- SERVICE PROVIDER
Avon and Wiltshire Mental Health Partnership NHS Trust
This is an organisation that runs the health and social care services we inspect
Listen to an audio version of the report for Avon and Wiltshire Mental Health Partnership NHS Trust from our inspection on 04 September - 04 October 2018, which was published on 21 December 2018. Listen to the report
Report from 4 September 2024 assessment
Contents
Ratings - Forensic inpatient or secure wards
Our view of the service
Date of Assessment 23 January 2024 We completed an unannounced inspection due to concerns we had about some areas of service quality. We assessed a small number of quality statements from the safe and responsive key questions and found areas of concern. The scores for these areas have been combined with scores based on the key question ratings from the last inspection. Staff were not always aware of who the designated unit nurse in charge was, who had authority to deploy staff to other wards in an emergency. Shifts were cancelled at short notice which meant some shifts were short staffed or covered by agency staff who did not know the patients well. Staff told us they were anxious about reporting incidents and using the Freedom to Speak Up Guardian process due to concerns of job security. Although some blanket restrictions had been removed around patients access to fresh air and refreshments, staff told us some night time restrictions remained in place because staffing levels were not changed to reflect a 24 hour service. Relatives told us they were concerned about the standards of care and the services over reliance on, and the quality of agency staff. Patients told us food choice and quality was poor. We found evidence that the service was slow to respond to concerns raised by patients. We reviewed learning from the service but found this was not applied in practice. For example, ward welcome packs were introduced but some staff did not know they existed. Staff did not follow ward rules such as no mobile phones on wards, and activity boards were introduced but we saw evidence of patient requests for activities that were not provided. We found regulation breaches concerning safety. However, senior leaders had responded to a number of patient care concerns and suspended staff from duties whilst investigations took place. The service are addressing staff culture concerns by providing more training and staff told us there were improvements in culture due to this.
People's experience of this service
Patients on Cary ward said restrictions had lifted, although this was not our finding. The kitchen remained locked while the garden door was open which meant patients could not access drinks or snacks whilst the garden was accessible and the TV room was also restricted. On Bradley Brook ward, a night mode was introduced which restricted patients during midnight and 6am due to low staffing and poor visibility in the garden. The night mode was a local solution eastablished by staff to manage the high acuity ward during nighttime hours. Whilst staff did understand the benefits of removing restrictions, they told us there was little guidance given from senior leaders and they felt unprepared to deliver a 24/7 service. Patients told us that although their ward activity boards were full, activities rarely happened due to low staffing levels and activities over the weekends were limited. Some relatives also said activities were limited which led to patient boredom and anxiety. Most relatives we spoke to commented on the high use of agency staff in the service and gave examples of difficulties they have had with communication because of this. Patients also told us there was a lack of permanent staff and the wards functioned better when substantive staff were on shift. Patient meeting minutes indicated that patients had complained about being spoken to without respect by staff and some staff behaviours.