The management of Derbyshire Healthcare NHS Foundation Trust has been strongly criticised, with its leadership given the Care Quality Commission’s lowest rating, in the wake of its latest inspection.
The trust’s management has also been issued with a warning notice by regulators and told to improve across a raft of areas but especially on equality and diversity, fire safety and safeguarding.
“The executive team lacked the full depth and breadth of skills required”
Overall, the East Midlands trust was rated “requires improvement”. It was also rated as “requires improvement” for the categories of being safe, effective and responsive.
But it was rated “inadequate” for being well-led following an inspection in June this year, though it received a rating of “good” for being caring.
The inspection in June was the organisation’s second this year. It was also inspected in January 2016 when the CQC and Deloitte carried out a joint inspection, which focused on the trust’s leadership.
The January visit followed concerns raised by whistleblowers to the CQC and during an investigation by NHS Improvement, which resulted in the trust being in breach of its license as a foundation trust.
At the time, CQC said it found full checks had not consistently been completed for some directors and the trust was told it must carry out a fit and proper person review for all directors.
“Assurance and reporting systems failed to recognise safeguarding issues”
The latest inspection in June found that improvements had been made since January with regard to this issue and the trust had met the fit and proper person requirements, said the CQC in its report.
However, the regulator warned that trust, which provides mental health and community services, still had significant leadership weaknesses.
CQC chief inspector of hospitals Professor Sir Mike Richards said: “Although some improvements had been made… the pace of change and the ability of the senior leadership to grasp the seriousness of issues had not been quick enough.
“We found that, as a group, the executive team lacked the full depth and breadth of skills required to enable the improvements needed in culture, governance and HR throughout the trust,” he said.
“Assurance and reporting systems failed to recognise safeguarding issues that occurred on wards for older people and, though senior staff were aware, no decisive action had been taken to effectively safeguard and protect people or their property,” said Sir Mike.
“Some staff lacked confidence in the leadership team and felt detached from the central management functions,” he added, though he noted that managers had started work to improve engagement with staff.
“Since our inspection in January CQC and NHS Improvement have been meeting with the trust leadership on a monthly basis. We will continue with this approach to assist it in improving the standards of care and treatment,” said Sir Mike.
The visit during June was carried out as part of CQC’s ongoing monitoring of NHS trusts and mental health services.
It found a raft of other serious concerns, resulting in a warning notice being issued that requires improvements to be made to equality and diversity, fire warden training and safeguarding.
The CQC said processes must be put in place to ensure patients treated under the Mental Health Act are given their rights in accordance with the Code of Practice.
The trust must also have processes in place to ensure a consistent approach to planning people’s care and patients must be able to access psychological therapies in a timely manner, said the CQC.
All equipment must be well maintained and checked in accordance to manufacturers guidelines, and learning from incidents must be captured to allow managers to identify themes and trends so they can act upon this and ensure people’s safety, it said.
The trust must also consistently maintain medication at correct the temperatures and ensure all emergency equipment is within its expiry date and accurately checked.
In addition, the trust must ensure that clinical staff have a consistent approach to the use of rapid tranquillisation, understand its risks and record its usage.
The appropriate number of suitably qualified staff must be on duty for each shift and mandatory training must be completed for all staff to achieve its target of 80%, said the CQC
Mental health trust given warning notice by CQC
Meanwhile, the trust was told to ensure robust systems and processes were in place to support safeguarding patients and safeguarding referrals must be made when appropriate.
Sir Mike said: “We had concerns about the safety of the environment, safeguarding and a lack of staff understanding regarding the Mental Health Act and the Mental Capacity Act.
“As a result of our inspectors’ findings in June, we issued the trust with a warning notice which requires it to make improvements within a set timeframe,” he stated.
However, he highlighted that the inspectors also witnessed some good practice across the trust, including that staff were consistently caring and treated patients with kindness, dignity and respect.
Similarly, feedback from both patients and carers, regarding the quality of care, was positive and demonstrated a staff had the patients’ best interests continually in mind, the CQC noted.
In particular, the inspections praised the trust’s child and adolescent mental health service (CAMHS), which they rated as “outstanding”.
“We are committed to learning from this report and to improving our processes and services”
Derbyshire Healthcare provides community services to children and families, mental health services to people with learning disabilities and people with substance misuse needs.
In response to the CQC’s report, the trust issued a statement saying that accepted the findings and was focused on the development of a “thorough action plan”.
“The trust acknowledges its rating of inadequate for the well led domain of the CQC’s report and is focused on improving leadership and processes in place for HR, governance and culture,” it said
“We are committed to learning from this report and to improving our processes and services in order to provide the very best care we can to our service receivers,” said the trust statement.
It added: “We are proud of the areas of good practice highlighted by this report, notably the CQC’s reflections that our staff are very caring, and that they consistently treat people with kindness, dignity and respect.”