North Staffordshire Combined Healthcare NHS Trust has been given an official warning about community mental health services for young people, after inspectors found there were not enough staff to provide quality care.
The trust’s child and adolescent mental health services (CAMHS) community provision was rated “inadequate” by the Care Quality Commission following an inspection of all core services in September last year.
“There was a perception among nurses that they are not valued”
Inspectors found staffing levels in community CAMHS were “not safe” because of staffing shortages in various disciplines, including nursing, with “excessively long” waits for treatment.
“There were not enough consultant psychiatrists, nurses, psychologists, or therapists,” said the CQC report. “We found staff on maternity or long-term sick leave were not replaced by temporary staff.”
Inspectors also found risk assessments of young clients were not always completed or safety plans put in place.
Mental health crisis services and health-based places of safety were also rated “inadequate” by the CQC, because of concerns about risk management and record-keeping.
Overall, the trust was rated “requires improvement”, with inspectors concluding that it was “good” when it came to caring.
However, the CQC’s report highlighted dissatisfaction among some nursing staff when it came to feeling valued.
“There was a perception among nurses that they are not valued, especially among learning disability nursing staff,” said the report, which highlighted a high turnover rate of 27% in learning disability services.
Even so, learning disability services were rated “good” and inspectors said community learning disability services were “outstanding”.
A key issue flagged up in the report was inconsistency in nursing leadership, with five different nursing directors in the past three years.
“This has had an effect on stability and the trust’s ability to effectively monitor quality and safety,” said the report.
The constant changes in the role prevented nurses having a strong say when it came to planning and redesigning services, the report stated.
Staff shortages spark warning for mental health trust
Maria Nelligan was appointed director of nursing and quality in October last year.
“Since October 2015, Maria has been in the director of nursing and quality post on a substantive basis and has played an important role in the improvements we have made to our services since the CQC inspection six months ago,” said a trust spokesman.
Inspectors also flagged up areas of good practice at the trust, including a pilot scheme to monitor staff stress levels during shifts.
Staff place a green or red token in a box at the end of a shift to indicate how stressful it was. They are then contacted individually and offered support where needed.
“Staff said that it was useful way to reflect upon how individual shifts impacted on stress levels,” said the CQC report.
Other examples of good practice include a service developed by the hearing loss specialist nurse to ensure patients with hearing difficulties had their needs met.
“They had secured ipads and online apps, which provided instant access to signers,” said the report. “Patients experiencing hearing loss would then have access to this service on admission throughout the trust.”
“We have made good progress since September, in particular in improving our CAHMS community services”
Trust managers said the organisation had made considerable progress since the inspection, which included efforts to address staffing and recruitment issues and improvements in mental health crisis services.
The trust had secured more funding from commissioners to recruit more clinical staff in community CAHMS and a recent external audit of the service gave it a “green” rating, it said in a statement.
“We have made good progress since September, in particular in improving our CAHMS community services, which has been supported by significant investment from the CCG,” said chief executive Caroline Donovan.
“The CQC also recognised our direction of travel is positive. While we are in no way complacent, we are confident that by addressing the recommendations of the inspection team and continuing to work with our commissioners, staff and service users, we will continue to improve,” she said.