Concerns about record keeping and nurse vacancies at services provided by Gateshead Health NHS Foundation Trust have been raised in a critical report by the Care Quality Commission.
Following an inspection in December 2016, the trust’s community mental health services for older people were assessed as “requires improvement”, and wards for older people with mental health problems were rated as “inadequate”.
”We have significant concern that these services aren’t as safe as they should be or effective enough”
The CQC found the trust’s hospital wards providing mental health services for older people did not meet patients’ needs.
Care plans were not holistic and featured only a list of prompts for nursing staff.
“We found no evidence in any of the 12 care records of a care plan which addressed the entirety of a patient’s mental, physical, emotional, social, spiritual or environmental needs,” said the CQC in its report on the service.
“None of the records had any evidence of a coordinated approach to planning care which included multiple professionals,” it added.
Both units that were inspected - Cragside Court and Sunniside Unit, based at the Queen Elizabeth Hospital – had high numbers of shifts covered by bank staff.
At one point, in October, Cragside Court was highlighted in the trust’s board report for having managed to cover only 71% of qualified nursing staff shifts.
”The service was overfilling shifts for nursing assistants…to mitigate where additional shifts could not be filled with qualified staff”
CQC report on Gateshead FT mental health services
“Whilst we were told the wards always had at least one qualified member of staff, the service was overfilling shifts for nursing assistants both to mitigate where additional shifts could not be filled with qualified staff and to reflect the patient needs and skill mix required on the ward,” said the CQC report.
“Staff on both units told us they felt there were not enough staff to offer one to one sessions with all patients,” it added.
In addition, the wards had not been adapted to meet the needs of older people or for those living with dementia. The layout of the wards meant staff could not see all areas.
Staff did not provide activities for people on evenings or weekends and placed blanket restrictions on them, he added. For example, people could not make their own hot drinks and snacks nor could they lock their bedroom doors.
In the community services, in central and east Gateshead, the electronic patient record system was found to be “neither reliable nor fit for purpose” which was causing staff “significant difficulties” for staff trying to access patient records, said the CQC.
”We are committed to providing excellent care for all of our patients, and are looking closely at the report”
The system did not support staff to deliver safe or effective patient care and was “potentially putting people at risk of harm.”
In addition, staff were not always recording risk assessments or updating care plans.
The trust was told to improve in a number of areas including risk assessments for ligature points, ensuring care plans reflect people’s needs and do not have gaps in information, and providing an effective electronic patient record system.
“We have significant concern that these services aren’t as safe as they should be or effective enough for the people using them,” said Paul Lelliott, deputy chief inspector of hospitals, and CQC lead for mental health, referring to both the community services and the two units.
“We have told the trust where they must improve and we will inspect again to ensure they have made the changes we have told them to,” he added.
Ian Renwick, chief executive of Gateshead Health NHS Trust, said that it was “very disappointed” in the CQC’s findings.
“We are committed to providing excellent care for all of our patients, and are looking closely at the report to understand exactly how we can improve these services over the coming months,” he said.
After the inspection, the trust acted immediately to improve its services and has begun a plan to make further changes and improvements, Mr Renwick added.