Midlands Partnership University NHS Foundation Trust

Updated 26 January 2024

Our rating of the trust stayed the same. We rated it as good because:

• We rated safe, caring, responsive and well-led as good. We rated effective as requires improvement. Our rating for the trust took into account the previous ratings of services not inspected this time. In this case that included the historic South Staffordshire and Shropshire Healthcare NHS Foundation Trust mental health services.
• Our decisions on the overall ratings consider factors including the relative size of services and we used our professional judgement to reach a fair and balanced rating.
• We rated well-led at the trust level as good. The trust had a strong and experienced leadership team, supported by efficient reporting and governance structures. Non-executive directors and the council of governors were very active in providing independent oversight of the executive team.
• Managers had successfully managed the merger of community services into the trust in June 2018. Integration of physical health and mental health services was having a positive impact on patient care. However, some services still required support to be fully integrated into the systems and culture of the trust. This was recognised in a post-merger action plan.
• Overall, clinical services were safe and effectively safeguarded patients from harm. Risk assessments were completed and update regularly within most services visited.
• In most areas care planning was personalised and holistic reflecting input from the patient or their carers. There was effective multi-disciplinary team working across the trust both within and between individual care teams.
• Physical health care needs were effectively addressed within the core mental health services.
• Staff ensured the rights of patients detained under the Mental Health Act. The trust closely monitored its use of the act and fulfilled its obligation under the Code of Practice. There was good practice in the use of the Mental Capacity Act and staff offered support to patients to make their own decision where possible.
• Staff were caring, and we heard overwhelmingly positive feedback about their professionalism and respect for the dignity and privacy of patients.
• With few exceptions, access to services was responsive; there was effective bed management in the mental health wards and timely responses to mental health problems in the community.
• The recovery college supported patients and staff with mental health problems overcome stigma and social exclusion. Led by current and ex mental health service users the college received very positive feedback about the skills and life lessons they had learned.

However:

• Managers could not provide assurance around the safety of care in the urgent care services. We found that the urgent care services had not been effectively integrated into the otherwise robust governance systems we found within the trust. This left us with concerns about the reporting and recording of incidents within the service.
• Staff left patients potentially at risk in the urgent care services. There was no triage system to determine the priority given to patients attending the two urgent care services. The time of clinical assessment of a patient had been determined by their time of arrival rather than need. The trust did promptly address this and institute a triage system within two working days.
• Although on a recovery journey, there were still concerns about the responsiveness and capacity to meet patient’s needs within the Shropshire, Telford and Wrekin child and adolescent community mental health services.
• Managers had not supported staff through regular clinical supervision in some areas. There was no central recording of supervision to allow care group managers to monitor this.
• Staff had not dealt with complaints received by the community health services in a timely manner. Managers were making changes in the way complaints were investigated to address this.
• Some clinical areas did not have the space or facilities to ensure confidentiality, good hand hygiene and lacked capacity to meet demand for appointments.
• Staff did not always have access to accessible information for patients or communication aids to support care delivery.

Updated 5 July 2019

We rated the service as good because:

• The leadership team helped keep people safe from avoidable harm and provided the right care and treatment, by planning for enough nursing staff with the right qualifications, skills, training and experience.
• Staff were provided with mandatory training in key skills. Compliance was good, and education, training and development was promoted, supported and embedded.
• The team provided care and treatment based on national guidance and could evidence of its effectiveness. Managers monitored and checked practice to make sure staff followed guidance. Staff consulted and adhered to National Institute for Health and Care Excellence guidelines which meant patients received evidence-based care.
• Staff of different disciplines worked together as a team to benefit patients. GP’s, nurses and other key professionals worked together to provide good care. Joint working and collaboration with external stakeholders were embedded in the work carried out to support patients and their families.
• Staff consistently cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness. Staff provided emotional support to patients to minimise their distress.
• Staff involved patients and those close to them in decisions about their care and treatment.
• Staff took account of patients’ individual needs. Interpreters were available for patients who did not speak English. Patients, carers and staff could access specialist services, for example, mental health teams for support.
• People could access the service in a timely manner. Staff responded to referrals to treatment promptly and in line with good practice.
• Managers had the right skills and abilities to run a service providing sustainable care. Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
• The trust was committed to improving services by learning from when things went well and when they went wrong. They promoted learning and professional development.

