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CQC report highlights improvements required for Cumbria Mental Health Inpatient Units

[A]n inspection by the CQC into mental health wards run by the Cumbria Partnership NHS Trust has found that they require improvement.

In February 2017 the CQC carried out an unannounced inspection of Mental Health Inpatient Units and Psychiatric Inpatient Care Units across the county.

Following the inspection the overall rating of Mental Health Inpatient Wards has remained as ‘Requires Improvement’, with two areas being rated as ‘Good’.

The CQC assessed the following five areas, which were each given a separate rating that led to the overall rating:

  • Are services safe?                Requires improvement
  • Are services effective?        Requires improvement
  • Are services caring?            Good
  • Are services responsive?    Good
  • Are services well-led?         Requires improvement

The report includes a series of actions that the Trust must take, which includes:

  • Ensuring that the medicine management is adequate across all wards.
  • Ensuring that patients have access to psychological therapies on all wards.
  • Improving the incident reporting system.
  • Addressing the out of hour’s medical cover available across the wards.
  • Ensuring records of consent to treatment for detained patients are undertaken.

Clare Parker, Director of Quality & Nursing at Cumbria Partnership NHS Foundation Trust said: “Despite the CQC rating remaining the same, we are incredibly proud of our staff who work within the mental health inpatient wards. They continually provide fantastic patient care through their positive approaches and show they are compassionate and kind. The Trust would like to take this opportunity to thank all staff for their commitment to continually improving our services.

“We know we still have more work to do to improve the areas highlighted in the report and will be continuing with the work already in place to address these issues and have already begun creating action plans to address other areas of improvement.

During the inspection the CQC also highlighted a number of positive findings including:

  • Staff morale was good and staff felt their managers supported them.
  • Family and carers were involved in multi-disciplinary meetings and in patients care and treatment.
  • Staff used appropriate tools to assess risk and the needs of patients.
  • Care plans were comprehensive and holistic. Staff ensured that patients’ physical health needs were being met.
  • Patients received regular one to one time with their named nurse.

Dr Andrew Brittlebank, Medical Director at Cumbria Partnership NHS Foundation Trust adds: “The CQC report highlights and recognises many positive practices and it is clear improvements have been made since the comprehensive inspection in 2015. In particular it is good to see the report acknowledging our Acute Admission pathway as an area of good practice and this is further supported by the pathway being nationally recognised. We know there are still other areas we need to improve upon and have plans in place to support this.

“Whilst we are aware we need to take action to improve out of hours’ medical cover there is no evidence to suggest this has adversely impacted on patient care. The way we provide medical cover across a large geographical area is not in the conventional way that the CQC is used to seeing and as there is no nationally agreed standard to work to.  We have already undertaken an extensive review of all of the options available to us and we have a quality summit later this month with the CQC and our commissioners to discuss how we address this.

“Due to recruitment issues and staff shortages, we have been unable to fully utilise psychological therapies. Our nurses have however been providing psychologically informed interventions via one to one sessions and we will be undertaking a quality improvement project planned to increase the psychologically informed practice across the wards.

“We have reviewed in detail why the support in place has not translated into all staff being aware of the capacity to consent within patient care and have undertaken a focus group with consultants to improve the uptake of training and manage this though clinical audit and supervision.  We are hopeful by implementing this recommendation from the CQC as priority we can address this with our staff to ensure patient assessments and treatment are as effective as possible.

“We also took immediate action on medicines management including investing in clinical pharmacy and monitoring records through clinical audit and supervision.”

Commenting on the report, Tim Farron MP said: “This report makes it clear that Kentmere ward is clean, well maintained with safe spaces for patients.  The concerns that the CQC has are around psychiatric medical cover overnight and at weekends and the incident response systems.

“During our successful campaign last year, the Partnership Trust consistently told us that the Kentmere ward wasn’t fit for purpose and was an unsafe space.  This CQC report today paints a very different picture.

“The Partnership Trust need to take immediate action to improve staffing levels on the Kentmere ward – and given the CQC’s comments, the Trust must not use this as an excuse to try and close the ward again.”

Workington MP Sue Hayman said: “For some time now, I have been concerned about mental health services in Cumbria. I’ve had a number of constituents come to see me with their concerns not only about family members having to travel out of the county for mental health treatment, but also about the treatment that they have received locally. I was interested to see in the report the comments about the capacity of out of hours care, because that is in particular an area that has been brought to my attention regularly by constituents.

“It’s very disappointing that once again the Trust has received a ‘Requires Improvement’ rating. I know that options are being explored to increase staff training. Cumbria of course has particular problems with delivering health services because of our difficult geography, but this should mean that we receive additional resources – in terms of both money and staffing – from Government to overcome this.

“This is one of the reasons I recently wrote to the Prime Minister, following her comments that she accepts that we do have problems with mental healthcare in this country, and that we need to provide better services across the country. It is all very well that she acknowledges this, but I want to know what she is actually going to do to deliver on her promise and give us the resources we need in Cumbria deliver a first class health service for everyone.

“I am glad that the report does recognise the constantly high quality of care being delivered by staff, and patients greatly appreciate this. We mustn’t go out of our way to undermine those people who are going out of their way to provide the best services they can under difficult circumstances.”

The full report will be available on the CQC website on Thursday 20th July.

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