A mental health trust in Lincolnshire has made enough improvements to have its rating raised to “good”, according to the Care Quality Commission.
Lincolnshire Partnership NHS Foundation Trust was previously told by the regulator that it “requires improvement”, following an inspection in December 2015.
The CQC found problems including staffing concerns, potential threats to patient safety due to ligature risks, and a lack of systems in place to monitor quality.
But at its latest inspection in April 2017, the CQC observed that the trust had made changes including installing CCTV, intercom systems and removing ligature risks.
There was also quick access to “heat maps” for each ward to help staff manage patients presenting with high risks, said the CQC in its report.
In addition, the trust had clear systems for recording and investigating incidents and lessons were shared.
“We noted improvements in most core services…However it had not fully addressed all of our previous concerns”
“The relatively new chair, director of nursing and chief executive were particularly praised by senior staff as being inspirational leaders,” noted the report.
There had also been efforts to reduce staffing vacancies, including supporting healthcare support workers to start nurse training, and the recruitment of 40 nurses in a year.
Nursing Times recently reported that the organisation had started paying Nursing and Midwifery Council fees for new recruits in a bid to attract more staff.
The organisation’s overall nurse vacancy rate had reduced from 5% at the end of 2016 to 3% by the end of March 2017. Empty nursing assistant posts had decreased slightly, from 12% to 11% in that time.
However, 14% of nurse posts were still unfilled in mental health crisis services and health-based places of safety.
Meanwhile, the report noted some wards still used a lot of bank staff, with child and adolescent mental health wards seeing 17% of all shifts filled in this way in 2016.
Inspectors also found issues with patients not having details of their physical healthcare needs included in care plans.
“We found patients with epilepsy and diabetes did not have specific care plans for how to manage these conditions”
“For example, on the acute wards for adults, we found patients with epilepsy and diabetes did not have specific care plans to inform staff how to manage these conditions, and within the community team for older adults, patients physical healthcare needs were not regularly reviewed or monitored,” said the report.
The trust was told to address this problem as well as to ensure patients nursed in seclusion had an appropriate care plan to reflect this. Staff must also have regular clinical and management supriison, said the CQC.
“We found that the trust had responded positively to the changes we asked it to make following our last inspection and we noted improvements in most of its core services,” said CQC deputy chief inspector of hospitals, Dr Paul Lelliott.
“Throughout the trust we saw staff treating patients with kindness, dignity and respect. Staff were helpful and understanding and used kind, supportive language that patients understood,” he said.
“However, although there had been significant progress at the trust, it had not fully addressed all of our previous concerns and we have highlighted areas where the trust needs to make further improvements,” he added.
“The trust has a clear focus on reducing the use of agency and bank staff”
Anne-Maria Olphert, the trust’s director of nursing and quality, said: “The areas of improvement raised by the CQC in their report form part of the trust’s continuous quality improvement programme which focuses on supporting staff, caring for people in a safe environment, transforming services to meet future needs and improving our collection of data. The improvements required around care planning, physical healthcare needs, supervision and record keeping will be addressed as a part of this piece of this ongoing work.
“The trust has a clear focus on reducing the use of agency and bank staff. We are working proactively to fill our vacancies and have a number of initiatives in place which resulted in our nursing vacancy factor reducing to 2% during 2016-17,” she said. “In September 2017 we will have 40 newly qualified nurses joining LPFT and we have also sponsored a number of nursing assistants to undertake their nursing training.
She added: “LPFT remains below the NHS Improvement agency cap and our agency usage is one of the lowest in the region. At times unforeseen circumstances or staff sickness require us to fill shifts with bank or agency to ensure high quality of care and safe staffing levels are maintained. Our bank pool includes a considerable proportion of internal staff which helps sustain continuity of care for patients.”