However:

• Staff did not always use control measures to prevent the spread of infection. For example, being appropriately bare below the elbow and removing painted nails.
• Staff within a minority of teams did not always complete risk assessments for each patient. Records did not always contain complete risk information to ensure staff could access appropriate risk information at the right time.
• The quality of documented patient records was variable. They were not always clear, up-to date and available to all staff providing care.

Updated 5 July 2019

We rated it as good because:

• We rated safe, effective, caring, responsive and well-led as good.
• There were sufficient numbers of suitably qualified staff to provide safe treatment for patients. Staff were encouraged to compete mandatory training relevant to their roles. Mandatory training rates were good, and these were actively monitored by managers.
• There was good use of skill mix within the service including that of dental hygiene therapists and dental nurses with extended duties. There was a proactive approach towards multidisciplinary working, these included the trust’s learning disability team with whom they had a good working relationship.
• Premises were clean and hygienic and used dental instruments were decontaminated and sterilised in line with nationally recognised guidance.
• There were systems in place to protect patients from abuse or neglect. The service had a good safety record and there were systems in place to reduce the likelihood of never events occurring.
• Staff were aware of the importance of obtaining informed consent prior to treatment. They had a good awareness of their responsibilities under the Mental Capacity Act 2005 and the principals of Gillick competence.
• Patients were treated with dignity and respect. Patients told us that staff were friendly, amazing, cheerful and fantastic. Staff took time to help patients who needed extra support such as those with learning disabilities, mental health problems and patients who suffer from dental phobia.
• The service took into account patients’ needs. All clinics we visited were fully accessible for wheelchair users or those with limited mobility. Translation services were available for patients who did not have English as a first language.
• The appointment system met patients’ needs and there were arrangements for patients requiring emergency treatment both in and outside normal working hours. Waiting times for initial assessment and treatment were generally good.
• There was a clear vision and strategy for the service and there were plans in place of how to achieve these. Staff morale was generally good across the service. There were effective governance arrangements in place. Staff engaged with patients, other healthcare professionals and external stakeholders in order to continually improve the service.

However:

• We found some out of date adrenaline in the emergency drug kit at one clinic. This had not been identified or disposed of by the process in place for checking the medical emergency drugs.
• Glucagon was not stored in a temperature-controlled environment and the expiry dates had not been changed to reflect this.
• At two clinics which we visited there were no size 4 oropharyngeal airways.
• At one clinic we visited the aspirin was not of the dispersible form as described in nationally recognised guidance.
• Medical emergency equipment and medicines were not taken on domiciliary visits. This had not been formally risk assessed.
• Although the service received very few complaints they were not always dealt with in a timely manner.

Updated 5 July 2019

We rated the service as good because:

• We rated safe, effective, caring, responsive and well-led as good.
• The service provided safe care. The ward environments were safe and clean. The wards had enough nurses and doctors and provided training in key skills. Staff assessed and managed risk well and used control measure to prevent the spread of infection.
• The service provided care and treatment based on national guidance and made sure staff were competent for their roles. Staff of different kinds worked together as a team to benefit patients. Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. Staff always had access to up-to-date, accurate and comprehensive information on patients’ care and treatment
• Staff treated patients with compassion and kindness, respected their privacy and dignity and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
• The service planned and provided services in a way that met the needs of local people and people could access the service when they needed it. The service took account of patients’ individual needs and treated concerns and complaints seriously.
• Managers at all levels in the service had the right skills and abilities and promoted a positive culture. The service had a vision for what it wanted to achieve and workable plans to turn it into action. The service had effective systems for identifying risks and managed information well to support all its activities. There was a strong sense of involvement in the service and pride in the hospital from staff.

