Multiple incidents of staff being asleep or not interacting with patients during observations are among key patient safety issues identified in a large mental health trust in East England, when inspected by the health care regulator.
The Care Quality Commission (CQC) has downgraded its rating for Essex Partnership University NHS Foundation Trust, which provides support, treatment, and advice to people experiencing poor mental health, including people detained under the Mental Health Act. After inspections in November and January in response to concerns about the safety and quality of services, CQC rated the trust as "requires improvement", down from "good", its newly published inspection report shows.
"We found multiple incidents where staff had fallen asleep or didn't interact with people during observations," said Rob Assall, CQC's director of operations in London and the East of England. "Yet senior leaders believed observations had improved because their data wasn't always accurate."
The trust's ratings for effectiveness, responsiveness, and quality of leadership also dropped from "good" to "requires improvement" after the inspections . The trust's rating for safety was again rated as "requires improvement", while its rating for caring dropped from "outstanding" to "good". The individual service ratings have also been updated.
The latest inspection came after a warning notice CQC issued to the trust last October after an inspection of its acute wards for working-age adults and psychiatric intensive care units (PICU).
Key CQC Findings
The key CQC findings included:
- People weren't always cared for by staff who knew them and the service well, due to a high usage of agency staff. On acute wards, there weren't always enough staff to keep people safe. Vacancy rates for qualified staff were 21%.
- Staff didn't always follow the trust's processes to safely store, prescribe, and give people medicines. There weren't always enough pharmacy staff on duty, with teams operating with a 45% vacancy rate overall.
- The trust had recently created a new complaints system, but some old complaints were still unresolved.
- People mostly said they felt safe, valued, and respected. However, some people on acute wards said staff on night shifts were uncaring.
The CQC also made a number of positive findings, including that staff were reported to be compassionate and knowledgeable when things went wrong, leaders understood the need to design services suited to the local population's needs, and the trust played a lead role in making COVID-19 vaccinations available to everyone in Essex.
Same Issues Identified in Previous Inspections
"When we inspected the trust, we were very disappointed to find people's safety being affected by many of the same issues we told the trust about at previous inspections," said Mr Assall. "This is because leaders weren't always creating a culture of learning across all levels of the organisation, meaning they didn't ensure people's care was continuously improving or that they were learning from events to ensure they didn't happen again.
"For example, one ward continued to restrict people going into the garden because of a blind spot where staff couldn't see people to ensure their safety," Mr Assall notes. "We told the trust to address this in October last year, yet people were still being restricted because the blind spot was still there."
Despite these issues, trust leaders recognised the need to develop a learning culture and were implementing many programmes to do so, he acknowledged.
"However, many of these improvement programmes started long after issues were identified, and it shouldn't have taken them this long to address things affecting people's safety and well-being."
The CQC said it would continue monitoring the trust to ensure it is providing safe care and treatment and is following through with its improvement programmes.
Working on a Number of Areas
In response to the CQC's findings, a spokesperson for Essex Partnership University Trust said : "We're committed to working with CQC and partners to improve the quality of care that we give to our patients and those who use our services.
The spokesperson emphasised that the trust is already working on a number of areas to improve services, so that their patients "receive the compassionate care they deserve".
Essex Partnership University NHS Foundation Trust, Care Quality Commission. Published 12 July 2023.