Agenda item

To receive the Care Quality Commission’s (CQC) Quality Report of the inspection of the Leicestershire Partnership NHS Trust (LPT) in November 2016.  The report was published on 8 February 2017. (Appendix A1)

The Chief Executive of LPT also submits a report which summarises the CQC’s key findings and the Trust’s initial response ahead of the production of a full action plan. (Appendix A2)

The Commission received the Care Quality Commission’s (CQC) Quality Report of the inspection of the Leicestershire Partnership NHS Trust (LPT) in November 2016.  The report was published on 8 February 2017. The Chief Executive of LPT also submitted a report that summarised the CQC’s key findings and the Trust’s initial response ahead of the production of a full action plan.

The Chief Executive LPT introduced the report and stated that:-

a)         The Trust had received a ‘Requires Improvement’ rating following the initial inspection in March 2015.  The follow up inspection in November 2016, involving 86 inspectors across 15 core service lines, had also resulted in an overall rating of ‘Requires Improvement’; although the Safe Services rating had improved from ‘Inadequate’ to ‘Requires Improvement’.  The individual ratings for Effective, Caring and Well Led Services were still rated as ‘Requires Improvement’; although it had been acknowledged that many improvements had been made since the initial inspection. The rating for a Caring Service remained unchanged as ‘Good’.   CAMHS Inpatient ward had received a ‘Good’ rating and progress had been made in adult mental health services.

b)         Although disappointing, the overall CQC rating was considered a fair assessment of the improvement journey since the initial inspection and the Trust remained confident that they were moving in the right direction.      

c)         There was still work to be done to improve the physical environment within the estate.  The Trust was in the process of changing 180 doors within the initial budget of £3m for improvements.  The Trust had been planning to re-build the place of safety unit for some time following the publication of the Mental Health Crisis Care Concordat which meant that it was no longer adequate for the new requirements in the concordat.  The Trust had consequently programmed the rebuilding of the unit but this could not be achieved between the initial and follow up inspections.  Rebuilding the unit was currently underway and it would reopen as all age facility, with separate entrances, in early June 2017.    

d)         Two central themes in the review were around staffing and the use of agency staff and the out of county pathway.

e)         CAMHS had been rated ‘Inadequate’ overall in relation to safety and being responsive in the initial inspection.  The focus since then had been to improve the waiting times for young people improving the initial triage service and introducing a new access model and additional resources for the team.  As a result no one was now waiting longer than 13 weeks for an initial assessment.  However, 640 young people were currently waiting for treatment and initiatives were being introduced to reduce this.  The Trust, as part of the Future in Mind initiative was working with the CCG to provide a programme of measures to improve eating disorders, and provide crisis intervention.  £1m of funding had been provided from 1 April 2017 for dealing with instances of unscheduled crisis.  There had been a 20% increase in demand in the previous year on top of the 10% increase in the previous year.  Staff were working with schools to reduce the growth in demands for service as current level of activity of 5,000 referral a year was not sustainable. 

Following discussion and questions from Members, the following responses were received:-

a)         The work with schools involved educational phycologists and school nurses.  Schools were being asked to identify any additional support they required to enable them to pick up potential issues at an early stage and to provide early intervention and help.  The work involved identifying skills staff may need and simplifying pathways to speed up the referrals process.   This process would be reviewed as journeys progressed along the new pathways and public health colleagues would be involved in the process.

b)         The training for staff development needed to be consistent and gradual; as it was not intended to put too much pressure on school staff and to keep their workload at manageable levels.  The process would be constantly reviewed and adjustments made as the process developed.

c)         Approximately £2m existing and new funding had been identified to support the commissioning process.  Phase 1 of the commissioning of Worth-It Projects, an innovative social enterprise dedicated to supporting children and young people to develop and improve their resilience and emotional wellbeing, had been completed.  They created bespoke evidence-based positive psychology coaching services which support children and young people to flourish.  The second phase of commissioning would begin soon.  Worth-It were identifying what the skills gap was and identifying measures that would ensure it could be closed.

