South West Yorkshire Partnership NHS Foundation Trust

Updated 6 December 2023

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

• We rated effective, caring, responsive and well-led as good, and safe as requires improvement. We rated 12 of the trust’s 14 services as good and two as requires improvement. In rating the trust, we took into account the previous ratings of the 10 services not inspected this time.
• Although we still rated the acute wards for adults of working age and psychiatric intensive care units core service as requires improvement we could see areas of improvement. We improved the overall ratings for two of the four core services inspected. We rated the community-based mental health service for adults of working age as good for all five key questions.
• The trust board and senior leaders had the appropriate range of skills, knowledge and experience to perform their role. The trust had a clear vision and set of values which were embedded and respected across the organisation.
• Leadership development opportunities were available, including opportunities for staff below team manager level. The leadership and management development offer to staff took an inclusive approach, the pathway was open to both registered clinicians and non-registered support staff.
• The trust’s target rate for appraisal compliance was 95%. At the time of inspection, the overall appraisal compliance rate was 97%. The appraisal process was aligned to the trust values and staff spoke positively regarding this process. On the whole staff felt respected, supported and valued within their teams.
• The trust had a policy on restrictive practices which had recently been introduced. Each ward now had a reducing restrictive practice log/risk assessment which recorded the local restrictions in place, and what the risk assessment was with and without each restriction in place, what the decision was, and the plan for review of any restrictive practice. This had helped services identify and reduce restrictive practices across the inpatient wards.
• On the whole, across the core services, we observed staff to be kind and caring towards patients. We observed positive relationships and could see staff knew the patients well.

However:

• We rated acute wards for adults of working age and psychiatric intensive care units as requires improvement overall. Although we could see areas of improvement since our last inspection the core service still rated requires improvement for the safe, effective, caring and well led key question.
• Children and young people were waiting over 18 weeks to receive treatment in some areas. Across the service four team’s referral to treatment times exceeded 18 weeks. There were significant delays in accessing assessment for children and young people with autism spectrum disorder in all locations that offered this service.
• Although staff reported feeing respected, supported and valued amongst their local team and most by the senior managers. Two groups of staff felt they were not valued by senior leadership.

Updated 24 June 2016

We rated this core service as good because:

• Systems to manage and report incidents were in place, safeguarding procedures were robust and records were up to date.
• Medicines were stored and administered appropriately. Equipment was readily available and cleanliness and infection control procedures were followed.
• Risks to the delivery of care for patients were managed and action taken to mitigate them.
• Services were mainly fully staffed, mandatory training was up to date and staff development was supported.
• Care and treatment followed evidence based guidance.
• Care pathways were coordinated, multidisciplinary working was effective and outcomes for patients were evidenced and audited.
• Patient’s consent to care and treatment was documented.
• Care was delivered with compassion and staff treated patients with dignity and respect. Patients were involved in decisions about their care and treatment and received emotional support.
• Community services had a clear vision focussed on the patient at the centre and the needs of patients influenced the planning and delivery of services, including care for patients with diverse cultural needs.
• Patients had timely access to services, with minimal waits for most services. Few complaints were received by the service.
• Governance arrangements supported the delivery of care for patients. Performance measures were used which were monitored and action was taken when issues were identified.
• The service demonstrated a positive, focussed culture.
• Community services operated in an environment that encouraged improvement and innovation.

Updated 24 June 2016

We rated community health services for children, young people and families as good because:

• Services were safe and people were protected from harm. Staff knew how to manage and report incidents. We saw there had been learning following serious case reviews. Risks were actively monitored and acted upon. We found that there were good safeguarding processes in place.
• We found that there was enough staff with the right qualifications to meet families’ needs.
• The clinics and health centres we visited were clean.
• Services were effective. We found good evidence that the service reviewed and implemented national good practice guidelines. The trust had also successfully implemented evidence based programmes, such as the family nurse partnership programme.
• We also saw that patient outcomes and performance were monitored regularly, and that all staff received regular training, supervision and an annual appraisal. There was good evidence of multidisciplinary and multi-agency working across the services.
• Services were caring. Children, young people and parents told us that they received compassionate care with excellent emotional support.
• Services were responsive. We found the service planned and delivered services to meet the need of local families. Parents, children and young people were able to quickly access care at home or in a location that was appropriate to them.

