North Essex Partnership University NHS Foundation Trust has been issued with a warning notice and told it must improve staffing, training and supervision among other issues.
The mental health trust was told to make immediate improvements following an unannounced inspection of its acute inpatient services by the Care Quality Commission in September.
“We were concerned that improvements were needed in a number of areas”
Inspectors found wards were not fully staffed, with shifts left unfilled and that staff were not receiving regular clinical supervision or training.
All wards had nursing staff vacancies and were using bank and agency staff with no permanent nursing staff on duty on several occasions.
For example, according to rotas, there were no permanent staff on duty in the psychiatric intensive care unit for two nights in a row in August.
In addition, inspectors found the trust was not meeting mandatory training targets. “This meant not all staff had received the required level of refresher training,” said the CQC’s report.
The inspection team also found variation in staff supervision, with compliance rates dipping as low as 12% on one acute ward. Meanwhile, no supervision took place on another acute ward throughout April and May, according to the trust’s own records.
Sir Mike Richards
Other concerns centred on learning from incidents, safeguarding and the involvement of patients and carers in care decisions.
The CQC latest visit followed an inspection of the whole trust by the regulator in August last year, when it was rated “requires improvement” overall.
The CQC’s chief inspector of hospitals, Professor Sir Mike Richards, said improvements had been made but more work was needed.
“We could see that much work had been done since our visit in August 2015 and that there were a number of areas of good practice at the trust,” he said. “The majority of patients gave positive feedback about their care.
“However, we were concerned that improvements were needed in a number of areas,” he said. “This included the trust’s assessment and management of risks for fixed ligature points on wards, there were concerns relating to the provision of segregated accommodation for men and women and learning from incidents needed to be shared with staff.”
Good practice highlighted by inspectors included the fact regular agency and bank staff were used to help ensure consistent care for patients.
They also praised the trust’s independent “guardian service” that staff could contact if they had any concerns about patient care and safety, whistleblowing, bullying and harassment, and work grievances.
Since the previous inspection findings were published in February this year, the trust said it had put an action plan in place, including a £1.6m investment in improving inpatient facilities as well as opening a new inpatient unit on the site of the Princess Alexandra Hospital in Harlow.
“I am deeply impressed with the commitment of staff”
Christopher Butler, who was appointed interim chief executive in March, acknowledged there was lots more work to do.
“I am grateful to the CQC for the positive comments it has made about the improvements it has seen in the trust,” he said.
“I am deeply impressed with the commitment of staff and the investments made in improving facilities. However, the CQC is right that there is much more to do, particularly consistency in providing services, and how the trust has oversight of this.”
Mr Butler said the way services were managed and mechanisms to ensure the board understood “frontline” work had been strengthened – changes that had taken place just six weeks before the unannounced inspection.
“The trust board is committed to seeing through the investments it continues to make in improving inpatient environments, ensuring consistency in its work, and helping people to support patients whilst holding people to account for their work,” he added.