Brighton and Hove’s mental health trust needs to improve, say inspectors

Posted On 29 May 2015 at 2:28 pm

The mental health trust that serves Brighton and Hove “requires improvement”, according to the Care Quality Commission.

The official watchdog gave its verdict this week after carrying out an inspection earlier this year on the trust which runs Mill View, in Hove, among many other services.

The CQC said: “Overall, we rated the trust as requires improvement and this was because

  • Two core services were rated as inadequate under safe
  • The trust had no plan in place to tackle the high rate of suicide
  • There were significant gaps in the flow of information, particularly around learning from serious untoward incidents
  • There were significant gaps in training, appraisal and supervision for some staff
  • The quality of care planning was inconsistent and did not always demonstrate how people were involved in their care
  • The trust lacked strategic direction
  • The trust had gaps in relation to providing the board with assurance

“However, caring in some areas was rated as outstanding and the trust is a place of innovation and ideas.

“It also clearly aspires to best practice in many parts of the services provided.

“There were inconsistencies in how services were managed and we found that some areas of care in learning disability and older people’s inpatient services were inadequate.

“These services require urgent attention to bring them up to acceptable standards of safety.

“We asked the trust to close Hanover Crescent (part of their rehabilitation services) to admissions due to an unsafe environment, with poor conditions of hygiene and low levels of staffing.

“The trust did this immediately.

“It was clear that the trust recognised that some areas are facing particular challenges and we found the managers and directors of the service were responsive to our challenge and acted swiftly to put things right.

“We have recommended a number of requirement notices to be put into force and these relate to ensuring that

  • standards of hygiene are maintained
  • staff are properly supported to receive their mandatory training
  • risks are properly identified
  • care plans involve people
  • “There was an elevated risk of people self-harming or committing suicide. Many of these deaths happened while people were in receipt of services in the community.

“There was an elevated risk of suicide within three days of discharge and within three days of being admitted to an acute setting.

“In total there were 80 deaths in the period from 1 November to 31 October 2014.

“While we recognise that it is not just the trust’s responsibility to develop a suicide prevention plan, we would urge the trust to initiate urgent work with public health and community agencies to address this.

“We were concerned that staff were not receiving timely feedback in relation to serious untoward incidents.

“We therefore asked the trust to supply us with details of length of time it took from notification of a serious untoward incident to time the report and action was completed and circulated.

“From the data supplied to us from the trust, it is struggling to meet timescales, with some investigations taking 220 days from start to finish.

“This may impact on their ability to close the loop on serious incidents and ensure that learning to avoid / prevent similar incidents from emerging is shared.

“The current average time taken to complete reports of serious untoward incidents is about four months.

“The trust must work to address this.

“The staff survey identified that there was an elevated risk to staff working extra hours and feeling stressed.

“The trust has a clear action plan to address this. This includes reviewing the staffing levels and skills mix on inpatient units and reviewing the use of three-day 12½ hours shift rotas.

“At the time of the inspection, the trust acknowledged that there was not a system in place to identify clearly where ‘agency’ staff were used.

“The trust raised this with CQC prior to the inspection.

“Overall, caring was rated as good, achieving outstanding in community child and adolescent services and forensic services.

“This was because staff were found to be compassionate, kind and motivated to go an extra mile for the people they served.

“We also found good solid evidence that the trust was sensitive to individual needs, taking cultural, religious and spiritual needs into account.

“They also provided good information to people and this was available in a variety of languages and formats.

“The trust is a place where innovation is given priority and this enables them to seek new ways of working and bring about change to service delivery.

“There is much creativity at a senior level. We would urge the trust to continue to ensure that the quality of more traditional services is maintained and that the desire to seek new and innovative ways of working is not at the expense of those services.

“The senior management team were very positive about the new Chief Executive Officer (CEO).

“They felt that having been through a difficult and challenging period that the culture of the board had changed for the better.

“We found the senior team to be open and transparent in their discussions with us. The CEO was able to describe the challenges facing Sussex.

“It was clear that the trust were in a period of some significant change, including a cultural change.

“We heard from staff and stakeholders that relationships with the trust had been difficult to manage at times but that this was becoming more positive.

“Many felt that the new CEO was responsible for bringing in a more visible and open approach.

“The trust did not have a clear strategic direction that was written down and understood by staff.

“The trust also lacked a framework to ensure that the board were clear about and understood the more detailed risks and challenges facing the organisation. It had identified the principal risks faced by the organisation.”

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