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Cumbria Partnership NHS Foundation Trust still ‘Requires Improvement’ says CQC report

stethoscope[T]he Care Quality Commission (CQC) has today published a report on Cumbria Partnership NHS Foundation Trust.

The trust has been rated Requires Improvement following an inspection in September and October 2017.

The six core services inspected were selected due to their previous inspection ratings or CQC’s ongoing monitoring had identified that an inspection was appropriate to understand the quality of the service being provided.

The six core services CQC inspected were:

  • Community health inpatient services
  • Community dental services
  • Wards for older people with mental health problems
  • Community based mental health services for adults of working age
  • Community based mental health services for older people
  • Specialist community mental health services for children and young people

CQC always assesses and rates services against five key questions. The trust has been rated as Requires Improvement for safe, effective, responsive and well-led and rated as Good for caring. Overall the Trust rating remains the same, Requires Improvement.

During September and October 2017 the CQC carried out unannounced inspections of six of the core services provided by CPFT.  The Trust was assessed on the following five areas overall, which were each given a separate rating:

Are services safe?                          Requires Improvement

Are services effective?                   Requires Improvement

Are services caring?                      Good

Are services responsive?               Requires Improvement

Are services well-led?                   Requires Improvement

This inspection was conducted against the backdrop of significant change including the recent appointment of a new chair and chief executive. The trust had a transitional senior leadership structure in place to reflect the close working relationship with North Cumbria University Hospitals NHS Trust.

In the safe key question, inspectors found that not all patient records were up to date and maintained. Not all staff had completed required training. Community mental health services at Whitehaven were unsafe for staff and service users, including poorly maintained pavements and paths.

For the effective key question, staff did not always record consent for treatment and, within specialist community mental health services for children and young people, care plans were not routinely placed in patient records. However, the inspection team did recognise that there was strong multi-disciplinary working between the professionals.

Long waiting times contributed to our rating of requires improvement for responsive. In particular patients waiting for dental treatment faced very long waits.

The rating of Requires Improvement for the well-led key question reflected our inspectors’ finding that the trust could not demonstrate how board members were assured about risks identified by the trust. This was because there was no clear link between the trust risk register and the Board Assurance Framework.

Caring was rated as Good, with positive feedback from relatives and patients who used services. Staff were dedicated to providing the best possible care for patients.

CQC have identified areas where Cumbria Partnership NHS Foundation Trust must improve. These include:

Community mental health services for older people

The provider did not ensure that care plans were comprehensive and up to date. Information was inaccurate and not reviewed in line with the trusts policy.

Community Dental Services

There was an excessive number of patients waiting more than 18 weeks for treatment under general anaesthesia

Wards for older people with mental health problems

The provider must ensure that informed consent to treatment and capacity to consent are clearly documented. Capacity assessments were not completed in all instances where patients lacked capacity.

Community health inpatient services

The provider must ensure that clinical risks such as, the national early warning score (NEWS) are robustly assessed, monitored and recorded and ensure all care records are up to date

Community based mental health services for older people

The provider must ensure that premises are fit for purpose or appropriately located, and ensure there are records to confirm medical equipment has been tested or recalibrated.

CQC’s Deputy Chief Inspector (and lead for mental health), Dr Paul Lelliott, said: “We are disappointed that the trust has not made more improvement since our last inspection in March 2016. This is reflected in the fact that we have once again rated it as Requires Improvement overall.

“This inspection was undertaken while the trust was undergoing major change, with new appointments at the top of the organisation. I am encouraged that the leadership team is working closely with neighbouring providers on plans to improve services to people in Cumbria.

“CQC will keep in close contact with the trust to ensure improvements are made and sustained.”

Stephen Eames, Chief Executive of Cumbria Partnership NHS Foundation Trust said: “I’m not at all surprised that the report highlights how caring and dedicated staff at CPFT are.  The inspection took place just weeks after I arrived as CEO of the Trust and while visiting staff and services I’ve been very impressed by their passion and commitment to patients. I am also pleased that the CQC noted how good the culture within the organisation is and how open and honest we are on all levels with our staff.”

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

  • Ensuring all patient records are up to date, care plans are fully completed and consent recorded
  • Improving the environment for service users at the community mental health service in Whitehaven.
  • Improving waiting times in some areas, particularly dentistry
  • Ensuring the Trust’s risk registers at Board level are aligned with the service risk registers

Stephen Eames, Chief Executive at Cumbria Partnership NHS Foundation Trust adds: “The report clearly identified the areas where significant improvements are required.  Key to this is the integration of health and care services across north and south Cumbria and the rapid development of Integrated Care Communities (ICCs).  This will enable us to align mental health services locally with the ICCs and for the more specialist services such as Child and Adolescent Mental Health Service (CAMHS) and forensic medicine, form strong partnerships with large providers in the North East and Lancashire.  The Deputy Chief Inspector of the CQC, Paul Lelliot, recognised that we were already working with neighbouring providers on plans to improve services and this is the key to services reaching a rating of good.

“I will now be driving this work forward this work and closely monitoring performance against the improvements we need to make.   I’m confident with the solid foundations we have, we can achieve a good rating within the next 12 months.”

NHS North Cumbria Clinical Commissioning Group’s Accountable Officer  / Medical Director Dr David Rogers said: “The report highlights that although the Trust has exceptionally caring and dedicated staff, there are still some areas that remain difficult to address and require a different approach. As commissioners, we are keen to see local services strengthened by greater alignment to the emerging Integrated Care Communities locally and building stronger partnerships with providers in the North East to improve the specialist services such as CAMHS.”

The services inspected include, Community Mental Health teams for adults and older adults, older adults mental health wards, Specialist Community Mental health Services for children and young people, Dental Services and Community Inpatient services.

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