Leicestershire Partnership NHS Trust is on an ongoing improvement journey to ensure the services it provides are of the very highest quality.

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1 CQC findings explained: staff briefing sheet Background Leicestershire Partnership NHS Trust is on an ongoing improvement journey to ensure the services it provides are of the very highest quality. On the week commencing 9 th March 2015 the Trust was inspected by the Care Quality Commission (CQC) using the new Chief Inspector of Hospitals methodology. These new style CQC visits are designed to look in depth at NHS Trusts in order to best understand the effectiveness of current systems and processes in ensuring the delivery of services which are safe, effective, caring, responsive to people s needs and well led. Our rating: The CQC has rated LPT overall as requires improvement This rating is made up of assessment against the five CQC domains, for which the colours indicate red (inadequate), amber (requires improvement) and green (good): Safe: Are people protected from abuse and avoidable harm? Effective: Does people s care and treatment achieve good outcomes and promote good quality of life and is it evidence based where possible? Caring: Do staff involve and treat people with compassion, kindness, dignity and respect? Responsive: Are services organised so that they meet people s needs? Well-led: Does the leadership, management and governance of the Trust assure the delivery of high quality, person-centred care, support learning and innovation and promote an open and fair culture? Ratings at a glance (continued overleaf) Specialist Community Health Services for Children and Young people Community based Mental Health Services for Adults of Working Age Child and Adolescent Mental Health Wards Safe: Effective: Caring: Responsive: Well-Led: Overall:

2 Community Mental Health Service for People with Learning Disabilities or Autism Community based Mental Health Services for Older People Mental Health Crisis Services and Health based places of safety Long stay/rehabilitation Mental Health wards for working age adults Specialist Services Community based Substance Misuse Services for Adults of Working Age Acute Mental Health Wards for Adults of Working Age and Psychiatric Intensive Care Units Wards for Older People with Mental Health Problems Community End of Life Care Community Health Inpatient Services Community Health Services for Adults Forensic Mental Health Inpatient/Secure Wards Wards for People with Learning Disabilities or Autism Community Health Services for Children, Young People and Families LPT Overall Provider Report RED Inadequate AMBER Requires Improvement Green - Good

3 Areas identified as good Staff want to provide high quality care, despite the challenges of staffing levels and some poor ward environments. The CQC observed some very positive examples of staff providing emotional support to people. Good multidisciplinary working and generally people s needs, including physical health needs, were assessed and care and treatment was planned to meet them. Procedures for incident management and safeguarding were in place and well used. Most people said they were involved in decisions about their care and treatment and that they and their relatives received the support that they needed. There were some very good examples of care plans being personcentred. However, not all care plans indicated the involvement of the service user. Patients were well supported during admission to wards and the CQC found a range of information was available for service users regarding their care and treatment. A user engagement strategy is in place which sets out the Trust s commitment to working in partnership with service users. There are a number of initiatives to engage more effectively with users and carers. Results from the Friends and Family Test indicated a good level of satisfaction with the service (91%). Advocacy services are available and promoted. Areas identified for improvement a brief summary from the overarching report (please see breakdown report for your service area for more detail relevant to you). Not all services were safe, effective or responsive, and the Board needs to take urgent action to address areas of improvement. You may already be aware of some of the immediate actions being taken as a result of the initial feedback. For example, for ligature risks, detailed risk assessments are being reviewed to ensure they fully resolve the concerns identified. We will be