Updated 27 January 2020

Our rating of this service improved. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients and acted on them. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff provided good care and treatment and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

• The reception area at Haywood Hospital did not allow the receptionist to clearly observe all patients in the waiting area.
• Some of the clinical notes were not detailed enough to capture all necessary information such as the red flags.
• Supervision was not recorded consistently.

• Not all staff demonstrated a good understanding of the Gillick Competency and Fraser Guidelines.

Updated 5 July 2019

Our rating of this service went down. We rated it as requires improvement overall.

We rated caring as good and safe, responsive, effective and well led as requires improvement because:

• Across the core service there were inconsistencies in addressing issues from the previous inspection. There were differences in quality of practice between Shropshire and Staffordshire. We concluded that services in Staffordshire were of a good quality. Our concerns were about the services for the people of Shropshire.
• In Shropshire there were concerns in the way the trust triaged referrals within the access team. At the time of the inspection despite the service having been commissioned, the trust had allocated no staff to assess people for attention deficit hyperactivity disorder (ADHD). This meant that the waiting list for pathways was high and waits were getting longer.
• Not all risk assessments were updated regularly and care plans within Shropshire lacked detail and did not reflect the views of the children and young people or their families. Carers and young people told us they were not given copies of care plans.
• Staff considered patients’ capacity to make decisions about their care but did not consistently or effectively record these considerations in the patient’ records within Shropshire.
• Services in Shropshire made limited use of outcome measures. This reduced their ability to monitor patient progress. Not all staff were aware of or involved in clinical audits.
• Staff morale in Shropshire was generally low and staff felt isolated from the other teams in the trust.
• Local managers in Shropshire had not ensured thorough and robust oversight or audits around the quality of documentation within the clinical records.
• Staff did not complete regular environmental risk assessments. Staff were not aware of where the environmental risks were.
• Staff were not consistently checking calibration of clinical equipment and there was no system in place to monitor this.
• Although we found that staff received regular supervision, the trust did not have a consistent and effective system for collating and monitoring supervision data.

However:

• Staff regularly reviewed the effects and side effects of medications on each patient’s physical health. This was an improvement since the transfer of Shropshire services into the trust.
• Staff knew how to identify abuse and safeguard young people in line with current recognised guidance and trust policy. Staff followed safeguarding processes and ensured that they highlighted any safeguarding information on the electronic recording system.
• Young people felt that staff listened to them and provided them with appropriate emotional and practical support. Young people described the staff as caring, supportive and non-judgemental.
• Staff in the teams provided a range of treatment and care for patients based on national guidance and best practice. Staff supported young people with their physical health and encouraged them to live healthier lives.

Updated 12 July 2016

We rated community mental health services for people with learning disabilities as good because:

• The trust had appropriate staffing levels across the teams and the caseloads were well managed to ensure patient safety.

• All of the teams completed patients’ comprehensive risk assessments and reviewed and updated them as a multidisciplinary team on a regularly.

• Staff had completed mandatory training and had the skills and knowledge to meet patients’ needs.

• Staff knew how to recognise and report incidents and the managers provided them with opportunities to learn lessons from incidents.

• Staff assessed and supported patients with their physical health care needs and monitored for any undesirable outcomes. Staff treated patients with respect and dignity and involved them in their care and treatment planning.

• Patients told us they were able and felt free to make a complaint and were confident that the trust would resolve them.

• Staff worked well with other external organisations such as GPs, acute hospitals, independent organisations, local authorities, police and housing associations to ensure that patients got the right support needed.
• The managers were knowledgeable and provided good leadership and support to the staff teams.

However:

• The care records we reviewed showed that staff did not consistently review, update, personalise and address all needs identified in the nursing care plan documentation.