d)         The place of safety unit had originally been established for adults, but the consequence of the Mental Health Crisis Care Concordat, had meant that it then needed to provide for young people as well. When the unit was originally established it had met the requirements that were in place at the time, but the recent Concordat had introduced additional requirements which would not be met until the rebuilding of the unit was completed.  

e)         The CQC had felt that the Trust was not managing the list of 640 young people waiting for treatment pro-actively enough.  The Trust had now addressed this issue and the process had been changed so that those waiting for treatment were contacted regularly to review their state of wellbeing.  

f)         Reducing the number of young people waiting for treatment would clearly be an indication of improvements being made and also maintaining or reducing the current performance on undertaking an initial assessment within 13 weeks of referral. This information on performance was now available.

g)         The Trust aspired to be at ‘Good’ if not ‘Outstanding’ and significant progress had been made since the first quality summit following the initial inspection.  Informal feedback suggested that improvements made in many areas were nearer to ‘Good’ than ‘Requires Improvement’. 

h)        The Trust was meeting the CQC on 16 March 2017 to agree the Action Plan for Improvement and this would be monitored at regular intervals to assess the progress made.  The monitoring report could be shared with the commission.

i)          The Trust accepted that it was disappointing that there had been some isolated incidents in the follow up inspection that had also been mentioned in the original inspection; such as reducing ligature points, missing equipment and fridge temperatures not being monitored adequately.  The Trust were trying to ensure that all staff undertake these tasks at all times across all 150 sites in the Trust’s estate, but the use of agency staff can contribute to this non-compliance.   The Trust was in a similar position to 5 other mental health providers in the East Midlands in the use of agency staff, and staff recruitment and retention was a national issue.  Acute and specialist services vacancies were currently running at 20%; hence the reliance on agency staff.  The CQC did not feel that the use of agency staff had impacted upon patient safety but it did consider it had an effect on staff morale.  The September intake for new nursing entrants was down 25% and this was of concern.

j)          The Trust were active in training permanent bank staff and encouraged agency staff to join their permanent and bank staff.  However, some people like the freedom agency work provided in choosing when to work, even though they lost out pensions and sick pay etc.  Agency staff generally received higher payments and even though a payment cap was being introduced.  The Trust was still confined by national conditions of service and payments in trying to encourage agency staff to become permanent staff.  The Trust had a recruitment and retention strategy, part of which involved working with schools to offer 300 clinical apprenticeships along with UHL.  Maintaining staffing levels was a challenge and remained one of the biggest risks facing the Trust.

k)         In comparison to the national picture, 60% of NHS Trusts were rated as ‘Requiring Improvement’, 35% were ‘Good’ and 5% were ‘Outstanding’.   

The Trust had invited Northumberland, Tyne and Wear NHS Foundation Trust (rated by the CQC as Outstanding) to visit them and share their experiences.  Their average length of stay in hospital for mental health patients was 25 days, which was below the national average.

The Chair thanked the representatives for responding candidly to Members’ comments and questions and, whilst it was clear there has been progress since the initial inspection, Members still had some concerns.   It was recognised by all that staff were working in difficult circumstances to provide good care for patients.  This was not made easier when the thresholds and classifications in inspection regimes changed.  Until recently, ‘Requires Improvement’ would have been classified as ‘Satisfactory’ or ‘Adequate’ which raised less emotive reactions than ‘Requiring Improvement’.  

AGREED:

1)         That the report be received and the representatives of LPT and the CCG be thanked for their contribution to the meeting.

2)         That a further report be submitted to the Commission on the services already being provided for CAMHS, what extra services are being commissioned, any additional services that may be desirable and what outcomes will be achieved.  The report to include the joint working arrangements between staff in schools, Worth-IT and other organisation involved in the process. 

3)         That the Action Plan and the matrix around the delivery of improvements in relation to the CQC Inspection report be submitted to the Commission in the autumn.