England’s Chief Inspector of Hospitals has found improvement at a Lincolnshire based NHS trust for mental health and learning disabilities.
he services provided by Lincolnshire Partnership NHS Foundation Trust have been rated ‘Good’ overall following an inspection by the Care Quality Commission.
The CQC team inspected core services provided by the Trust over five days in April 2017 and found a number of improvements had taken place since it was last inspected. The previous inspection, in December 2015, had resulted in the trust being rated as ‘requiring improvement’ due to issues in a number of areas.
Inspectors, including specialists and experts in their field, visited the trust and rated the care provided by staff to be Good regarding whether services were safe, caring, responsive and well-led, but effectiveness of services were still rated as ‘requiring improvement’.
CQC’s Deputy Chief Inspector of Hospitals (and lead for mental health), Dr Paul Lelliott, said: “Overall, we concluded that Lincolnshire Partnership NHS Foundation Trust now provides good care to the population that it serves. We found that the trust had responded positively to the changes we asked it to make following our last inspection and we noted improvements in most of its core services.
“Throughout the trust we saw staff treating patients with kindness, dignity and respect. Staff were helpful and understanding and used kind, supportive language that patients understood. They encouraged patients to give feedback about their care, and provided people with information in easy read formats to help them access further support where needed.
“Since our last inspection, the trust has worked to reduce the risks to patients on the wards who might harm themselves. Staff were now more aware of the risks in the ward environments and re-assessed these regularly. On inpatient wards, staff had quick access to ‘heat maps’ to assist the safe management of patients at high risk of self-harm or suicide.”
But he went on: “Although there had been significant progress at the trust, it had not fully addressed all of our previous concerns and we have highlighted areas where the trust needs to make further improvements.
“The trust knows what it must now do to ensure further improvements are made.”
Areas where the Trust must take action to improve further include delays in accessing psychological therapies, compliance with mandatory training and clinical supervision and quality of risk assessments and care plans. The inspectors also highlighted that LPFT could not always provide a bed locally for patients who require admission to adult acute mental health wards.
Dr John Brewin, LPFT Chief Executive was pleased that the work of staff had been reflected in the report.
He added: “There is a great deal we can be proud of in this report but we are not complacent and will continue to work to improve our services for patients. We know there are areas that we need to focus on in order to enhance our services and provide effective care.”
Dr John Brewin, Chief Executive said: “The areas of improvement raised by the CQC in their report form a part of the Trust’s continuous quality improvement programme which focuses on supporting staff, caring for people in a safe environment, transforming services to meet future need and improving our collection of data.
“Not all of the solutions to the issues identified in the report rest with the Trust alone and we will carry on working with our partners across the health and social care system to support us in addressing availability of local beds.”
He said: “In the summer we will open a new psychiatric intensive care unit for males which will greatly assist us in ensuring we are able to keep Lincolnshire patients more local. A similar business case for a female high dependency unit is also being developed in partnership with commissioners.
“We have been working to reduce psychology waiting times and the appointment of new staff and process changes has seen a 61 per cent reduction in number of people waiting since October 2016. The service prioritises patients with most complex needs and is working with other mental health teams and independent providers to manage waiting times.”
Several areas of good practice were highlighted during CQC’s inspection, including:
○ Volunteers regularly visited inpatient wards for older people with therapy dogs. This gave comfort to patients, particularly those who had been dog owners and offered a source of conversation. Community teams for children and young people had also introduced an animal assisted therapy service.
○ On long stay rehabilitation wards, at Discovery House, there was a patient run café which recently employed a previous patient in a paid role. The service offered a range of temporary paid job opportunities for patients. These included gardening and car valet roles.
○ The crisis and home treatment teams had good working relationships with the police and the trust was arranging for staff to be based, out of hours, with the police to signpost patients to mental health services quickly.
○ Staff in community services for children and young people had established an “outcomes oriented child and adolescent mental health service (CAMHS)” model of care that had been recognised in NHS innovation awards. Other child and adolescent mental health services nationally had adopted this model. The service had developed a large crisis and home treatment team, which offered provision for assessment and support 24 hours a day.
○ The psychiatrist working for the forensic secure inpatient ward had developed an IT application for use by staff to access information on National Institute for Health and Care Excellence (NICE) guidelines on the wards.
○ Staff treat patients with kindness, dignity and respect. Their attitudes are consistently helpful and understanding. They are passionate about helping patients with mental illness.
○ Staff encourage patients to give feedback via daily ward meetings, patient forums, surveys and other available mechanisms.
○ Patients are involved in their care, their goals and aspirations are part of their care plan and they are given a full explanation of the different treatments available. Patients and carers said that they felt listened to, they were treated well and they were taken seriously.
○ Staff show strong therapeutic relationships with their patients and clearly understand their needs.
○ Patients are involved in projects across the organisation including recruitment, patient involvement groups and peer support work. There are also groups supporting carers.
○ Staffing levels across all core services are planned and regularly reviewed.
○ The Trust reviews and manages ligature risks within services and each inpatient ward has a system of ‘heat maps’ in place specific to their ward, which helps staff safely manage patients presenting with high risk of self-harm or suicide (a ligature risk is a fixed point which someone could use to harm themselves).
○ Senior managers in the trust are visible and the cultural shift within LPFT had enabled the board to show stronger and more charismatic leadership. Staff reported positive morale, job satisfaction and felt empowered in their roles.
○ LPFT has a good working relationship with local stakeholders, including the commissioners and the Police.
The full report can be found on the Care Quality Commission website: www.cqc.org.uk/provider/RP7