• Services were well led. Staff we spoke with told us the patient was at the centre of what they do, they were positive and proud about working for the organisation. There was an open culture in the service, and staff were engaged in the process of service improvement. Staff reported being supported by their line managers and teams within the organisation.
• Staff worked with national and regional partners to share good practice. The service had been recognised by the Department of Health for their information sharing procedures and also received recognition from the Institute of Health Visiting and NHS England following the development of the health visitor caseload weighting tool. All managers were very proud of their teams.

Updated 24 June 2016

We rated community inpatient services as good because:

• The service prioritised patient protection and there were defined systems, processes and standard operating procedures to keep people safe and safeguarded from abuse. We saw evidence of open and transparent culture in relation to incident reporting. Opportunities were available to learn from investigations and staff were comfortable reporting their concerns or any near misses. The duty of candour process and practice was in place across all community inpatient locations. Complaint and concern responses were provided in a timely way with improvements made to the quality of care as a result.

• The department was clean and there were infection control and prevention audits, which showed high scoring outcomes. We found that medicine management and recording of information was to a good standard and well maintained.

• Training levels were in line with trust targets as a whole and staff competence was apparent during inspection. All safeguarding training took place as part of the trust’s mandatory training programme and nursing staff demonstrated a good level of knowledge in relation to safeguarding triggers, forms of abuse and processes.

• Risks to people who use services were assessed, monitored and managed on a day-to-day basis. Risk assessments were person-centred, proportionate and reviewed regularly. The service applied national early warning scores to identify when the escalation of care needs was appropriate.

• Feedback from numerous patients across both of the community locations was very positive. We heard that staff responded compassionately to patients’ needs and were skilled in dealing with vulnerable individuals with complex physical and mental health needs. Relatives said they felt involved and had the opportunity to speak with medical and nursing staff when required.

• We observed the treatment of patients to be compassionate, dignified, and respectful throughout our inspection. Ward managers were available on the wards so that relatives and patients could speak with them as necessary. Staff were hard working, caring and committed to delivering a good quality service. They spoke with passion about their work and were proud of what they did.
• We found that the trust’s contribution to local and national audit was in line with the national average, and evidence of changes made by specialities in response to their outcomes was available and had been actioned.
• Planning and delivery processes were in a place to enable services to meet the needs of the local population. The importance of flexibility, choice and continuity of care was evident within each service. The needs of different people were taken into account when planning and delivering services and reasonable adjustments were made to remove barriers when people found it hard to use or access services.

• There was evidence of competent, responsive, multidisciplinary working between all professionals. They worked closely with the local authority when planning discharge of complex patients and when raising safeguarding alerts.

• The behaviours and actions of staff working in the division mirrored the trust values of ‘patients’ first, safe and high quality care, and responsibility and accountability’ of which we saw multiple examples of during our inspection.

Updated 24 June 2016

Overall we rated the trust as good for community end of life care services because:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Lessons were learned and communicated widely to support improvements.

• High performance within the service was recognised by credible external bodies.

• Staff in the community and on the wards of the community hospitals demonstrated a consistently good level of knowledge of end of life care issues.

• The palliative care team was multi-disciplinary with medical, nursing, social work, occupational therapy, physiotherapy and dietetic membership.

• The end of life care lead for the trust was also the end of life care lead for the locality and the trust had a significant role in contributing to the shaping of end of life care services.

• We saw that staff would find ways of making the experience of care as easy as possible for people and that there was a commitment to end of life care at all levels ofthe community service.