• Staff did not always carry out assessment of capacity to consent in a consistent way in all teams. Some records where patients had been identified as lacking capacity had no documentation in place.

• There was a lack of resources to respond promptly and adequately to out of hours crisis situations. The out of hours service had no learning disabilities skilled staff that were available to respond to patients’ needs.

Updated 12 July 2016

We rated  community based mental health services for older people as outstanding because:

• The services were committed to research and innovation. Staff were involved in research projects to improve the efficiency of the services. Staff were innovative in their approach and had invested in developing learning material. They used technology to share their knowledge to help people learn about working with older people in mental health services.
• The services were responsive to the needs of its staff. Staff routinely received supervision and annual performance reviews. Staff had mandatory training, which managers monitored to ensure compliance. Managers supported staff to develop their skills by funding external and specialist training courses. Staff worked together to develop specialist internal training programmes. There was a culture of leadership at all levels. As a result, staff morale was good.
• All of the service locations were comfortable, safe, and had suitable facilities for patients including those with mobility concerns. There were secure door entry systems and staff complied with lone working policies and local procedures. There was a firm commitment by all staff to work with patients in their homes or at the nearest possible location if there was a requirement to be seen outside their home.
• Staff provided high quality treatment and care. Different professionals worked well together to assess and plan for the needs of patients. Patients had up-to-date, individualised care plans. These focussed on helping patients in gaining independence and confidence, avoiding the need for hospital or other residential care.
• Staff from all disciplines were caring and compassionate. Staff routinely encouraged meaningful engagement with patients and their carers. Service users and carers were also involved in service improvements, for example, staff interviews.
• Staff used specialist tools to assess and monitor patients who used the services. To aid their recovery, patients had access to specialist psychological therapies, for example, psychological improved access to psychological therapiesIAPT).
• All services had a good track record on safety and staff managed risk well. Staff undertook risk assessments for each patient. They had been trained in safeguarding and there was cohesive joint working with social services. Staff knew how to report incidents. Managers investigated the incidents and then shared lessons learned with staff.
• The services had good relationships with their commissioners and made adaptations to service provision when agreed.
• Each service was well led and managers were approachable and accessible to their staff. They had the skills, experience and motivation needed to drive forward the services. Managers and staff were continually looking for ways to improve outcomes for their patients. The CDEMhome treatment Telford and Wrekinservice received accreditation by the Memory Services National Accreditation Programme (MSNAP)

However:

• Some specialist services had high caseloads; for example, the memory clinic at CDEM Home Treatment Telford & Wrekin.

Updated 5 July 2019

Our rating of this service improved. We rated it as good because:

• The service provided safe care. Clinical premises where patients were seen were safe and clean and the physical environment of the health-based places of safety met the requirements of the Mental Health Act Code of Practice. The number of patients on the caseload of the mental health crisis teams, and of individual members of staff, was not too high. Staff assessed and managed risk well and followed good practice with respect to safeguarding.

• Staff working for the mental health crisis teams developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and staff engaged in clinical audit to evaluate the quality of care they provided.

• The mental health crisis teams included or had access to the full range of specialists required to meet the needs of the patients. Managers ensured that staff received training, supervision and appraisal. Staff worked well together as a multi-disciplinary team and with relevant services outside the organisation.

• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.

• Staff treated patients with compassion and kindness and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.

• The mental health crisis service and the health-based places of safety were easy to access. Staff assessed people promptly. Those who required urgent care were taken onto the caseload of the crisis teams immediately. Staff and managers managed the caseloads of the mental health crisis teams well. The services did not exclude people who would have benefitted from care.

• The services were well led, and the governance processes ensured that procedures relating to the work of the service ran smoothly.

