CQC

In early 2018 the Care Quality Commission (CQC) published its full report into our Trust. This followed a comprehensive inspection in September 2017.

While we were given an overall rating of Requires Improvement, at our CQC Quality Summit on the 28th February 2018 Jane Ray, the CQC’s Head of Hospital Inspection for Mental Health in London, said we just missed out on receiving a Trust-wide Good rating. This was based on significant improvements seen since the CQC’s previous inspection in 2015.

The CQC provided us with a chart of our performance across their five domains for inspection: Safe; Caring; Effective; Responsive; Well-led. And, we received Good for three of those domains - Caring; Responsive and Well-led.

Two services were also rated as being Outstanding:

  • Specialist Forensic Services;
  • Community-based Mental Health Services for Older People

This is a great accolade for us and we must share this excellence more widely across the Trust.

A few positive things the inspectors highlighted from the report are:

  • Of the 12 separate mental health and community health services visited eight were rated as good or Outstanding, and four as Requires Improvement
  • Most staff felt proud to work for BEH and were committed to ensuring they delivered good care for patients. Most staff supported patients with kindness, respect and support
  • Staff in the outstanding community based mental health services for older people and forensic/secure inpatient wards worked in partnership with patients and carers to plan care and develop services that were responsive to their needs. Staff had supported patients in the forensic/secure inpatient wards to deliver self-catering food
  • Staff in forensic inpatient/secure wards supported patients to give feedback. Patients described positive changes resulting from their input including the introduction of mobile phones, laptops and self-catering on the wards
  • The Trust had engaged with patients, carers, staff and stakeholders to develop the Trust values. Staff appreciated the interactive training available to help them understand how to apply these values in their work
  • Trust leadership was open. BEH engaged well with staff and encouraged them to raise concerns when they had them. Many staff told the CQC they found the Trust a good place to work
  • Trust systems enabled staff to escalate risks. In most areas, senior leaders knew where areas of concern were and had plans to address these
  • Staff took consideration of the needs of patients and put in place plans to support them. Staff established close links with local community organisations to provide patients with personalised support
  • Stable leadership was provided to the Trust through the Board and the executive leadership team who had an appropriate range of skills, knowledge and experience

However, the inspectors also noted issues, some of which are highlighted below:

  • Staff found it hard to keep patients safe and protect their privacy and dignity because some of the Trust’s buildings were old and did not provide a good environment for patient care. Some patients at St Ann’s hospital were required to sleep in dormitory rooms. Patients who needed access to seclusion rooms sometimes had to be moved through public areas and had to use bathrooms that contained potential ligature anchor points. The Trust had improved many ward environments since the last inspection and had proposals to rebuild St Ann’s hospital, but it needed to continue work to improve all environments
  • Staff in three of the core services did not always complete and update risk assessments in sufficient detail to ensure they managed risks to patients and themselves. Staff in the acute wards for adults of working age and psychiatric intensive care units did not complete physical health checks for patients following rapid tranquilisation
  • The Trust still needed to embed improvements in physical health monitoring and planning especially in community services for adults with mental health needs. Staff did not always ensure, in partnership with GPs, that patients had received physical health monitoring. Staff in wards for older people with mental health problems did not complete diabetes care plans for patients that required them
  • Staff did not always receive regular formal supervision. In some teams managers did not record when staff completed formal supervision or what had been discussed

The Trust already has an action plan in place to focus on any areas highlighted by the CQC, and this work is ongoing.

Andy Graham, BEH’s Interim CEO says: “Staff have done a fantastic job helping the Trust improve services and the care provided to patients. We narrowly missed out on Good, but I think aiming for Good isn’t good enough for us. I want our Trust to become an Outstanding organisation. We already have two Outstanding services with our Specialist Forensic Services and our Community-based Mental Health Services for Older People. There is no reason our other services can’t follow suit, and that is why the Board and I will be striving for outstanding over the next couple of years.”

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