Birmingham and Solihull Mental Health services 'require improvement' for patient safety, says CQC
Birmingham and Solihull Mental Health NHS Foundation Trust has been rated as "requires improvement" following its latest inspection.
In the new Care Quality Commission (CQC) report, the trust’s overall rating for caring and responsive remained as good, while safe, effective and well-led remained as requires improvement.
Its overall status remains "requires improvement" - the same as the last CQC report.
The inspection, as part of the CQC’s continual checks on the safety and quality of healthcare services, was carried out in October, November and December.
The team visited five mental health services: acute wards for adults of working age and psychiatric intensive care units, mental health crisis services and health-based places of safety, rehabilitation services, wards for older people with mental health problems and forensic inpatient or secure wards.
Following the inspection, a warning was issued to the trust to focus its attention on rapidly improving to keep people safe due to concerns found within the acute wards for adults of working age.
What did inspectors find?
In three of the five services, staff were not complying with mandatory training in immediate life support and safeguarding.
A lack of activities were available for patients on most wards.
Access to support for patients from occupational therapists and psychologists was low on most wards.
Risk management plans did not always detail how identified patient risks were to be managed. Not all patients that needed them had risk assessments in place.
Some staff said they did not know who their leader was because of the lack of visits to the services.
What did inspectors praise?
CQC inspectors said staff followed best practice in anticipating, de-escalating, and managing challenging behaviour.
Most ward environments were clean, well-maintained, and fit for purpose, however, there were some concerns about the environments at Reaside, and the Caffra seclusion suite.
The trust was developing the presence of the patient voice at board level, and whilst leaders acknowledged improvements were needed in this area, there was a clear strategic aim to get this right, according to the CQC.
The report found staff managed discharge well and had a thorough planning system from an early stage and made clear plans with patients.
Patients had good access to services and waiting times were in line with trust policy.
"Staff treated patients with compassion and kindness"
Lorraine Tedeschini, CQC director of operations in the Midlands, said: "When we inspected Birmingham and Solihull Mental Health NHS Foundation Trust, we found improvements were needed in several areas to ensure people’s safety.
"Understaffing was a big concern, and while many NHS services and those in the wider care sector face staffing challenges, the trust must find ways to minimise the risk this poses to people in its care.
"We found some shifts where there weren’t enough qualified nurses on duty, as well as low levels of staff supervision across some services meaning staff weren’t getting the appropriate support to deliver safe care.
"This understaffing issue had a direct effect on people’s care and well-being and resulted in a lack of activities being available for people on most wards. People’s access to support from occupational therapists and psychologists was also low on most wards.
"However, since our last inspection the trust has appointed a new chief executive and a new board has been formed which is developing a clear strategy and vision, with leaders who are passionate about positive change and improvement.
"Despite understaffing issues, staff must be commended for treating people with compassion and kindness and understanding their individual needs.
"We will continue to monitor the trust and will return to check if the necessary improvements have been made. If we find this is not happening, we will not hesitate to take further action to keep people safe."
A spokesperson for Birmingham and Solihull Mental Health NHS Foundation Trust said: "We accept the findings of the CQC Report and, whilst we have made some progress in addressing the issues raised, we recognise that we have further work to do in order that we can continually provide the best possible care for our service users.
"It was encouraging that the CQC mentioned that our staff treated patients with compassion and kindness and understood the individual needs of patients, that staff actively involved patients and families and carers in care decisions and that they followed best practice in anticipating, de-escalating and managing challenging behaviour. “