"We know we need to improve" - whistleblowers lead CQC watchdog to inspect NHS Trust & this is what they found

The Care Quality Commission (CQC) inspected the Pennine Care NHS Foundation Trust late last year after receiving information of concern from whistleblowers and people using the service.

A report has been issued this week, and it reveals that the overall rating for the Trust’s wards for older people with mental health problems has dropped from Good to Requires Improvement overall. The service also dropped from Good to Requires Improvement for how well-led, effective, caring and responsive it is. Being safe has been re-rated as Requires Improvement. Pennine Care NHS Foundation Trust remains rated Requires Improvement overall.

Warning notice

The CQC has issued a warning notice to focus the trust’s attention on making specific improvements to ensure care was person centred, as well as providing enough staff with the right skills and training to meet people’s needs.

CQC inspectors also found breaches (which were not part of the warning notice) to regulations related to consent to care and treatment, and people’s safety. CQC told the trust to submit a plan showing what action it is taking in response to these concerns. This has been provided, and CQC will continue to monitor the trust to ensure these improvements are made and people are safe while it happens.

Alison Chilton, CQC deputy director of operations in the North West, said: “We found at our inspection of Pennine Care NHS Foundation Trust’s wards for older people with mental health problems, that some of the concerns we had received about the safety and quality of the service were substantiated. We would like to thank people using the service, and staff for their bravery in sharing their concerns, as it helped us to have a better picture of the care being provided to people, which determines if we need to take any action to keep people safe, including carrying out an inspection.

“On the wards we found there were times when there wasn’t enough permanent staff, and sometimes people were cared for by staff who weren’t familiar to them, particularly at night. Also, staff didn’t always have time to sit down and talk to people and give them the social interaction they need. It was also concerning that staff weren’t always trained to provide care to people in a safe way. For example, many staff caring for people with dementia hadn’t received any dementia awareness training.

“However, despite these issues, people and their relatives felt that wards were clean and well maintained which helped to keep them or their loved ones safe.

“We shared our findings with the Trust, so they know where improvements are needed, and since the inspection, they have informed us that they have started to make progress on these. We will continue to monitor the service closely, including through future inspections, to ensure people are safe.”

Inspectors found:

• Care plans did not always show how care was centred on the individual or that the views of carers or relatives had been taken into account.
• Some relatives and carers fed back that visiting times were restricted, and they were only allowed an hour with their relative.
• It was not clear that people who were not detained under the Mental Health Act could leave the wards freely. People did not always have a clear understanding of their rights.
• There was no quality assurance process to check whether compliance with the Mental Health Act was taking place for people.

However:

• Levels of physical restraint and other restrictive practices such as seclusion were low.

What does the Trust say?

Tim McDougall, executive director of quality, nursing & healthcare professionals at Pennine Care NHS, said: “We accept the findings of the CQC’s assessment of our older adult mental health wards and are fully committed to addressing the areas identified for improvement. Our focus is on delivering high-quality, person-centred care for all our patients.

“While the inspection highlighted challenges, it also recognised positive practice - the compassionate care of staff, clean and safe ward environments, and our culture of safety and openness.

“We are already delivering a robust improvement plan focused on strengthening clinical standards, patient engagement, staff training and ward leadership. We’re also improving compliance with mental health law, access to therapeutic activities and work to further embed a culture of kindness, respect and safety.

“Importantly, we are working in partnership with patients, carers and staff to ensure lasting change. We’re proud our efforts are reflected in our latest NHS Staff Survey results which showed improvements across all seven themes, scores above the national average, and recognition as the best mental health and learning disability trust to work for in the North.”