Updated 5 July 2019

Our rating of this service stayed the same. We rated it as good because:

• The service provided safe care. The ward environments were safe and clean. The wards had enough nurses and doctors. Staff assessed and managed risk well, managed medicines safely, followed good practice with respect to safeguarding and minimised the use of restrictive practices.
• Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients cared for in a ward for people with a learning disability (and/or autism) and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
  
• The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training and appraisal. The ward staff worked well together as a multi-disciplinary team and with those outside the ward who would have a role in providing aftercare.
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983.
• The service worked to a recognised model of mental health rehabilitation. It was well led, and the governance processes ensured that ward procedures ran smoothly.

However:

• Managers did not always offer staff support in their roles. Staff were not always receiving regular one to one supervision, and managers were not documenting that supervision had taken place, in line with trust policy.

Updated 12 July 2016

• The service provided good quality, safe environments that promote recovery.
• We saw a proactive approach to de-escalation which had resulted in low levels of incidents and seclusion use.
• Patients care plans were holistic, personalised and reflected the patients’ views.
• Staff in the service were dedicated, caring and understood the individual needs of the patients.
• A full range of staff made up a skilled and dedicated MDT.

However:

• Staff had implemented blanket restrictions in response to recent incidents. Many of the restrictions were common place on forensic wards due to associated security measures but needed to be reviewed on a regular basis in order to promote positive risk taking

Updated 12 July 2016

We rated the Long stay rehabilitation mental health wards as good because:

• We found the ward to be clean, spacious and comfortable with a good quality of furnishings and décor throughout, including a large garden area for fresh air.

• Staff were caring, kind and compassionate and had a good knowledge of the patient group.

• Carers received a wide variety of information and had access to carers’ groups and carers’ representatives on the ward.

• Patients had the choice of a wide range of therapeutic interventions and activities, to aid their recovery.

• The multidisciplinary team ensured each patient had an effective rehabilitation plan, which was well coordinated and gave patients the opportunity to express their views and participate in their care and treatment.

• We saw there was a good governance structure in place, and staff met regularly to discuss and reflect on the care and treatment they provided.

Updated 26 January 2024

Our rating of this location stayed the same. We rated it as good because:

• The service provided safe care. The ward environments were safe and clean. The wards had enough nurses and doctors. Staff assessed and managed risk well. They minimised the use of restrictive practices and followed good practice with respect to safeguarding.
• Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. Staff engaged in clinical audit to evaluate the quality of care they provided.
• The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
• The service was well led and the governance processes ensured that ward procedures ran smoothly. The trust had shared learning from other areas which had been implemented across this service.

However:

• Generally, the rationale for restrictive interventions for individual patients was recorded well. However, we did not see this within all the patient care records we reviewed. Not all care plans included discussions with the patient around restrictive interventions in place to keep people safe.
• Staff had monitored and recorded fridge temperatures that were used to store medications. However, staff had not taken action when the fridge temperatures were outside of the recommended limit for a period of time and staff had not escalated or dealt with it. This could potentially effect the efficacy of the medication within the fridge.

Background to inspection

We carried out this unannounced focused inspection because we received information of concern about the safety and quality of the services.

We inspected the safe, caring and well-led key domains. We rated safe, caring and well-led as good.

We inspected the 4 older adult wards, Bromley and Baswich at St George’s hospital in Stafford and Holly and Oak at the Redwoods Centre in Shrewsbury.

• Bromley ward has 14 beds and is mixed sex
• Baswich ward has 12 beds and is mixed sex
• Holly ward has 16 beds and is mixed sex
• Oak ward has 16 beds and is mixed sex

What people who use the service say

Staff looked after them well, they were kind, supportive and helpful. Some patients said staff couldn’t do enough for them. There were enough staff to aid them when required and keep them safe. There were lots of activities which they enjoyed. The wards were clean and generally felt calm.