• 84% of patients known to the Specialist Palliative Care Team achieved their preferred place of care at the end of life.

• The integrated multidisciplinary model adopted by the palliative care service supported the development of responsive care packages in the community, including the management of a supportive care at home service.

• There was a clear vision, strategy and values for end of life care with well-defined objectives that were reviewed as part of a district end of life care steering group.

• We observed strong leadership from the Specialist Palliative Care Team (SPCT) and senior staff in the community.

• There was a commitment and culture for providing high quality end of life care that was patient focused.

• Innovation was apparent across the SPCT as a whole.

• The service proactively engaged staff and patients to ensure their views were heard and acted upon, including the use of volunteers to obtain patient and family feedback.

Updated 23 August 2019

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

• Staff did not always assess or manage risk well. Staff did not follow up on all identified risks, create management plans or appropriate crisis plans. The service did not actively monitor children and young people on waiting lists to detect and respond to increases in level of risk.
• Children and young people were waiting over 18 weeks to receive treatment in some areas. Across the service four team’s referral to treatment times exceeded 18 weeks. There were significant delays in accessing assessment for children and young people with autism spectrum disorder in all locations that offer this service. Children and young people on waitlists did not have a formal care plan until they received intensive treatment. For those admitted into the service care plan entries were written from a clinical perspective, more so than for the individual receiving treatment.
• Staff did not always record consent clearly for children or young people in their care records.
• Staff did not ensure that children and young people and their families and carers had access to all the information they should. This included information on complaints, carers assessments and LGBTI support.
• Issues relating to on-call provision were not yet fully resolved. There were staffing gaps in the rotas as there were not enough staff to cover all responsibilities.
• Staff did not always follow systems and processes for cleaning and checks of clinical equipment. The Barnsley service did not have CQC ratings from the previous inspection displayed in patient areas.

However;

• Clinical premises where children and young people were seen were safe and clean. The number of children and young people on the caseload of the teams, and of individual members of staff, was not too high to prevent staff from giving people using the service the time they needed. Staff ensured that children and young people who required urgent care were seen promptly.
• The service had identified issues with long waiting lists for intensive treatment and gaps in commissioning and were working to resolve these. When appropriate, they provided low level interventions to those waiting for intensive treatment. They were implementing new service models to better meet the needs of people using the service and were working with commissioners to get additional funding and a clear service specification.
• Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment and in collaboration with families and carers. They provided a range of treatments that were informed by best-practice guidance and suitable to the needs of children and young people. Staff engaged in clinical audit to evaluate the quality of care they provided.
• The teams included or had access to the full range of specialists required to meet the needs of those using the service. Managers ensured that these staff received training, supervision and appraisal. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation.
• Staff understood the principles underpinning capacity and competence in line with the Mental Capacity Act and Gillick competence.
• Staff treated children and young people with compassion and kindness, respected their privacy and dignity, and understood their individual needs. They actively involved children, young people and their families and carers in care decisions.
• The service was easy to access in terms of referrals and initial assessment. Staff assessed and were able to expedite treatment for children and young people who required urgent care promptly. The criteria for referral to the service did not exclude children and young people who would have benefitted from care.
• The service was well led, and the governance processes ensured that procedures relating to the work of the service ran smoothly.