4 working to support staff in continuing to contribute towards the delivery of the action required to address areas for improvement over the next few weeks. The CQC have also highlighted safer staffing levels, again an area we have worked hard to improve and where we are confident that we have robust risk management plans in place, whilst we fully implement our agreed recruitment strategy. Disappointingly, the CQC have said that we have failed to ensure all the improvements at the Bradgate Unit following compliance actions in Whilst we are aware there is more work to do, we know that all staff have worked hard and made significant progress over the last 18 months. We are confident that we can use this as an opportunity to learn from and share the significant good practice the CQC have identified through their report, as we continue to work with our staff, patients, carers and partners to provide the very best mental and community health services for the communities of Leicester, Leicestershire and Rutland. While the Board and senior management had a vision with strategic objectives in place, staff did not feel fully engaged in the improvement agenda of the Trust. We have worked hard over the last year on improving our staff engagement. Our most recent staff survey shows that there has been a rise in the number of staff feeling engaged. Our vision and strategic objectives have been renewed over the last year and this will take time for our staff to connect with across all of our 120 plus sites. We have introduced a Listening into Action engagement programme, which encourages staff to engage with and actively participate in our improvement agenda, working together to find solutions. This is an ongoing programme, but staff who have been involved so far have been overwhelmingly positive. We have also invested in a leadership programme for staff across the Trust, again, supporting them to lead change and connect other staff with our vision and values. Finally, we have introduced new monthly staff awards scheme (The Valued Star award) linked to our values. We are proud that our values of trust, respect, integrity and compassion have shone through as we are recognised as a caring organisation. You are the Trust s greatest asset and we are confident that together we will continue to build on our strengths and achievements, and make the improvements identified by the CQC. The Trust Board and the senior management team are committed to ensuring that each and every one of you can play an active part in contributing towards our improvement journey. Further Listening into Action events and local meetings will be held to work over the action plans and continue to connect our staff into the Trust s values and vision. Over the next few weeks the executive team and Board members will come out and

5 about to see some of you, and a range of interactive briefing sessions will also be held. The first Ask the Boss online forum on esource (Tuesday 14 th July from 1-2pm) will provide a further opportunity for you to offer your ideas on improvements and engagement. Morale was found to be poor in some areas and some staff told us that they did not feel engaged by the Trust. There is nothing more important to the Board and Executive team than listening to the views of our staff and service users. A Trust of our size, covering such a large population and area, will always have areas where staff feel more or less engaged. However because of their commitment to listening to our staff, the Trust Board have introduced many new initiatives over the last year. This is reflected in our latest staff survey results which show that there has been an improvement in the proportion of staff feeling engaged. Our staff are our greatest asset, and it is very important to ensure that you feel recognised and valued for your efforts, and this will continue to be a high priority on our improvement journey. We found that while performance improvement tools and governance structures were in place these had not always brought about improvement to practices. We know that we need to get better at learning from our lessons and will be reviewing our processes to improve this. We are pleased however that the CQC acknowledged that the trust has systems in place to report and investigate incidents, and that staff felt confident that they could report any concerns and these would result in learning and changes to practice. We had a number of concerns about the safety of this Trust. These included unsafe environments that did not promote the dignity of patients; insufficient staffing levels to safely meet patient s needs; inadequate arrangements for medication management; concerns regarding seclusion and restraint practice: insufficient clinical risk management. Our chief executive, Dr Peter Miller, is quoted in the media release issued on 10 July as follows: I am proud that the CQC have recognised the commitment and care of our staff. Most people that spoke with the CQC said that they were involved in decisions about their care and treatment and that they and their relatives received the support that they needed. I am pleased that the CQC have said they observed some very good examples of practice and received positive feedback from patients and carers.

6 We recognise that there are a number of areas where we need to improve and have already taken some immediate actions to address these such as those related to medicines management and recruitment of physical health staff in adult mental health. Detailed risk assessments are being reviewed to ensure they fully resolve the concerns identified. We will be working towards the delivery of the action plans required to address areas for improvement over the next few weeks, with the support of our commissioners and partners. The CQC have also highlighted safer staffing levels, again an area we have worked hard to improve and where we are confident that we have robust risk management plans in place, whilst we fully implement our agreed recruitment strategy. It has been acknowledged that nursing shortages is a national problem. However, we have begun looking at new and creative ways to address this. Disappointingly, the CQC have said that we have not made all the improvements at the Bradgate Unit following compliance actions in Whilst we are aware there is more work to do, we know that our staff have worked hard and made significant progress over the last 18 months. We also know that the CQC report reflects that people who use inpatient services said they generally felt safe and supported. Finally the CQC have reported on how we have more demand on some of our services than we have capacity to deliver. We know that long waiting times are not acceptable and we are committed to addressing this with support from our commissioners. Over the last 18 months we ve made significant progress on our own improvement journey, by increasing staffing levels, changing the skill mix in nursing staff, increasing the number of therapists, and investing in leaders across the Trust. We want to build on the significant positive feedback received from patients about their experience of our services to ensure our care continues to be as safe as possible. Safer staffing more detail: We acknowledge that we have had problems with recruiting permanent staff in various areas; nursing staff shortages are a problem being faced by NHS Trusts across the country. We have been working hard to address this, introducing a rolling programme of recruitment, open days and new training posts. This has begun to lead to an increase in posts offered. However, staffing levels remain a concern for us, and we have robust action plan in place. We are also looking at different ways of delivering services using a wider variety of staff roles such as assistant practitioners and health care assistants. The Board has recently signed off a new recruitment strategy to help us address this further. We were concerned that information management systems did not always ensure the safe management of people s risks and needs.

