Agenda item

The recent inspection report is attached for the Select Committee to read. Officers from the CQC and AWP will attend the meeting and give a brief presentation.

Tony Fletcher, CQC Inspection Manager introduced this report to the Select Committee. He explained that the inspection visit was carried out over a two week period from 16 May to 27 May 2016 and covered a large geographical area and range of services.

He stated that during the inspection we visited 37 wards, four health based places of safety, 28 community teams and spoke with:

• 127 patients

• 22 carers

• Members of the executive team and trust board, including the chief executive and the chair

• Twenty two senior managers

• 93 service and ward managers

• 357 other staff, including registered nurses, health care support workers, doctors, psychologists, occupational therapists and practitioners.

He highlighted three key areas from within the report.

Wards for patients with dementia were not dementia friendly with the exception of ward four in Bath. However, environmental security in the forensic and secure services had improved significantly since our inspection in June 2014 and risk were managed well at both a ward level and individual patient level.

We had serious concerns with the timeliness of Mental Health Act assessments for people detained in the places of safety. Data showed that a significant number of people were in places of safety for over 12 hours waiting for assessment, and many for two or three days. There were eight occasions between March 2015 and April 2016 where people were there beyond the legal limit of 72 hours.

There were also delays in the attendance by the child and adolescent mental health (CAMHS) service (provided by another trust) when there was an admission of a young person. One young person was detained under Section 4 of the Mental Health Act due to the lack of availability of a second doctor to undertake an assessment at the place of safety.

He said that they had found that the trust had made some significant improvements to the safety and quality of services, staffing levels and governance arrangements even at the time of inspection.

Councillor Paul May commented that he was pleased to hear the progress being made especially with regard to governance.

Tony Fletcher replied that key appointments had been made by the Director of Nursing. He added that a further inspection would likely take place in 2017 to assess if the changes are working.

Councillor Paul May asked if the inspection assessed whether the services provided were appropriate for the needs of the community.

Tony Fletcher replied that it did not. He said that the inspection assessed the safety of the provision being provided.

Councillor Eleanor Jackson commented that it was good to see a vast improvement of the ligature policy as it had previously been inadequate. She said that there remained a shortage of around 29 acute beds which had seen some patients sent to Salisbury and Harrogate.

Tony Fletcher replied that he had heard evidence of patients being sent a long distance for acute provision.

Councillor Eleanor Jackson urged for better care in the community with regard to psychiatric care.

Tony Fletcher replied that in the opinion of the CQC the crisis teams had improved.

Councillor Lin Patterson asked if there were any plans to rationalise the area covered by the Trust.

Dr Bill Bruce-Jones, Clinical Director AWP replied that there were not, but that local delivery units do exist and are aligned.

The Director of Integrated Health & Care Commissioning commented with regard to bed capacity that the 8 beds that had been closed at Hillview Lodge had been re-provided through some additional beds in B&NES and the local area. She added that the intention is for further re-provision to include current and future need.

Councillor Paul May asked if AWP can provide a local specialist service.

Dr Bill Bruce-Jones replied that he felt strongly that it would be a great shame they could not provide a full range of services. He added that there was a three year project plan to provide bed provision within B&NES.

Councillor Vic Pritchard asked how much money would be required for the project.

Dr Bill Bruce-Jones replied that it would cost £20m.

The Director of Integrated Health & Care Commissioning said that they anticipated being able to access some funding for the project through NHS Improvement and that they were actively looking for other sources of capital funding.

Councillor Paul May asked if the project would achieve enough revenue.

Dr Bill Bruce-Jones replied that a business case has been prepared.

The Director of Integrated Health & Care Commissioning said that the CCG have confirmed this.

Dr Bill Bruce-Jones gave a presentation to the Select Committee regarding the response from AWP following the inspection. A copy of the presentation can be found on their Minute Book and as an online appendix to these minutes, a summary of the presentation is set out below.

Our experience

“Inspectors were respectful and collaborative.”

“The dialogue with inspectors was excellent; they keep us abreast of their findings so we were able to address many issues within a day.”

What was said

One core service ‘Inadequate’

One service ‘Requires improvement’

Six rated ‘Good’

Overall: Requires improvement.

Place of Safety - What do we know?

We lacked breadth and depth and coordinated data on Place of Safety quality and performance.

Within our health-based Places of Safety, the wait for a Mental Health Act assessment was too long and breaches to 72 hour rule “occurred in the absence of adequate escalation processes.”

Information – What do we know?

91% of people detained under S136 arrive with police (or police and ambulance).

Mason Unit detained five times as many people compared with other suites (+50 compared with average 10).

Place of Safety – Making a Difference

We will have an established system wide response to the issues identified by the CQC initially led by Keith Pople.

We will have sustainable Places of Safety with individuals detained appropriately and within timescales, acknowledging reduction in detention times to 24 hours.

Older Adults – What do we Know?

Our record keeping in relation to The Mental Capacity Act, Incident reporting and Care plans were inconsistent.  Adherence to care plans and collaborative involvement with service users was also variable.

The standard of our Inpatient environments was variable. They were not all “dementia friendly”.

Older Adults – what did we do?

Nurse Consultant for Dementia Care has created a ‘Dementia Strategy’ for the trust which will guide the organisation in addressing areas highlighted by the CQC and beyond in reference to government policy. The aim will be to achieve excellence in care for this target group.

The Trust has implemented a Trust wide audit of in-patient units against King’s Fund standards for dementia friendly environments, to be completed by December 2016.

B&NES – Specific Issues

Vacancies and recruitment in Intensive Service

Ward 4 environment

B&NES – Good Practice

Fresh Art project

Therapies service – Quality improvement audit

Recovery service – community medicines management

Councillor Bryan Organ asked if the new Police building in Keynsham had helped with regard to a Place of Safety.

Dr Bill Bruce-Jones replied that it did not as it is not designed appropriately.

Councillor Lin Patterson asked what makes the Talking Therapies Service the best in the country.

Dr Bill Bruce-Jones replied that it takes a lot of hard work and a great team of young practitioners.

Dr Ian Orpen said that he echoed the comments regarding Talking Therapies and that it was one of the best Mental Health Services he had seen in his career.

The Chair thanked Tony Fletcher and Dr Bill Bruce-Jones for attending the meeting on behalf of the Select Committee.