Leicestershire City Council are proposing to keep Leicestershire Partnership NHS Trust as the provider, as it is a high performing service, and to recommission 0-19HCP by using Section 75 of the National Health Services Act of 2006. Services have been transferred to this provider from another provider, Mental health crisis services and health-based places of safety, an inspection looking at part of the service. Staff morale was low and they felt disempowered in some areas. Not all families and carers knew they could attend virtual ward meetings and care programme approach meetings. We found that there were often delays in hospital beds being identified with some people placed out of area away from their family, friends and community. Care plans were generalised, not person centred or recovery focused. Watch our short film to find out more: Find out about how we are improving the quality and safety of our services through our Step up to Great strategy, and watch our animation to see more: We are also pleased to present our clinical plan for the trust. Each priority within our approach is being led by an executive team member and progress is being monitored through our quality governance framework. This left patients without access to treatment when they needed it most. Managers had plans in place to address this issue. We found evidence that patients, at the Bradgate Mental Health Unit, and in some instances, staff, smoking in ward areas. There was evidence of items being submitted to the trust risk register where appropriate. Staff did not always have time to attend clinical supervision sessions and patient information systems were inconsistently utilised and did not always enable effective working. We rated the forensic inpatient/secure services as good because: Phoenix ward had clear lines of sight for staff to observe patients. Staff told us they felt supported by their line managers, ward managers and matrons. the service isn't performing as well as it should and we have told the service how it must improve. the service is performing well and meeting our expectations. Staff said the system was difficult to use and this had affected the information recorded in patients notes. Your information helps us decide when, where and what to inspect. When staff raised concerns or ideas for improvement, they felt they were not always taken seriously. The dignity and privacy of patients across three services we visited was compromised. Not all medicine records included allergy information. We found that there were still errors within the staffs application of the Mental Capacity Act. A carers group was available to give support. Mandatory training that fell below 75% included adult immediate life support, adult basic life support, safeguarding children level 3 and fire safety awareness. The environment in the crisis service did not ensure confidentiality as rooms were not sound proofed and conversations could be heard outside the room. The trust could not ensure continuity of care for these patients. Staff knew how to report any incidents on the trusts electronic reporting system and could raise concerns for the trust risk registers. Mandatory training compliance for trust wide services was 91% against the trust target of 85%. Staff routinely referred patients to access additional support for employment, housing, benefits and independent mental health advocacy. Medication management systems were in place and followed to ensure that medicines were stored safely. Nursing staff interacted with patients in a caring and respectful manner. We heard many examples of interesting innovation projects and work that staff groups had done which impacted on and improved patient care. There was good multi-disciplinary working within the teams and good communication with other organisations. The trust had key roles in the development of health and social care system working, and collaboration with other care providers to improve provision of mental health services. Patients and their relatives felt involved in the care provided. Annual Statement 2009 for - PDF - (opens in new window), Annual Statement 2010 for - PDF - (opens in new window), In Staff were positive about the level of support they received, including regular supervision and line management. Creating high quality compassionate care and well-being for all | Leicestershire Partnership NHS Trust - We provide mental health, learning disability and community health services for a population of more than a million people in Leicester, Leicestershire and Rutland. The trust had made significant improvements to develop a strengthened vision and strategy. Two patients discharges were delayed at The Agnes Unit because the commissioners could not find specialist placements. We saw an example of an SI investigation and also action taken from lessons learnt. There was little evidence that staff supported patients to understand the process, no involvement of family or independent mental capacity advocate in most mental capacity assessments. Curtains separated patients bed areas and the rooms were not secured to allow free access; meaning that patients could have their property removed by other patients. A high number of outpatient appointments were cancelled. We noted how much time the new executive team had invested in making and implementing improvements during the COVID-19 pandemic. The service was meeting the target for initial assessment within 13 weeks of referral with a compliance of 99%. Patients did not have access to psychological therapies, as required by the National Institute for Health and Care Excellence (NICE). This did not demonstrate a consistent temperature, had been maintained to assure the safety and efficacy of the medicines. Services were planned and delivered in a way that met the current and changing needs of the local population. Often patients were admitted to hospital out of the area especially if they need a more intensive support. Services were planned and delivered in a way that met the needs of the local population, for example the Diana Service and the Family Nurse Partnership. Patient outcomes for people using trust services were very good and the trust was able to demonstrate that their services had a positive impact through good data collection and review mechanisms. we have taken enforcement action. Suspended ratings are being reviewed by us and will be published soon. Fire safety was much improved, withfire drills carried out regularly. Staff received robust and detailed shift handovers, including information on patient risks, observation levels and physical healthcare concerns and how these were to be managed. Patients told us that appointments usually run on time and they were kept informed when they do not. Infection prevention and control (IPC) was well managed and monitored and services were responsive to deal with frequent changes in IPC requirements during the pandemic. Improvements had been made to the seclusion facilities, and further improvements were planned across the service to improve patient experience and promote privacy and dignity. Staff gave examples of working with people with diverse needs considering their ethnicity, gender, age and culture. Find out more. The trust had reviewed existing systems and processes identified improvements and implemented changes. We rated Leicestershire Partnership NHS Trust as Requires Improvement overall because: Published There was a lack of understanding in teams how their own plans, visions and objectives connected with the trusts vision. The trust had a range of information displayed on the ward and the hospital site relating to activities, treatment, safeguarding, patients rights and complaint