A mental health trust has been taken out of special measures after inspectors upgraded its overall rating from “inadequate” to “requires improvement”.
Norfolk and Suffolk NHS Foundation Trust was the only mental health trust to receive the lowest Care Quality Commission rating, following its inspection in October 2014.
It was subsequently placed in the special measures support scheme for struggling healthcare providers in February 2015.
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The commission has now raised the trust’s rating to requires improvement and fellow regulator NHS Improvement said it was taking it out of special measures based on the CQC’s recommendation.
However, the trust remains rated “inadequate” for whether services are safe. It was rated “requires improvement” for whether services were effective, responsive and well led, and “good” for whether they were caring.
NHS Improvement and the trust will now agree an action plan to address the safety concerns, which include:
- a number of environmental safety concerns including ligature points
- mixed sex accommodation not meeting national guidance
- concerns about the design of seclusion and places of safety, and seclusion not being managed within the Mental Health Act code of practice
- staffing levels being insufficient on inpatient wards
NHS Improvement’s delivery and improvement director for the East of England, Frances Shattock, said the trust had made “positive progress” since its initial inspection.
She added: “There is clearly much more to do to ensure that the trust sustains and builds on these improvements. We will continue to provide the trust with extensive support to ensure it is able to give the standard of care patients expect.”
“Morale had significantly improved, there were better systems”
CQC inspectors carried out a follow-up inspection at the trust in July and August and found “considerable progress” had been made, according to their latest report on the organisation, published today.
Chief inspector of hospitals Professor Sir Mike Richards recommended the trust be taken out of special measures after finding it had “clearly gained from the intensive support of the regime”.
He said: “Our return to Norfolk and Suffolk NHS Foundation Trust showed significant improvement had taken place. There clearly remain areas where further work is needed, in particular with regard to how the trust manages risks to people’s safety, but we found considerable and positive change had taken place.
“Morale had significantly improved, there were better systems for recording and learning from incidents and people’s needs were assessed, with care and treatment planned to meet those needs,” he added.
Examples of good practice at the trust:
- The ‘care farm’ initiative and recovery college demonstrated areas where improvement and innovation had taken place.
- One clinical psychologist had been given a one day a week funded programme to promote a ‘research friendly’ environment. The same psychologist ran 15 minute morning ‘mindfulness’ groups for staff to help reduce staff stress.
- At Julian Hospital, carers were involved in the redesign of an information booklet to improve communication, reduce patient distress and create a patient-centred admission process.
- A new occupational therapy model of care had been developed at Julian Hospital to increase therapeutic interventions and reduce incident rates; for example for falls, violence and aggression. As of March 2016 a reduction of incidents was identified.
- In the older people’s community teams, we saw an example of good practice where a team had developed an additional cognitive stimulation therapy group for younger people with dementia, which met in a pub to reduce any stigma.
- Members of the Child and Adolescent Mental Health Service (CAMHS) teams attended child and family research meetings held every two months to support the development of research within the service.
Areas where the trust has been told it must make improvements:
- Action must be taken to remove identified ligature anchor points, to mitigate risks where there are poor lines of sight and ensure that the environment does not increase the risks to patient safety.
- Mixed sex accommodation must meet Department of Health and Mental Health Act (MHA) code of practice guidance and promote safety and dignity.
- Seclusion facilities must be safe and appropriate, and seclusion and restraint must be managed within national guidance and the MHA Code of Practice.
- There must be enough personal alarms for staff and patients must be able to summon assistance when required.
- Sufficient staff must be available at all times to ensure patients’ needs are met and all staff must complete statutory, mandatory and, where relevant, specialist training.
- All risk assessments and care plans must be in place, updated consistently and reflect the full and meaningful involvement of patients.
- Medicines must be stored, administered, recorded and disposed of safely.
- An immediate review of clinical information handling and systems must be undertaken so that risks can be identified and patient safety protected.
- People must receive the right care at the right time through the trust giving them suitable placements to meet their needs and access to 24 hour crisis teams.
- The trust must ensure that its processes capture and learn from adverse incidents.