Updated 3 July 2018

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

• The trust had acted upon our feedback from the previous inspection of this service. People’s risk assessments were available and easily accessible in all the electronic care records we reviewed. They were up to date and demonstrated staff assessed, managed, and monitored people to protect them from avoidable harm and abuse.
• The teams we visited included a full range of staff disciplines. Staff worked in a collaborative manner and were flexible in their approach across the different functions provided in each location.
• People received effective care and treatment. Staff planned and provided care and treatment that was in line with current evidence based standards and best practice. Staff completed care plans that were holistic, personalised, and involved people in decisions about their care and treatment.
• There were sufficient numbers of skilled and experienced staff in the community teams. Staff felt their caseloads were manageable. All staff met the trust’s compliance target for appraisals, supervision and mandatory training. Staff we spoke with felt valued and well supported by their clinical leads.
• Staff provided compassionate care and clearly understood people’s feelings, preferences and their social needs People were involved in decisions about their care and treatment. Communication with people was clear and individualised. Staff used open questions and simple language. They gave people time to respond and provided appropriate levels of verbal prompting if necessary.
• The trust had acted upon our feedback from the previous inspection of this service. They had restructured the service to include multi-disciplinary teams providing a more joined up approach. This led to a significant reduction in waiting times with improved access to a range of specialist assessments. The community teams had a clear pathway that provided flexibility for staff to provide care that met the needs of individual patients. The intensive support teams responded to urgent and crisis referrals within the recommended referral wait times.
• The service had a clear and effective leadership structure. Senior staff were knowledgeable about the service and committed to making continuous improvements. Staff morale was positive overall and the culture of the service was consistent with the trust values.

However

• The base at Wakefield was in the city centre and also used by several mental health services. The location and multi-discipline use of the base presented staff with challenges regarding retention of health support workers and agile working. The waiting area was large and impersonal, with no easy read information displayed.

Updated 8 February 2017

We rated South West Yorkshire Partnership NHS Foundation Trust as good because:

• All the teams were using electronic patient records to store patient information. This meant staff had better access to records, the documentation and records were consistent, and there was less chance that work was duplicated or missed. Care documentation was completed in a timely manner.

• Staff carried out routine assessments within the nationally recognised targets of 14 days, and urgent assessments within four hours. Teams were able to offer treatment to patients in a timely manner from assessment. All the teamsallocated a care coordinator within a week of the patient having their assessment. Some specialised treatments took longer than others, however, the trust data demonstrated they were able to meet all treatments within 18 weeks.Patients had access to crisis support 24 hours a day seven days a week.

• At this inspection all the actions we told the provider it should take had been completed. Staff were learning from incidents at a local level, trust level and national level. Senior staff held monthly meetings open to all staff looking at serious incidents and what learning would take place. This included learning events where the trust reviewed incidents that took place in other services where the lessons learnt could also be applicable to them. Learning from incidents was also embedded into team meetings and supervision.

Updated 24 June 2016

We rated South West Yorkshire NHS Partnership Foundation Trust as good because :

• The environment of the health based places of safety (136 Suites) were adequate and in line with Mental Health Act guidance. It optimised patient dignity, safety and comfort.
• The crisis teams had robust monitoring of medication and had rapid access to psychiatry; patients could be seen within the day. We saw examples of the crisis team learning from incidents and implementing changes within their practice. Staff across all the teams were up to date in their adult and child safeguarding training.
• All the teams worked alongside external stakeholders to respond to people in crisis effectively. This was in line with the trust’s responsibilities under the crisis concordat.
• All initial assessments are carried out by a band 5 or band 6 nurse. If a band 5 nurse carries out the initial assessment, this is always discussed with a band 6 nurse. We saw initial assessments were comprehensive and detailed. Staff across all the teams had a good understanding of the Mental Health Act and Mental Capacity Act. They understood the guiding principles and were able to give examples of how they could apply it in practice.
• We observed meaningful, compassionate and person centred care delivered by dedicated staff. Patients were positive about their experiences with the crisis teams.
• Staff within the crisis teams met their targets to complete initial assessments within four hours of referral. We observed flexible working around patients’ needs. Staff adjusted their schedules so that patients could attend their appointments. Crisis teams utilised a range of resources which increased the quality of the service they delivered, for example, self-help leaflets and interpreting services.
• We saw effective use of auditing which provided oversight of team performance. These enabled team leaders to plan work and identify gaps. We saw teams shared good practice across the different regions, learning from each other’s experiences. Staff had good morale and were happy about how they were managed. Staff felt valued and that their thoughts mattered.

