Mental health and community services ‘require improvement’, says watchdog

An NHS trust that provides mental health and community services across five Greater Manchester boroughs has been told it must step up its performance by the health watchdog.

Pennine Care NHS Foundation Care Trust has been given a rating of ‘requires improvement’, following its most recent inspection by the Care Quality Commission – the same ranking it was given in 2016.

The trust provides services in Rochdale, Bury, Oldham, Stockport, Tameside and Trafford – as well as Glossop, just outside the conurbation.

Five of its 17 ‘core services’ were assessed by the CQC – acute wards for adults of working age, wards for older people with mental health problems and mental health crisis services, community dental services and community urgent care.

Overall – taking into account the results of services not inspected this time around – the CQC rated one as ‘outstanding’ (child and adolescent mental health wards), 10 as ‘good’ and six as ‘requiring improvement’.

Some areas of ‘outstanding practice’ were identified by officials, and the trust’s performance was ‘good’ in terms of how caring and responsive it was.

But the watchdog also found four breaches of fundamental standards relating to safe care and treatment, good governance, staffing and person-centred care.

The trust must now improve its record on safety, effectiveness and leadership.

Officials say that ‘significant improvements’ have been made since the last inspection in 2016 – which they say are testament to hard working staff and their ‘dedication’ to patient care.

Inspectors found that, while measures had been taken to improve safety, ‘there remained a risk of harm’.

Outlining its safety shortcomings, the report says that staff did not ‘consistently review’ the effects of medication on patients’ physical health in line with national guidance.

It adds that this is ‘especially’ the case ‘when the patient was prescribed a high dose of antipsychotic medication and rapid tranquilisation’.

In a summary of findings, inspectors note that ‘psychiatric intensive care unit beds were not always available when a patient required more intensive care’ and ‘female patients were unable to access a psychiatric intensive care unit bed within the trust.’

Patients were also said to have ‘limited access to outside space and leisure facilities’.

Moreover, recommendations to prevent future deaths had not been fully implemented within acute wards for adults of working age and psychiatric intensive care units.

Among the services inspectors visited was Taylor Ward, in Tameside – a 22-bed in-patient ward for men and women.

Here they found that the ward ‘did not always ensure that patients were kept safe and their privacy and dignity was maintained’.

The report adds: “Staff had not considered nor assessed the risk of a patient being admitted to mixed-sex accommodation as part of the admission process, nor were there any alerts to inform the ward of previous history regarding disinhibited behaviour.”

Officials acknowledge there have been ‘several improvements; in the trust’s systems and processes, but the report adds: “Patients were at risk of not receiving effective care or treatment. There was a lack of consistency in the effectiveness of the care, treatment and support that patients received.”

However, there was also praise for the services provided by the trust, particularly for its ‘caring’ nature.

Patients were said to be shown compassion and ‘treated with dignity and respect’, while carers were also well-supported.

Staff also provided those in their care with information in a way that would help them to understand it, and patients, families and carers were all able to give feedback about the services.

Responsiveness was also found to be good, with waiting times from treatment ‘generally good’.

Arrangements to admit, treat and discharge patients were all found to be in line with good practice.

The trust was also praised for having taken ‘active steps to engage with patients who found it difficult or were reluctant to engage with mental health services’.

Areas of outstanding practice included the Irwell Unit at Fairfield General Hospital in Bury, and the Saffron Ward, in Stockport.

Clare Parker, executive director of nursing, healthcare professionals and quality governance, said: “While our overall trust rating hasn’t changed, the inspectors have recognised many significant improvements since our last inspection.

“The majority of our services have been rated as good. We’re particularly pleased that our older people’s mental health wards have improved to good and our dental services, which were inspected for the first time, also achieved good.”

She added: “These positive findings are testament to our hard-working staff and their dedication to providing the very best patient care.

“We recognise that we must act to make the improvements identified in the report and plans are already in place.

“Overall, we are pleased to be on a positive journey towards achieving a good rating. Of course, our ultimate goal is to be an outstanding Trust and we will continue to work hard to achieve this.”

Nick Statham, Local Democracy Reporter