trust to ensure that staff had the skills and knowledge to routinely undertake and record mental capacity assessments in accordance with the Mental Capacity Act 2005. At this inspection we found that staff had a good working knowledge of the Mental Capacity Act and recorded this fully in patients’ care records.
• Patients told us staff were caring, compassionate and responsive to their needs, providing emotional and practical support. Staff involved patients and their carers in their care and looked after their best interests. Staff showed excellent levels of care for both patients and carers. Carers told us that staff “went the extra mile”.
• There were adequate numbers of staff available to provide information to patients, carers and referrers ensuring they knew what to do if the patient’s condition deteriorated.
• The service used opportunities to learn from incidents, complaints and audits which resulted in improvements being made.
• Staff received regular supervision and support from their team managers, and attended to their training needs. Staff told us morale was good and they worked well as a team.

However:

• Clinical supervision was not offered to all staff and formal supervision was not recorded in all teams.
• Appropriate signage was not provided to help patients find their way around the memory service at maple house.
• Patients had access to psychological therapies but not always to psychologist.

Updated 28 March 2019

Updated 15 February 2018

Our rating of this service stayed the same. We rated it as good.

A summary of our findings about this service appears in the Overall summary.

Updated 15 February 2018

Our rating of this service improved. We rated it as outstanding.

A summary of our findings about this service appears in the Overall summary.

Updated 28 March 2019

Our rating of this service went down. We rated it as requires improvement because:

• Care plans were not all individualised. On Ward 6, we found three records where partial identical information had been duplicated across three different patient’s care plans, including the wrong patient’s name. Two records on Ward 4, two did not contain a care plan relating to specifically to factor identified in the risk assessment, for example, fall risk and diabetes.
• Ward 7 had two multiple occupancy dormitories which restricted the privacy of patients accommodated in those rooms .

However:

• The service provided safe care. Wards were safe and clean. Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.
• Wards had access to the full range of specialists required to meet the needs of the patients. Managers ensured that these staff received training, supervision and appraisal. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation.
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• Staff treated patients with compassion and kindness and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
• The service was well led and the governance processes ensured that procedures relating to the work of the service ran smoothly.

Updated 15 February 2018

Our rating of this service stayed the same. We rated it as good.

A summary of our findings about this service appears in the Overall summary.

Updated 21 February 2017

We have changed the overall rating for substance misuse services from requires improvement to good because:

• Services had made important improvements since their last inspection in 2015. These improvements included consistent approaches to risk formulation and management across all services. There was a strong focus on ensuring the safety of staff and those who used services and the introduction of new systems and processes maintained a robust focus on managing the risk of harm.

• There was a commitment from leadership to standardise a consistent supervision system across all of substance misuse services. There were career development opportunities, role specific training and organised reflection and learning and development sessions for staff at all levels.

• There was good partnership working between the trust community teams and their partner agency Addiction Dependency Solutions. They were fully integrated clinical and medical services with recovery at the forefront.

• Services were patient, family, carer and community focused and led. Recovery and building recovery capital were the objectives of stakeholders. There was a strong focus on providing support to families and carers, involving them and supporting them in managing some of the difficulties that they might experience.

Updated 28 March 2019

Our overall rating of this service stayed the same. We rated it as good because:

• Clinical premises where patients were seen were clean. The number of patients on the caseload of the teams, and of individual members of staff, was not too high and staff managed waiting lists well to ensure that people who required urgent care were seen promptly. Staff assessed and managed risk well and followed good practice with respect to safeguarding.
• Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and staff engaged in clinical audit to evaluate the quality of care they provided.
• The teams included or had access to the full range of specialists required to meet the needs of the patients. Managers ensured that these staff received training, supervision and appraisal. Staff worked well together as a multi-disciplinary team and with relevant services outside the organisation.
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• Staff treated patients with compassion and kindness and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
• The service was easy to access. Staff assessed and treated people who required urgent care promptly and those who did not require urgent care did not wait too long to start treatment. The service did not exclude people who would have benefitted from care.
• The service was well led and the governance processes ensured that procedures relating to the work of the service ran smoothly.

However:

• The management plan on how to reduce the risk of identified potential ligature risks was not detailed enough to identify how all the risks were to be mitigated.