7 We have been open and honest with the CQC that our IT systems are not where we want them to be. There are currently various information management systems for patient records which we are working towards streamlining and connecting. However, this will take time and investment to put right. Detailed risk assessments are being reviewed to ensure they fully resolve the concerns identified. We will be working towards the delivery of the action plans required to address areas for improvement over the next few weeks, with the support of our commissioners and partners. Some staff had not received their mandatory training, supervision or appraisal. Investing in the development of our staff, and in turn the quality of care they provide, is a key objective of our Trust. Mandatory training is regularly monitored and reported on across the Trust, reporting into our workforce steering group. Where this is seen to be an issue, we have processes in place to trigger reminders and escalate to managers in a supportive manner. A comprehensive performance and development review process is also in place that uses the same system. We have recently linked training and performance to pay progression as an added incentive to ensure that our staff are up to date on their training and meet the objectives they are set. We acknowledge that levels of mandatory training in life support need improvement across the Trust and will be reviewing our action plans to support staff to ensure all relevant training is undertaken in a timely manner. We would encourage staff now to get booked onto any mandatory training that they are not up to date with. We would also welcome staff suggestions and conversations around how we can improve how lessons are learnt from incidents and how they are embedded into practice. A lack of availability of beds meant that people did not always receive the right care at the right time and sometimes people were moved, discharged early or managed within an inappropriate service. The CQC have reported on how we have more demand on some of our services than we have capacity to deliver. We know that long waiting times are not acceptable, and we are committed to addressing this with support from our commissioners. For example, we have recently opened up a new facility for those experiencing a mental health crisis called Box Tree Farm. Previously, there was a risk that a person experiencing a mental health crisis would be admitted to hospital because there wasn t a suitable alternative. Box Tree Farm now provides an alternative to hospital. The new service aims to prevent unnecessary hospital admissions which, in turn, will

8 help ensure that there is availability in a local hospital for someone who really needs the care that is offered in an inpatient setting and so, lessen the demand for beds outside of Leicester, Leicestershire and Rutland. It will also extend choice in nonclinical settings. We want to help people get into recovery as soon as possible. By improving the way our community mental health teams work, we want to reduce a patient s time in hospital and support more people with mental illness in the community. This means improving support around recovery and resilience (staying well), through appropriate, quality, and efficient care as soon and as quickly as possible. We were concerned that the Trust was not meeting all of its obligations under the Mental Health Act. We recognise that there are a number of areas where we need to improve and have already taken some immediate actions to address these. Detailed risk assessments are being reviewed to ensure they fully resolve the concerns identified. We will be working towards the delivery of the action plans required to address areas for improvement over the next few weeks, which will be monitored through the governance structure. We have already taken action with: immediate strengthening of mental health act scrutiny process positive and pro-active care initiatives improvement in seclusion monitoring urgent focus on improving the safety of environment (ligature points and seclusion). Safety in Child and Adolescent Mental Health Service - CAMHS The safety of our vulnerable children and young people is paramount in everything we do. We acknowledge that there are improvements to be made, and have recently undertaken a review of the service as well. We are however pleased that the service provided has been assessed as caring, as the views of our young service users and their carers are always sought. We are also pleased that our staff training around safeguarding has been recognised, as have our assessment processes. The CQC have highlighted that staffing levels have not been increased in line with an increase in admissions. This is disappointing as we regularly monitor that we have safe staffing levels in place. In fact, we are currently overstaffing our inpatient unit in case of crisis emergencies. We would welcome the support of our commissioners in addressing the increasing demand on the service. For example, we are putting together a case for commissioners to fund a new children s crisis service as our

9 current service would greatly benefit from this extra support to keep young patients closer to home.