Enforcement action taken for second time this year against mental health trust 

Tees Esk and Wear Valleys NHS Trust were issued for the second time this year with a warning notice and asked to make urgent improvements.

Inspectors from CQC visited the trust between June and August this year.

She said she had conducted a surprise inspection of inpatient forensic departments due to concerns about unsafe staff numbers and poor culture within the service.

Nine suites were searched, all in Roseberry Park in Middlesbrough. The level of services has been reduced from good to inadequate.

Roseberry Park, Middlesbrough

The Central Quality Commission said the briefly announced inspections were also conducted at community mental health services for working-age adults, health-based crisis and safe spaces services, as well as Child and Adolescent Mental Health Services (CAMHS). This was due to concerns raised about the safety and quality of these services.

CAMHS in the community continues to be classified as requiring improvement and community mental health services for working adults have been reduced from good to requiring improvement.

Health-based crisis services and safety premises have improved and are now rated as good, and were previously rated requiring improvement. The overall rating of confidence is still also requires improvement.

Brian Krana, Head of Hospital Examination (Mental Health and Community Health Services) at The Queensland Centre: “When we examined trust, we found that the leadership team demonstrated an open and honest culture, yet we were concerned about the culture within inpatient forensic wards. Because of these concerns, we issued Trust with a Warning Notice, which identified specific areas for improvement in inpatient forensic wards and also required improvements in child and adolescent mental health services in the community by a specified deadline.

“During our visit to inpatient forensic departments, we found a poor culture, and staff told us they did not feel respected or supported. We found issues with staffing levels that affected the quality of care provided and patients were upset that their planned leave did not always happen because of this.

“Although the Fund has commissioned an external review of the culture within the inpatient forensic wards, actions taken to improve it have not been effective. This culture has a negative impact on patient care and must be addressed by the leadership team as a matter of priority.

“We were concerned about staffing issues in child and adolescent mental health services in the community. People were waiting too long for assessments for autism, and there was a lack of support for people waiting for an appointment. However, we were told that the treatment was of good quality and the staff gave helpful advice.

“The trust is beginning to address our concerns and learn what additional improvements are needed to better oversee what is happening across the organization and improve the culture. We will continue to monitor it and come back to check on its progress.”

This is the second warning notice submitted to the fund this year. In January, inspectors visited credit wards for working adults and psychiatric intensive care units and rated services as inadequate.

The inspection came in response to an incident that resulted in the death of a patient. A follow-up examination was conducted in May and the TQM says that while it has found significant improvements have been made, they were not fully included at the time of the examination and the rating as “requires improvement” is still in effect.

The trust is also the subject of an ongoing independent investigation by NHS England into the failures at West Lane Hospital in Middlesbrough which was closed in August 2019 after the deaths of two teenage girls.

In response to the report, Trusts CEO Brent Kilmurray said he fully agrees that there is still much work to be done, and steps are already being taken to address the issues highlighted in the report.

He said: “The common denominator in most of the issues raised by the QC is staffing pressures. Reducing that pressure is our biggest challenge and we are working hard to solve this problem. There is a staff shortage at the NHS level, and the problem is particularly acute in this region. Comes This is at a time when the demand for our services is particularly high and we have invested in recruitment for a range of vacancies and new roles to meet the demand.

The pandemic has meant employee absenteeism due to illness has been at an all-time high over the past 18 months. Against this background, our staff strive to provide the best possible care.

“Our crisis teams – the first point of contact for those who need it most – have done particularly well to improve their ratings to good in really challenging circumstances.

“We take cultural issues very seriously and have put in place new management arrangements to address this, putting our values ​​of respect, empathy and responsibility at the heart of everything we do, all aiming to make this a great place to work.

“In the meantime, we will work with the CQC to ensure their requirements are positively met.”

More about the report

The inspectors published a list of concerns:

  • There weren’t always enough staff in some services who knew patients well enough to keep them safe. In some services, this affected the safety and quality of care and meant that staff were not always responsive to patients’ needs.

  • There were high waiting times in the community mental health services for children and young adults. Oversight of the waiting list management process was lacking and the risks to children and young adults were not reviewed.

  • Although overall compliance with mandatory training was good, there was some poor compliance. This means that some staff did not have the basic skills required to provide safe care.

  • The systems and processes for escalating performance and risk issues from the wing/team level to the board of directors were not effective.

  • Staff did not always adequately report and record incidents.

  • Patients were not always adequately protected from abuse and there was no trust-level policy to protect adults.

  • Trust requires continuous improvement in its approach to equality and diversity. Employees with disabilities or from a black and minority ethnic background were more likely to be harassed, bullied, or abused.

  • Investigations into complaints and serious incidents have not always been conducted in line with trust policies.

The report also mentioned a number of positives:

  • The Board approved further investment in the workforce for inpatient services and there was an ongoing recruitment process in response to recruitment challenges.

  • The trust took action in response to enforcement action after we searched intensive care units for acute and psychiatric conditions. As a result, more effective systems for assessing and managing patient risks have been simplified and introduced within inpatient services.

  • There was good engagement with staff, governors and external partners.

  • The trust created a new committee for the Board of Directors (the People, Culture and Diversity Committee) and appointed an executive director for people and culture, to embed a more strategic approach to people and culture within the trust.

  • Employees completed annual evaluations, which included discussions about development and career advancement.

  • There have been strong regulations in place regarding the effective management of controlled and controlled drugs.

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