However,

• We saw that the staff on the 136 suites did not always review their ligature risk assessments in a timely manner.
• Monitoring for Mental Health Act and Mental Capacity Act training were not always present.
• Appraisals for staff had not been completed equally across the four crisis teams.
• Not all teams provided crisis team leaflets describing their crisis service other than in English.
• Not all teams were commissioned to have police liaison officers.
• The crisis team in Barnsley had high levels of sickness. The sickness levels year to date was 12%.
• Teams felt less confident with the management structure above the team leaders.

Updated 3 July 2018

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

• The trust had acted upon our feedback from our previous inspection of this service and there had been overall improvements in the safety of patient care.
• Following our previous inspection, the ward had taken action to reduce blanket restrictions. However, there was no system or process that supported how staff identified and reviewed blanket restrictions and some blanket restrictions remained.
• Staff had a culture of openness and honesty and safety was a high priority for all staff. Managers monitored the safety and quality of the service and took action to improve safety. Staff regularly assessed and monitored risks to patients, to protect them from avoidable harm and abuse.
• Patients received effective care and treatment. Staff planned and delivered care and treatment that was in line with current evidence based standards and best practice. Training for the Mental Health Act and Mental Capacity Act was now mandatory for all staff. Staff completed care plans that were holistic, personalised, and involved patients in decisions about their care and treatment.
• Staff provided person-centred care that patients’ needs and treated patients with dignity and respect. Feedback we received from people who used the service was overall positive and we observed staff who were kind, caring, and respectful. However, we had concerns about the limited opportunities for patient feedback and carer support on the ward.
• The ward had a clear pathway that provided flexibility for staff to deliver care that met the needs of individual patients. Staff planned and managed admissions and discharges to the ward so that patients had timely access and successful discharges from the ward. The facilities promoted the comfort, dignity and privacy of patients and the ward planned to make further improvements to the environment.
• The ward needed to make further improvements in the arrangements for reviewing blanket restrictions and obtaining the views of people who used the service. However, staff morale was overall positive about managers who were highly visible and supportive. Senior staff were knowledgeable about the ward and committed to making continuous improvements.

Updated 6 December 2023

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

We rated the service inspected as requires improvement. Overall, we rated safe, effective, responsive, and well-led as requires improvement and caring as good.

We visited 9 of the forensics wards provided by the trust at the following locations:

Fieldhead

Newhaven ward, a 16 bedded low secure/ learning disability ward.

Bretton Centre:

Sandal Ward, a 16 bedded low secure ward.

Thornhill ward a 15 bedded low secure ward.

Ryburn Ward, a 7 bedded low secure ward.

Newton Lodge:

Priestley ward, a 17 bedded medium secure ward

Johnson ward, a 15 bedded medium secure ward

Chippendale ward, a 12 bedded medium secure ward

Appleton ward, an 8 bedded medium secure/ learning disability ward

Hepworth ward, a 15 bedded medium secure ward

We also carried out a Mental Health Act monitoring review visit on Bronte ward, at the same time as the inspection. This will follow the normal process for these reviews.

Our rating of services went down. We rated them as requires improvement because:

