During October 2017 the Care Quality Commission (CQC) inspected five core Leicestershire Partnership NHS Trust (LPT) service areas* previously rated by them as either inadequate or requires improvement. We are pleased to say that this inspection removed all ‘inadequate’ ratings and showed improvements in numerous areas. We received a ‘good’ rating for community health services for adults and a ‘requires improvement’ rating for the core mental health services inspected. Overall, the Trust was rated as ‘requires improvement’ for safe, effective, responsive and well led and ‘good’ for caring.
Dr Peter Miller, Chief Executive of LPT said: “We are pleased that our ratings are moving in the right direction and we have much to be proud of. Although our overall rating remains the same it is great to see no more ‘inadequate’ ratings; ten ratings have moved up, six of which have moved up to ‘good’. This is credit to our caring, committed staff, who have worked hard since the CQC’s previous inspection in November 2016, during what has been a financially challenging year. I am proud that the report highlights our staff are ‘kind, caring and respectful towards patients’, and that ‘most patients spoke positively about their care’.
“We are pleased to see overall ratings go up to ‘good’ in our community health services for adults. I particularly welcome the fact that the inspectors have recognised improvements in our specialist community mental health services for children and young people, and the strengthened monitoring of waiting lists, as they have improved the previous ‘inadequate’ rating for their safety and responsiveness. We continue to work through our improvement plans.
“The inspection team welcomed the introduction of our new all-age mental health based place of safety and the report recognises improvements in the safety in our wards; we would have liked to see an improved rating that reflected this investment. We were however pleased to see improved ratings for several areas, and positive feedback for our application of the Mental Health Act. We are committed to going much further than this and have begun a five-year transformation programme for our mental health and learning disability services.
“I am disappointed that the well-led review of LPT concluded with a ‘requires improvement’ rating, particularly as inspectors had noted improvements in our leadership approach, for our organisational shared vision and values, and that staff reported feeling supported by senior managers.
“In summary, I am pleased that our ratings are moving in the right direction and thank our staff for the progress we have made so far to transform the way we deliver services. We are committed to this improvement journey, and to providing the best quality care for our patients, service users and their families.”
*The services inspected were:
- Acute wards for adults of working age and psychiatric intensive care units
- Community-based mental health services for adults of working age
- Mental health crisis services and health-based places of safety
- Specialist community mental health services for children and young people
- Community Health services for adults.
The other 10 core services were not inspected during this inspection because they were not assessed as high risk or they were rated as good in the November 2016 inspection.
The CQC reported these positive findings:
- The inspectors found that we had addressed the issues regarding the health based place of safety identified in the previous inspection.
- The process for monitoring patients on the waiting list in specialist community mental health services for children and young people had been strengthened
- Care planning had improved, particularly in the crisis service.
- There was an effective incident reporting process which investigated and identified lessons from incidents which were shared in most teams.
- There is ‘effective multi-disciplinary working’ between staff teams
- Patients and carers knew how to complain and complaints were investigated and lessons identified.
- Staff were kind, caring and respectful towards patients. Most patients spoke positively about their care and said they were involved. Patients had access to advocacy.
Areas identified for improvement:
- Some maintenance and sound proofing issues in some environments
- Issues with staffing levels in some community teams, however the CQC noted that ‘the trust tried to book regular bank and agency staff to provide continuity of care’. We are not alone in the current national recruitment shortage for nursing staff and have recently strengthened our recruitment and retention strategy.
- Some medicines management issues
- High caseloads in community teams, although it was recognised that this is high on the Trust’s risk register and plans are in place to manage this.
- Some care plans did not record patient involvement adequately, however the CQC noted that ‘most patients spoke positively about their care and said they were involved’.
- Not all staff record their clinical supervision
- There are two and four bedroom dormitories in mental health wards which is not ideal, however we require significant investment to change these environments.
- Some data quality issues were identified, however the CQC noted that ‘the trust was aware of the issues in relation to waits and data quality and was working towards addressing them’.
- Improved rating of ‘good’ for community health services for adults. The report highlights that ‘Patients were protected from avoidable harm and abuse, systems were in place to investigate incidents and concerns and staff received suitable training in safety systems.’
Our evidence based best practice, and the support, dignity and respect we show our patients, planning our services around local needs, were all commended.
Given the previous inadequate rating on safety and responsiveness for our CAMHS community service, we were pleased to read: ‘The process for monitoring young people on the waiting list had been strengthened since the last inspection. The service met the target for seeing referrals within 13 weeks of referral. There were no patients waiting for more than a year which was an improvement since the last inspection.’ This is credit to the hard working team who continue to transform the effectiveness of this service.