Cumbria Crack

CQC report says “little improvement” in Cumbria psychiatric care

The Care Quality Commission (CQC) has today published a report on Cumbria Partnership NHS Foundation Trust. The trust has been rated Requires Improvement following an inspection in May and June 2019.

Between 21 May 2019 to 25 June CQC inspected four of the trust’s core services. Acute wards for adults of working age and psychiatric intensive care units, wards for older people with mental health problems, wards for people with learning disability or autism and mental health crisis services and health-based places of safety. CQC also looked specifically at management and leadership to answer the key question – Is the trust well led?

The inspection marks the third time the trust has been rated Requires Improvement overall. Inspectors reported little progress had been made in the services they visited. Inspectors also reported not all governance systems were effective in assessing, monitoring and improving care and treatment. A robust system was not in place to enable the board to have clear oversight of quantity and quality of supervision. The trust’s health-based places of safety did not always have dedicated staffing to observe patients using the service.

However, improvements were seen in the safety of wards for older people with mental health problems.

There was enough qualified and experienced nursing and medical staff to keep patients safe, and the ward had shown a good history of safety. Acute wards for adults of working age and psychiatric intensive care units also showed improvement. Inspectors saw there was a strong skill mix of staff to treat patients and care was recovery focused. Both services were rated Requires Improvement overall.

Jenny Wilkes, Head of Hospital Inspection, said: “It’s positive to see some improvements being made at the trust and staff continue to treat patients with kindness and compassion. However, this is the third time we have rated the trust Requires Improvement overall.

“At our previous inspection the trust was undergoing major change, due to the merger with North Cumbria University NHS Trust, and continues to do so. We have made our findings very clear to the trust, and we continue to keep the trust under observation and will return again to see whether improvements have been made and sustained.”

Across all four services which were inspected, staff were recognised for their kindness and compassion with the CQC saying that staff ‘respected patients’ privacy and dignity’ and ‘understood the individual needs of patients to understand and manage their care, treatment or condition.’ Staff were praised for involving patients and their families/carers in decisions about their care and treatment. Continual improvement through learning lessons and implementing change as a result of complaints, incidents and feedback was also recognised and it was noted that staff ‘generally felt proud and positive to work for the Trust and their team’.

An area of outstanding practice was highlighted on Ruskin Unit at Carleton Clinic, Carlisle which is an assessment unit for patients with conditions such as Dementia. The CQC said: “Staff on Ruskin unit used innovative approaches when working with patients. This included the use of the extra care area for patients who required a low stimulus area during periods of agitation. The area had also been used for patients at the end of life. This meant that families could stay with their loved ones on the ward in a private, comfortable area. The environment on Ruskin was particularly dementia friendly. The ward had a homely feel and staff ensured that patients were comfortable.”

In the wards for older people with mental health problems (Ramsey unit at Furness General Hospital in Barrow, Ruskin Unit and Oakwood Unit at the Carleton Clinic in Carlisle), the rating for ‘safe’ has improved to ‘good’ overall because the service was found to be well staffed with staff assessing and managing risks to patients and following best practice in managing challenging behaviours.

On Edenwood Unit at Carleton Clinic (unit for people with a learning disability or autism), the CQC found that staff understood the individual needs of patients and enabled patients and their families to give feedback.

On the acute wards for adults and psychiatric intensive care units (Rowanwood and Hadrian Units at Carelton Clinic, Yewdale Unit at West Cumberland Hospital, Dova Unit at Furness Hospital in Barrow and Kentmere at Westmorland General Hospital in Kendal), when looking at how effective the service is the CQC improved the rating to ‘good.’ The inspection team noted that staff understood their roles and responsibilities under the Mental Health Act and worked together for the benefit of patients including ensuring care plans were regularly reviewed and updated.

When inspecting the four mental health crisis services and health-based places of safety across Cumbria, the ratings did go down from previous inspections however the team found that staff assessed and managed risk to patients and understood how to protect patients. They also found that the crisis service was easy to access.

Several areas for improvement were also raised by the CQC and work is already underway to address these with some actions already complete. These include concerns around the physical environment of some of the accommodation such as Oakwood, Dova and Kentmere. There are improvement plans and business cases in place to be taken forward for each of these areas. On Dova Unit, some of the issues have now been resolved.

The Trust will be taking action and will be supporting Northumberland, Tyne & Wear NHS Foundation Trust (NTW) and Lancashire Care NHS Foundation Trust (LCFT) as services are transferred on 1st October. The organisations are working together to ensure that the transfer is undertaken safely and effectively and this will include taking onboard feedback from the CQC following the recent inspection.

Stephen Eames, chief executive of CPFT and North Cumbria University Hospitals NHS Trust, said: “Despite some of the pressures services are under, what shines through the feedback following the focused inspection on four of our mental health services is the continued kindness and compassion shown by our staff. I would like to commend the staff today for their hard work and commitment which I know will continue when staff transfer to our partner providers from 1 October.

“I know that the issues identified by the CQC in their report are at the forefront of plans for both NTW and LCFT to take forward. NTW has a long track record of providing outstanding care across an extensive geographical area and will be able to bring more expertise to help improve the quality of services in north Cumbria and tackle some of the longstanding challenges. NTW has already undertaken a number of clinical reviews in order to begin improvement work which has already had positive outcomes in our CAMHS services as well as a big reduction in patients being seen out of area which has improved patient experience. In addition, they have been successful in gaining significant transformation funding for crisis & home based treatment and mental health liaison services in Cumbria.

“In south Cumbria, NTW is working in partnership with LCFT to drive improvements and transformation across services there. We are committed to continuing to work in partnership with both organisations in order to ensure that there is a smooth transition of services for the benefit of our staff and patients.”

Tim Farron MP said: “This damning report is the result of poor leadership from the Trust and severe underfunding from Government with the victims being people young and old with mental health conditions.

“One silver lining here is the CQC have found that the mental health staff on the front line do a great job caring for patients – but of course that was never in doubt.

“My fear is that, as the Partnership Trust wraps up next month, those who are responsible for this inadequate leadership will continue to prosper in new roles while the patients who are suffering will continue to suffer – we must remember that Lancashire Care Trust hardly have a glowing CQC reference.

“I will continue to fight to make sure that everyone struggling with mental health conditions will get the highest quality support as close to where they live.”