Staffing pressures and a lack of understanding about legislation, which requires healthcare professionals to assess a patient’s ability to consent to treatment, have been identified by inspectors at a community and mental health trustin Worcestershire .
The Care Quality Commission rated Worcestershire Health and Care Trust as “requires improvement” overall, after three out of five key assessment areas were found to need changes.
“The trust must review its contingency arrangements for sickness and absence in staffing”
When assessing how safe the service was, inspectors noted that while staffing was at an acceptable level on inpatient wards, this was achieved through the use of temporary workers.
Inspectors found there was a “staffing challenge” in the inpatient and child and adolescent mental health services (CAMHS), due to a 16% vacancy rate and additional pressures from staff sickness across the CAMHS team.
They also noted that in some cases young people were not assessed in a timely manner by CAMHS professionals and, therefore, had their treatment delayed.
“The trust must review its contingency arrangements for sickness and absence in staffing to ensure young people in CAMHS receive assessment and treatment without long delays,” stated the regulator in its report on the trust.
“Some staff had a limited understanding that capacity was linked to specific decision”
Meanwhile, the CQC said the community and mental health team had “expressed concern” about the reliance on bank and agency staff to cover posts – the funding for which was expected to end soon and, as a result, lead to further pressure.
Inspectors noted the trust had ongoing recruitment campaigns and that wards had a suitable mix of qualified nurses with other workers.
But when assessing how effective its service was, it found the trust’s staffing levels meant at times planned activities and leave for detained patients had to be cancelled at short notice.
The regulator also said the trust must ensure it had sufficient staff on its Harvington ward, which provides inpatient care for acutely mentally ill adults, after patients reported staff were too busy to spend time with them.
“Variable” knowledge and practice of the Mental Capacity Act – requiring healthcare professionals to assess a patient’s ability to consent to each treatment – was also identified by the regulator.
It found some staff were well informed about the legislation, while others – particularly in the inpatient services and rehabilitation team – had a “limited” understanding.
“We have already developed an [improvement plan] and many of the actions are already complete”
“It appeared that some staff had a limited understanding that capacity was linked to specific decisions and some records showed that where it was assessed that the patient lacked mental capacity this was for all decisions the patient would make,” said inspectors in their report.
However, they noted that in particular the community health services were delivered to a good standard overall and that across all parts of the organisation services were rated as “good” for being caring and well-led.
CQC deputy chief inspector of hospitals Dr Paul Lelliott said: “In particular the trust must improve the quality and safety on Harvington Ward.
“As well as finding some areas for improvement, we also found a number of areas of good practice across Worcestershire Health Care NHS Trust. In particular we concluded staff in nearly all parts of the trust were caring and compassionate,” he said.
The trust’s director of nursing Sandra Brennan said the organisation had developed an action plan since the CQC visited in January and many improvements had already been made – including reviewing staffing on adult mental health wards and providing additional training.
She said: “A consistent message following inspections has been the high standard of care staff showed their patients, and the passion and professionalism they had for their services.
“We also recognise the issues identified which require improvement,” she said. “We have already developed a plan and many of the actions are already complete.”