The health watchdog has issued Avon and Wiltshire Mental Health Partnership NHS Trust with a warning notice after concerns about safety and treatment on some of its wards. The Care Quality Commission (CQC) served the trust the notice following unannounced inspections.
Following the inspections in January, this week the acute wards for adults and psychiatric intensive care units were rated as 'requires improvement'. It is the same rating that was given during the watchdog's last inspection of the services, and the trust says it is "committed to quickly achieving the CQC’s requirements".
Staff shortages, long and complex caseloads and gaps in training were identified this time as reasons for the trust’s failure to ensure adequate safety of patients, with the question 'are services safe?' given the lowest rating of 'inadequate' in the new report. The overall rating was 'requires improvement'.
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A statement from the CQC said: "Following the inspection we issued a Warning Notice under Section 29A of the Health and Social Care Act 2008 due to our concerns that patients on the acute inpatient wards were not receiving safe care and treatment under regulations 12 and 17 of the Health and Social Care Act 2008 (regulated activities).The trust responded to the warning notice with an action plan and timeframes to address the issues and improve the safety of care."
Specialist community mental health services for children and young people in North Bristol and North Somerset were not considered to be safe or clean. Older adults were not seen to be treated with respect and dignity by staff when entering their rooms or interacting with them during an activity, inspectors said.
However the CQC report also outlines that a good level of care was seen in the trust’s long stay units for the long stay and rehabilitation mental health wards for working-age adults. Serena Coleman, CQC deputy director of operations in the south of England, said: “While we found care on the trust’s long stay wards met standards people have a right to expect, people’s safety wasn’t always being ensured on the acute wards and psychiatric intensive care units.
"The acute wards faced significant pressure due to staffing shortages, which meant observations weren’t always undertaken often enough. This was worsened by some poor record management, and environments that didn’t always support people’s safety.
"While staffing challenges are affecting much of the NHS, leaders must ensure this doesn’t undermine people’s safety. We’ve issued the trust with a warning notice, so it’s clear about the improvements it must make in these areas.
“Despite the pressure they were under, staff created a positive culture, collaborating well together to support people’s best interests. Care and treatment of people on the long-stay or rehabilitation wards continued to meet good standards overall.
"Risks were well managed, and the service had enough staff to ensure people’s safety. However, there were gaps in staff training, including to support people whose distress presented risk to themselves and others. Although managers told us they are addressing this.
“We reported our findings to the trust so it knows where it must make improvements, and where there’s good practice on which it can build. We’re monitoring the trust closely to ensure people’s safety, and we’ll return to assess whether improvements have been made.”
According to the CQC, the trust provides eight wards for older people with mental health problems across five sites - Aspen ward at Callington Road hospital, Cove and Dune wards at Long Fox Unit, Amblescroft North and South wards at Fountain Way hospital, Liddington and Hodson wards at Victoria Centre, and ward 4 at St Martin’s hospital.
During the inspection the CQC visited all five sites and seven wards - Amblescroft South and North, Aspen ward, Cove and Dune wards, ward 4 (St Martin's Hospital) and Hodson ward. It said the inspections were prompted "because we received information giving us concerns about the safety and quality of the services".
Trust's response
In response to the Care Quality Commission's (CQC) report, Dominic Hardisty, Chief Executive at Avon and Wiltshire Mental Health Partnership NHS Trust, said: “While we are pleased to receive an overall 'Good' rating across our rehabilitation wards, we are disappointed that the care in our adult inpatient wards did not meet the high standards that our patients deserve.
"Safety will always be our top priority and we are committed to quickly achieving CQC’s requirements. Immediate action was taken to update our Quality Improvement Plans and significant progress has already been made to improve care."
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