• Some aspects of ward environments were not safe. Up to date ligature risk assessment were not always accessible to staff. Equipment was not always checked to ensure it was in date and safe to use in an emergency. Records showed the temperatures in some clinic room fridges were not always kept within the required range.
• Staffing pressures meant there were high levels of bank and agency staff on some wards which impacted on the quality of care patients were receiving. Staffing pressures also meant that patient’s leave was sometimes cancelled.
• Staff did not always use least restrictive practices. On one ward, we found high levels of restraint, including prone restraint being used.
• Staff did not always consider individual circumstances when applying restrictions.
• Positive behavioural support plans were of variable quality, not always informed by psychological formulation and were not always used effectively to reduce incidences of prone restraint on wards.
• Supervision levels varied across wards. Staff on some wards did not receive regular supervision and it was not clear if staff had received the required level of supervision as set out by the trust. Staff did not always attend regular team meetings.
• Not all staff had received training on meeting the needs of patients with a learning disability or autistic people. This training was not mandatory for all staff and although training for staff on learning disability wards had been introduced in April 2023, it had not been completed by all staff.
• Staff did not always respect patients’ privacy and dignity. Staff sometimes accompanied patients on leave in scrubs which identified them as a patient of the hospital. The therapy room on one ward was not sound proofed and private conversations could be heard on the ward.
• Governance processes did not always ensure managers had full oversight of quality or ensure that ward procedure ran smoothly. We found significant variations between wards which included the completion and recording of staff supervisions and mandatory training. On some wards meaningful activities were not always available to patients. Prone restraint was not monitored and managed effectively.
• Staff did not fully implement the trust’s duty of candour policy. A written letter of apology was not always sent to people as required and senior staff were not clear about this requirement.

However:

• The service mainly provided safe care. The ward environments were mostly clean. The wards mostly had enough nurses and doctors to ensure the wards were safe. Staff mostly assessed and managed risk to individual patients well. Staff managed medicines safely and followed good practice with respect to safeguarding.
• 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 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 mostly included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers mostly ensured these staff received training and appraisals. The ward staff worked well together as a multidisciplinary 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 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.
• Staff planned and managed discharge well and liaised with services that would provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.

How we carried out the inspection

During our inspection we visited 9 wards which were based on 3 sites at Newton Lodge, the Bretton Centre and Newhaven.

During our visit we:

• conducted 9 ward tours.
• spoke with 31 members of staff.
• spoke with 25 patients.
• spoke with 9 carers.
• checked 22 records and reviewed a range of seclusion and restraint records.
• observed a handover and a multi-disciplinary team meeting.
• conducted an evening visit.
• carried out medication checks.
• reviewed a range of policy and documentation.

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.

Updated 24 February 2017

We rated South West Yorkshire Partnership NHS Foundation Trust as good because:

• The service had effective governance process in place which demonstrated a clear link between senior management and front line staff.

• Weekly multidisciplinary review meetings and risk review meetings were held and patients care plans and risk assessments were updated as required.

• Patients had the opportunity to speak to a consultant at least once a month or more regularly if requested.

• Patients’ physical health was monitored regularly through weekly physical health and wellbeing clinics led by a band 6 nurse and the junior doctor.

• Staff had received training in the Mental Health Act and completed regular audits of patients consent to treatment records, all of which were correct and in date at the time of the inspection.

Updated 23 August 2019

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

• The service had enough nursing and medical staff to deliver care and keep people safe from avoidable harm. Staff assessed patient and environmental risks and responded to changes in that risk. Staff reported adverse incidents and learnt from when things went wrong.
• Staff assessed the physical and mental health needs of patients on admission and worked collaboratively to meet patient need. Patients had access to a range of professionals as part of their care. Staff were supported with regular supervision and annual appraisal.
• Staff treated patients and carers with kindness and respect. Patients and carers were able to give feedback on the care and treatment they received. Patients and carers we spoke with were positive about staff and the service.
• There were clear admission criteria and processes. Staff managed beds well. Patients had access to a range of facilities and information. Staff were responsive to patient needs, including those with a protected characteristic.
• Staff considered managers to be supportive and described an open and honest culture. Governance systems and processes allowed staff to assure the quality of care and generate improvements. Managers were aware of the challenges the service faced and had plans to address them. Staff had been involved in an ongoing service transformation project.

However:

• Staff described challenges in managing a mix of organic and functional patients and signage on some wards was not dementia appropriate.
• Staff did not always review the use of as required and covert medication.
• Risk assessments were not always comprehensive or completed in a timely manner. Care plans were not always personalised and did not always evidence patient involvement.
• Wards did not have access to dedicated psychology input.

