Failure to filter new care policies through the workforce led to Humber NHS Foundation Trust being rated “inadequate” for safety, its nursing director has said.
The Care Quality Commission rated the mental health trust as “requires improvement” overall earlier this month, following an inspection in April.
“We had refreshed the policy but it had only just landed”
Problems flagged up during the inspection included: using restrictive practices such as seclusion not compliant with the Mental Health Act; its rapid tranquilisation policy being out of date; staff not always reporting the use of face-down restraint; and forensic staff supervising all patients opening their mail.
However, the trust’s director of nursing, quality and patient experience, Hilary Gledhill, said that new policies were already in place to rectify the problems.
Ms Gledhill said the trust had refreshed its policy around seclusion to be in line with the Mental Health Act, but the work “had not got the pace behind it should have” when inspectors visited in April.
She added: “By the time of the CQC inspection, we had refreshed the policy but it had only just landed, not everyone was aware of the new policy and practice was not in line with that policy.
“We were absolutely transparent with the CQC. The policy was already there, but when they came it had just come out,” she told Nursing Times’ sister title Health Service Journal.
The CQC issued Humber FT with a warning notice on three issues – “inappropriate” rapid tranquilisation, seclusion and segregation not being in line with the Mental Health Act, and staff supervising patients opening their mail.
Ms Gledhill stressed the trust had refreshed its seclusion policy, reviewed cases of rapid tranquilisation and stopped supervising all patients opening their mail.
She said there are now weekly reports on seclusion, with a new policy focus on the reasons for secluding a patient, who needs to be involved in the decision and seclusion exit plans.
She added: “On the back of what [the CQC] was saying, the seclusion policy has been refreshed and put back out with more detail around developing exit plans for patients.
Trust has acted to improve safety, says nursing director
“Absolutely everything around seclusion is now audited. We have seen from that increased scrutiny and staff knowledge a steady decrease in cases of seclusion,” she said.
Ms Gledhill said there had been “confusion” around the new policy at the time, adding: “The policy was already there, but when inspectors came it had just come out.”
She also said supervising the opening of all patients’ mail had stopped. The trust had previously been told by the CQC to stop this practice following an inspection in 2014.
Ms Gledhill said she had not been at the trust at the time of the 2014 inspection. “I don’t know what previous assurances were made, but it has stopped and it is a different process. “It needs to be on a patient by patient basis, we are checking and monitoring that is the case,” she said.
HSJ interview and CQC report