Agenda item

Dr Henry Ticehurst, Medical Director/Deputy CEO (Acting) will report at the meeting.

Dr Henry Ticehurst, Medical Director provided members with an update in respect of the CQC Action Plan.

The CQC conducted an announced visit week commencing 13^th June 2016.  The inspection was conducted as part of an ongoing comprehensive mental health inspection programme.

The Overall ratings for the services of the provider was: Requires Improvement

Are services safe?                                                           Requires Improvement

Are services effective?                                                    Requires Improvement

Are services good?                                                          Good

Are services responsive?                                                 Good

Are services well led?                                                     Requires Improvement

Staff were on the whole responsive, respectful and caring and professional in their attitudes and worked to support the patients.

Staff had a good understanding of safeguarding.

The Trust had business continuity plans in place across services for emergencies and staff said they were supported by their managers.

Multi-disciplinary team working was well developed across the Trust both internally and externally.

The Trust had a range of facilities that provided and promoted recovery, comfort, dignity and confidentiality to the patients and families in their care.

Good practice was highlighted in: Older people’s services, learning disability services; CAMHS and End of Life Care

Six services were rated as requires improvement, these were:

• Wards for older people with mental health problems

• Acute wards for working age adults and psychiatric intensive care units

• Community based mental health services for adults of working age

• Mental health crisis services and mental health-based places of safety

• Community end of life care

• Community health services for adults

The main areas for improvements:

Breaches of guidance for same sex accommodation in wards for older people and acute wards for working age adults and psychiatric intensive care units.

Trust medicine management policy was not being observed.  Issues around deprivation of liberty of those age over 16 and mandatory training was under the Trust minimum

• The monitoring of physical health was varied across the mental health services, with some of the mental health services not monitoring physical health and recording it in their care records.
• There were inconsistencies in staff composition in teams within the same service, with different levels of staff and different skill mix of staff.
• On the wards for working age adults there was high bed occupancy across all of the wards which led to patients’ needs not being met in a timely manner.
• On wards for working age adults patients did not always have a bed to return to upon return from leave.
• Patients in some community services were waiting longer than the targets for assessment and commencement of treatment.  This meant that patients were waiting longer than 12 weeks for assessment and longer than 18 for treatment in the Health Young Minds service.
• There was a lack of cohesive working across the boroughs in some of the services. Teams in some services did not have much interaction between them and worked separately.
• There were inconsistencies regarding skill mix in teams across, different areas of the same service as well as inconsistencies in local governance arrangements
• There was no fixed timescale for completing management investigations and some investigators had not had investigation training. Investigations were not all sufficiently thorough, actions did not identify nor any future risk mitigation plans identified. They were not always undertaken by an impartial investigator.

Members were invited to ask questions and the following issues were raised:

In response to a Member’s question in respect of wheelchairs and the Corporate Risk Register, the Medical Director reported that this is an ongoing issue for the Commissioners within the CCG.

In response to a question about Matrons, the Medical Director reported that there had been a drop in the number of Matrons across the Trust and this was in part due to financial constraints.

Members of the Joint Committee raised concerns that issues in respect of training and medicine management highlighted in the report are in part due to problems with supervision, lack of training and lack of funding.

With regards to the Duty of Candour, the Medical Director acknowledged the concerns raised by members, the Trust challenged the information presented in the CQC report as they did not think it fairly represented the Trust’s position.

In response to a Member’s question in relation to staff engagement, the Head of Communications reported clinicians will visit programmes, wards and community services.  The Trust is planning an engagement event with staff in respect of the mental health strategy; Board meetings rotate around the Pennine Care footprint and the staff engagement strategy is currently being revised.

In response to concerns raised in respect of a lack of cohesive working across the Trust, the Medical Director reported that work is underway to prevent this.  Those who work within mental health services are usually wedded to an organisation whereas those who work in community services are wedded to a locality.  The Medical Director acknowledged more work could be done to share the learning within Community services.

The Medical Director reported that the Trust financial position is an issue for the Trust it is hoped that this may be a helped by additional funding being made available as part of GM Devolution.

It was agreed:

Members will continue to scrutinise the CQC Action plan and may consider establishing a task and finish group to review a particular area of the plan