Updated 6 December 2023

We carried out this unannounced focused inspection because we received information giving us concerns about the safety and quality of the service.

We rated the service as requires improvement, with all five domains of safe, effective, caring, responsive and well led rated as requires improvement.

We visited all of the acute and psychiatric intensive care unit (PICU) wards provided by the trust at the following locations:

The Dales, Calderdale Royal Hospital:

• Elmdale ward, a 24-bed female acute ward
• Ashdale ward, a 24-bed male acute ward

Priestley Unit, Dewsbury and District Hospital:

• Ward 18, a 23-bed mixed gender acute ward

Fieldhead Hospital, Wakefield:

• Nostell ward, a 22-bed female acute ward
• Stanley ward, a 22-bed male acute ward
• Walton PICU, a 14-bed mixed gender PICU

Kendray Hospital Barnsley:

• Clark ward, a 14-bed female acute ward
• Beamshaw ward, a 14-bed male acute ward
• Melton PICU, a 6-bed mixed gender PICU

Our rating of services went down. We rated them as requires improvement because:

• Staffing pressures within some specific staff groups were impacting on the experience of patients and the quality of care they received.
• Physical restraint of patients in the prone position (face down) was used more frequently than national guidance recommends.
• People were not always adequately monitored following the administration of emergency medication or while in seclusion.
• People did not always have access to psychological therapies in line with recommended national guidance relating to their condition (for example, individuals with a diagnosis of personality disorder).
• A high proportion of staff were not having regular performance appraisals in line with the trust’s appraisal policy.
• Staff were not receiving mandatory training on meeting the needs of people with a learning disability and/or autistic people in line with the national recommendation that all staff working within a CQC registered service should receive this at a level appropriate to their role.
• When people had their capacity to consent to their treatment formally assessed, this was not always appropriately documented in their care records.
• Records did not always show that people using the service and their relatives were meaningfully involved in their care.
• At Kendray Hospital the wards were running at over 100% occupancy (due to the practice of admitting new patients to the bed of someone who was on authorised leave from the hospital) and there had been a number of admissions to non-bedroom areas such as lounges.
• The care environment did not always meet the needs of the patients, particularly where people had additional needs due to protected characteristics such as disability or religion.

However:

• The wards were clean and free from avoidable risks including ligature risks, staff regularly assessed environmental risks and took action to mitigate these.
• Staff complied with best practice in relation to infection prevention and control including hand hygiene and wearing appropriate personal protective equipment.
• Medicines were managed safely and records of the storage and administration of medicines were accurate and up to date.
• Staff were aware of their responsibilities in relation to safeguarding adults at risk of abuse and raised safeguarding concerns appropriately.
• Staff complied with the requirements of the Mental Health Act and the Mental Capacity Act.
• Staff treated people kindly and with respect, we observed positive and supportive interactions between patients and staff on the wards.
• People could give feedback about their experience and changes were made as a result of this. Complaints were investigated in a timely manner and people received a response to their concerns.
• Senior leaders created a culture on the wards where patients and staff felt supported and were able to express their views.
• There were systems in place for monitoring the quality of care and effective assurance processes to inform the trust board of the standard of care on the acute and PICU wards.

How we carried out the inspection

Before the inspection visit, we reviewed information that we held about the location.

During the inspection visit, the inspection team:

• visited all 9 wards and looked at the quality of the environment

• spent time on the wards observing how staff were caring for people

• observed a governance meeting and a ward round

• spoke with 33 patients on all 9 wards

• spoke with 12 relatives/carers

• spoke with 7 care co-ordinators for patients on the wards

• received feedback from a independent mental health advocate who visits the wards

• spoke with members of the senior management team including 1 service manager, 1 matron, 7 ward managers and 2 clinical leads

• spoke with 6 doctors including consultants, specialty doctors and junior doctors

• spoke with 25 other staff members including nurses, health care assistants, occupational therapists, activity coordinators, psychologists and discharge coordinators

• looked at the prescription charts for all patients, 20 full sets of care and treatment records and other care records, for example seclusion and restraint records

• looked at a range of policies, procedures and other documents relating to the running of the wards.

