North East mental health trust recruits 80 more care staff after CQC deems services 'inadequate'

A North East Mental Health Trust has pledged to spend £3.6 million on recruiting 80 more care staff after its services were found to be inadequate by the Care Quality Commission.

As ITV News Tyne Tees revealed on March 19, the CQC decided on enforcement action after visiting five psychiatric intensive care units at the Tees, Esk and Wear Valleys NHS Foundation Trust in January.

The CQC said it was concerned patients were being put at risk in three of the hospitals, and inspectors downgraded services to 'inadequate' at:

• West Park in Darlington

• Roseberry Park in Middlesbrough

• Cross Lane Hospital in Scarborough

A full report into those inspections, which were carried out across three hospital sites, has been published. 

CQC’s head of hospital inspection for the north (mental health and community health services), Brian Cranna, said: 

“During our inspection of Tees, Esk and Wear Valleys NHS Foundation Trust’s acute wards and psychiatric intensive care unit service, we found concerns that urgently needed addressing. 

“We found these five wards were providing a service where risks were not assessed effectively or managed well enough to keep people safe from harm. In particular, staff did not fully understand the complex risk assessment process and what was expected of them. The lack of robust documentation put people at direct risk of harm, as staff did not have access to the information they needed to provide safe care.

“It was also concerning that governance systems had not ensured staff understood when and how to observe and engage with people who used the service, and that leaders had not taken action to ensure staff were supported to keep people safe. 

“The trust know what improvements must be made and we continue to monitor the service closely and will return to check on their progress.” 

CQC findings from the inspection included: 

• Staff did not assess and manage risks to patients well or use a system that was robust enough to assess patient risk effectively.

   

• Inspectors saw three different meetings in place where patient risk was discussed between the multi-disciplinary team and the nursing team. However, inspectors found that the information in handovers and risk documentation did not match for 11 of the 16 patients that were reviewed.

• The trust governance systems failed to ensure that staff understood and complied with the trust’s observation and engagement policy to maintain patient safety. The observation and engagement audit that was in place at the time of the inspection did not ensure that hourly checks were being completed for patients on general observations, or that night-time observation plans were in place for patients.

• The wards did not have a good track record on safety, and the service did not manage patient safety information well. Incidents were not always discussed in order to learn from them and reduce future risks. In particular staff were unable to describe any communication from leaders to alert them to areas of risk following a recent serious incident. Although some staff were aware of the incident, not all staff could describe any changes to practice as a result of learning from this.

• Leaders had failed to ensure that staff knew what was expected of them when assessing and documenting patient risk. Staff told inspectors they didn’t have the training they needed to help them carry out this part of their role. 

The Trust was told to make several improvements including: 

• Ensuring they have systems and processes in place to effectively assess, monitor and mitigate the risks relating to the health, safety and welfare of service users.

• Have an effective procedure and process in place to review and learn from serious incidents.

• Make sure all staff receive the appropriate training to carry out patient risk assessments appropriately and consistently.

• Ensuring staff understand and comply with the trust’s observation and engagement policy required to maintain patient safety.

In response to the Care Quality Commission's inspection report, Trust Chief Executive Brent Kilmurray said: "We fully accept the issues raised in the report and have taken immediate action. As a result, we already have a better environment for patients on our wards. 

"We have also provided assurance to the Care Quality Commission (CQC) that effective systems are in place in our wards and that further improvements will be made across our services, with work already underway. 

"The report has rightly highlighted issues we had already identified as needing improvement and we were already working to address them. A huge amount of work has taken place since the CQC visited our inpatient wards in January and we're continuing to make improvements for the benefit of our patients and staff.  

"To support that, we will be spending £3.6 million on recruiting 80 more care staff across our inpatient wards. We are also making significant investment in technology that will free our people to spend more time on patient care." 

The Trust said it accepted a need for greater clarity, improved processes and training, and better communication so its staff can deliver patient risk assessments appropriately and consistently.