How we carried out this inspection

During the inspection we:

• visited the 4 older adults mental health wards
• reviewed the quality of the environments
• observed how staff cared for patients
• spoke with 15 patients who were using the services
• spoke with 8 carers or family members
• spoke with 32 staff members
• reviewed 18 patient care and treatment records
• reviewed 16 medicine prescription records
• attended 4 multi-disciplinary meetings
• reviewed a range of policies, procedures and other documents relating to the running of the services

You can find information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

Updated 19 May 2023

Midlands Partnership NHS Foundation Trust was formed on the 1 June 2018 following the acquisition of Staffordshire and Stoke on Trent Partnership NHS Trust by South Staffordshire and Shropshire Healthcare NHS Foundation Trust.

The trust provides mental health and community health services across parts of Staffordshire, Telford and Wrekin and Shropshire. The trust holds national contracts for providing mental health care to the Ministry of Defence. They also have extensive involvement in prisons, substance misuse services and Improving Access to Psychological Therapy services through their Inclusion brand. This gives them a large geographical spread with services stretching from the Isle of Wight to the Yorkshire. The trust is also a major provider of sexual health services commissioned to provide a service in Telford and Wrekin, Shropshire, Leicester City, Leicestershire and Rutland, Stoke-on-Trent and Staffordshire.

We carried out a comprehensive inspection of this trust in February and April 2019 and inspected 9 core services. As a result, the trust was rated as good overall, with safe, caring, responsive and well led rated as good and effective rated as requires improvement.

This inspection was a focussed, unannounced inspection of acute wards for adults of working age and psychiatric intensive care units (PICUs) provided by Midlands Partnership NHS Foundation Trust (MPFT). The inspection was focussed to specific areas of the safe and well-led key questions.

We carried out this inspection following notifications we had received about serious incidents that involved patients from the trust’s acute wards for adults of working age during September and October 2022. This included three incidents where patients had taken their own lives during a period of leave from the ward they had been admitted to, and four fire setting incidents that had occurred at The Redwoods Centre. CQC also received concerns in relation to these incidents from Shropshire Fire and Rescue Service, British Transport Police and Staffordshire Police.

The Trust provides acute inpatient wards for adults of working age and PICU’s at two locations, St George’s Hospital in Stafford and The Redwoods Centre in Shrewsbury. The wards are:

• St George's Hospital, Brocton ward, 20 beds: mixed sex.
• St George's Hospital, Chebsey ward, 19 beds: mixed sex.
• St George’s Hospital, Milford ward, 18 beds: mixed sex.
• St George's Hospital, Norbury PICU, 11 beds: male only.
• The Redwoods Centre, Birch ward, 16 beds: mixed sex.
• The Redwoods Centre, Laurel ward, 16 beds: mixed sex.
• The Redwoods Centre, Pine ward, 16 beds: mixed sex.

We previously inspected the trust’s acute wards for adults of working age and psychiatric intensive care units (PICUs) in June 2019. The inspection was part of a comprehensive inspection to check on the safety and quality of nine trust services. We rated acute wards for adults of working age and PICU’s as good overall, with only one domain, effective, rated as requires improvement. Following the inspection, we told the trust they must ensure managers provide staff with regular one to one supervision that is consistently recorded for personal support, professional development and work performance according to the trust’s policy. This was a breach of Regulation 18(2)(a), Staffing of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During our inspection on the 2 and 3 November 2022, we visited Birch ward and Brocton ward. When we inspected, Birch ward had 16 patients admitted and Brocton ward had 17 patients. Both wards included patients detained under the Mental Health Act 1983. Following the inspection we asked the trust for a range of information and data specific to all 6 acute wards for adults of working age and PICU.

Due to the seriousness of our concerns following our site visits, we used our powers under Section 29A of the Health and Social Care Act 2008 to issue a warning notice to the trust. We use Section 29A warning notices with NHS Foundation Trusts when it appears that the quality of health care provided by the trust requires “significant improvement”. The notice provided the trust with a deadline by which they were required to make significant improvement to the areas identified in the notice. Details of the notice can be found at the end of the report under enforcement actions. Following the inspection, the Trust submitted an action plan to address the areas of concern we identified.