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

The patients we spoke with gave us a mixture of positive and negative feedback about the service. People mostly told us that the wards were clean, they felt safe and staff managed incidents of aggression well. Some people told us there was always enough staff on duty, but some said the wards were often short staffed and there were a lot of agency workers, particularly on the night shift, which had a negative impact on the quality of their care at times. Most of the people we spoke with said their community leave and/or activities had been cancelled due to staffing pressures on at least one occasion.

People told us that staff treated them kindly and, if they had been subjected to any restrictive interventions such as physical restraint or seclusion, this had been done respectfully and safely. People usually felt they were given enough information about their medicines and said they could access a doctor when they needed to, although some people said there were delays in doctors attending out of normal working hours. Some of the people we spoke with said they felt involved in their care and they were able to give feedback about their experience, but some people felt less involved. People told us that staff gave them privacy as much as possible and they were able to access quiet spaces on the ward. Everyone we spoke with was able to access fresh air sometimes, but patients at The Dales, Priestley Unit and Kendray Hospital had more limited access to outside space, which some people found frustrating.

People gave positive feedback about the occupational therapy support they were receiving overall. Some people said there was not a lot to do on the ward, particularly at weekends. Some people told us that the care environment did not meet their individual needs, for example cultural dietary needs or accessibility needs due to a disability. People knew how to raise concerns about their care and they mostly told us that these were taken seriously and problems were addressed.

The carers we spoke with told us that they were happy overall with the care their relative was receiving in hospital. They said the wards or visiting rooms they saw when they visited were clean and they were able to visit as often as they liked, spending regular time with their relative both at the hospital and away from it (when the person had been granted leave). Relatives told us that most of the staff were kind and supportive towards their family member, although some people told us that individual staff members seemed less interested in their relative, particularly on the night shift.

Several of the carers we spoke with said the ward their relative was on seemed to be short staffed. Some of the people we spoke with said they did not feel that staff kept them informed about their relative’s progress or involve them in decisions and most said they had not been offered any information about the support available to them as a carer. Some relatives said they felt there was a lack of organisation and streamlined processes on the wards, which made it challenging for them to keep up with how their relative was doing.

Updated 23 August 2019

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

• The service had enough staff, who knew the patients and received basic training to keep patients safe from avoidable harm. The number of patients on the caseload of the teams, and of individual members of staff, was not too high to prevent staff from giving each patient the time they needed.
• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it.
• Staff provided a range of treatment and care for the patients based on national guidance and best practice. They ensured that patients had good access to physical healthcare and supported patients to live healthier lives.
• Staff from different disciplines worked together as a team to benefit patients. They supported each other to make sure patients had no gaps in their care. The teams had effective working relationships with other relevant teams within the organisation and with relevant services outside the organisation.
• Staff treated patients with compassion and kindness. They understood the individual needs of patients and supported patients to understand and manage their care, treatment or condition.
• The service was easy to access. Its referral criteria did not exclude patients who would have benefitted from care.
• The service had made significant progress towards reducing the waiting list times for access to psychological therapies. Although, continued to have some patients who had been waiting for an average of 174 weeks.
• Leaders had the skills, knowledge and experience to perform their roles, had a good understanding of the services they managed.
• Staff felt respected, supported and valued. They reported that the provider promoted equality and diversity in its day-to-day work and in providing opportunities for career progression. They felt able to raise concerns without fear of retribution.

However:

• Following the migration to the new electronic patient records system we found information relating to patients’ risk assessment and care plans was not easily available and, in many cases, information had been transferred in to different areas of the new system.
• Resuscitation bags at Drury lane had not been checked for two weeks resulting in the airway aids been out of date.
• Staff in Barnsley and Kirklees told us they did not find senior managers to be visible within the service.