Our rating of acute wards for adults of working age and psychiatric intensive care units (PICUs) went down. We rated them Inadequate because:

• The trust relied on temporary staff to maintain safe staffing levels across the acute mental health wards for working age adults and the PICU but could not demonstrate all temporary staff received inductions to the wards they worked on or had easy access to the trust’s electronic systems. Incidents demonstrated temporary staff were not always familiar with trust policy and procedural guidance or expectations about staff conduct while working.
• The trust was unable to demonstrate sufficient numbers of staff completed and remained up to date with mandatory training requirements. They also failed to demonstrate sufficient numbers of staff regularly participated in supervisory activities and this had been a requirement from our previous inspection.
• The trust did not meet national guidance to ensure staff had received safeguarding children training to the appropriate level.
• Environmental assessments, including ligature risk assessments and fire safety assessments, were not always sufficient to ensure safety and failed to identify all areas of potential risk and detail actions to reduce the harm from those risks.
• The trust failed to demonstrate how staff always safely managed items of potential risk as part of patients’ personal property. This had resulted in incidents of avoidable harm to patients.
• Records failed to demonstrate staff always assessed patient’s mental states at the point of taking leave and recorded these discussions and decisions in patients’ clinical records
• We saw a significant increase in mixed sex accommodation breaches since our previous inspection and there were concerns about the implications of mixed sex ward environments contributing to sexual safety incidents.
• Challenges around staffing and access to essential information failed to demonstrate processes to share actions and lessons learned following incidents always worked effectively and engaged all staff working within the acute mental health wards for working age adults and the PICU.

How we carried out the inspection

During our inspection on the 2 and 3 November 2022, we visited Birch ward and Brocton ward. During the inspection we:

• observed how staff cared for patients;
• spoke with 11 patients who were using the services on Birch ward, Pine ward, Laurel ward and Brocton ward;
• spoke with 22 staff including; nurses, healthcare support workers, matrons, and staff responsible for estates, staffing and budgets;
• reviewed 12 patient care records;
• observed 1 patient meeting;
• met with 2 care groups led by senior staff;
• reviewed a range of policies, procedures and other documents relating to the running of the services.

You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

What people who use the service say

During the inspection we spoke with 11 patients; 7 at The Redwoods Centre and 4 at St. George’s Hospital. We found patients’ feedback and experience differed between the two sites. Patients at St George’s Hospital provided positive feedback about staff and said they were kind and respectful, while patients at The Redwoods Centre raised concerns. This included the number of temporary staff deployed on wards, the visibility and accessibility of staff for patients, and staff conduct including sleeping on duty and using inappropriate language. This also appeared to impact on whether patients felt safe and cared for during their stay in hospital. Patients of The Redwoods Centre told us they did not always feel safe during their admission and they found the conduct of staff, particularly temporary staff, was not always respectful, caring and polite.

Updated 12 July 2016

We rated South Staffordshire and Shropshire Healthcare NHS Foundation Trust as good because:’

• Patients had access to a wide range of professions who offered modern and holistic treatments. This included psychologist, psychiatrists, nurses, occupational therapists and social workers who were trained to deliver dialectical behavioural therapy, cognitive behavioural therapy and eye movement desensitisation and reprocessing therapy.

• Feedback from patients and carers was very positive about staff and the service overall.

• Referral to treatment times were good and there was a tiered approach which ensured that patients with an urgent requirement for treatment were assessed quickly.

• Teams had developed systems of working to ensure that information was shared throughout the team. Leadership was good across all of the services we inspected. Managers were well respected and could demonstrate good knowledge of their team.

However:-

• The quality of care planning and risk assessments was variable. In some cases these documents were filled out well and contained lots of patient centred information; we did find some however that were out of date or did not contain enough information.

• There was an issue in some teams linked to social work input. Social work services were externally sourced in some services and this had meant that the social workers changed regularly and did not have the same access to training and development as trust employed social workers.