information. We rated the trust as inadequate for well-led overall. long stay or rehabilitation wards for working age adults. Clinical supervision was not taking place regularly across the service. Records about the use of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) were inconsistent. However, we found: We rated the child and adolescent mental health wards as requires improvement because: We rated community-based mental health services for older people as good because: We rated learning disability and autism community services as good because: We gave an overall rating for forensic/secure wards of requires improvement because: We rated Leicestershire Partnership NHS Trust long stay / rehabilitation mental health wards for working age adults as requires improvement because: Overall rating for this core service Good. There were delays in maintenance and repairs in some areas. The trust could not always provide a bed locally for patients who required admissions to its mental health wards. Staff told us their managers were supportive and senior managers were visible within the service. This impacted on the time available for staff development and training. o We do what we say we are going to do. Patients were offered smoking cessation treatments, nicotine replacement therapy (NRT), or free vapes. The electronic data held by the trust was currently being validated with large numbers of visit records not closed on the database. Ward teams did not hold regular team meetings. Staff would still work with people who were on waiting lists so that they received some level of service. In July 2019, the new trust board formed a buddy relationship with a mental health and community health service NHS trust in Northamptonshire (Northamptonshire Healthcare NHS Foundation Trust NHFT) following the previous inspections in 2018 and 2019. There were inconsistent practice around conducting searches onpatients. Not all patient records showed a full assessment of need, including physical health needs or up to date care plans. There were no pharmacy services within the community mental health teams or crisis team. Patients occasionally attended the service. There were effective methods for obtaining feedback from service users and carers and feedback was acted upon. The use of restraint was low and staff used it as the last resort and if verbal de-escalation had not been successful. Patients were not always involved in the planning of their care. Patients privacy and dignity had been addressed at The Willows, Cedar and Acacia wards with changes made to male and female wards. We rated them as requires improvement because: During the inspection, our inspection teams carried out the following activities across 11 wards in the services: During our well-led inspection, we spoke with 32 senior leaders of the organisation and looked at a range of policies, procedures and other governance documents relating to the running of the trust. The group established a deliberate self harm and suicide group in the last year to oversee specific incidents of this nature. Staff carried out physical observations in public areas in one service, and staff did not always record or explain why some observations of patients were required. Some wards and patient areas had blind spots, where staff could not easily observe patients. o We are passionate and creative in our work. o We are one team and we are best when we work together. Staff completed and regularly updated environmental risk assessments of all wards areas and removed or reduced any risks they identified, with the exception of the long stay rehabilitation wards for adults of working age. The community adult team caseloads varied. We found significant issues with trust level governance, oversight of environments, a failure to address keys issues and a lack of pace with delivering essential improvements. Care and treatment was planned and delivered in line with evidence based guidance and standards, and systems were in place to ensure trust policies reflectedthe latest guidance. A further review was an examination of processes and procedures within the trust for reporting investigations and learning from serious incidents requiring investigation. There could be risks posed by the use of different recording systems across teams as staff may not all have access to all records. Managers had a system in place for tracking and learning from safeguarding incidents and other reportable events. Wards had good evidence of multi-disciplinary team working, enabling staff to share information about patients and review their progress. Response times to maintenance request were variable. We found: However, we noted one issue that could be improved: We spoke with six members of staff including matrons, team leaders and mental health practitioners and reviewed all the assessment areas the adult psychiatric liaison team uses. The trust confirmed community hospital staff were expected to undertake four clinical supervision sessions across the year. Following this inspection the trust were required to ensure teams were adequately staffed to prevent impacts on staff workload and ensure staff completed mandatory training in line with trust requirements.Insufficient progress had been made against these notices. Staff did not assess and record the risks posed by medicines stored in patents homes. Meeting these standards and developing the capability to exceed them, will not only ensure that we continue to improve and respond flexibly to changing needs as an organisation, but will also help our staff to fulfil their potential, both in terms of personal achievement and career advancement. Patients own controlled drugs were not always managed and destroyed appropriately. the service is performing well and meeting our expectations. However, no time frame was set for the work to be completed. The ward had sufficient staff to provide care and treatment to patients. Engagement and joint planning between departments was well developed. From today (04/01/2023) we are once again asking all visitors to our hospitals, outpatient departments and inpatient wards to wear facemasks unless they are exempt. There were a high number of patients on the waiting list for treatment in the specialist community mental health services for children and young people. The trust employed registered general nurses (RGN) to assist with assessment and management of physical healthcare needs for patients. There were waiting lists of up to 18 months for psychology and up to 40 weeks for other treatment within the personality disorder service. We rated community based mental health services for adults of working age as requires improvement because: Access to the service was delayed due to variable caseloads and waiting times. There was no funding for staff to provide activities so patients had limited access to activities of their choice during their stay. This was an issue highlighted at our inspection in 2018. The clinic rooms across sites had all the equipment calibrated. For services we haven't rated we use ticks and crosses to show whether we've asked them to take further action or taken enforcement action against them. Crisis and relapse care plans were in place for the people that used services. Where relevant we provide detail of each location or area of service visited. The health-based place of safety did not meet some aspects of the guidance of the Royal College of Psychiatrists. In rehabilitation wards, staff did not always develop and review individual care plans. The community therapy rehabilitation unit at Hinckley did not have a defibrillator in the unit for staff to use in an emergency despite staff having been trained how to use one. The work in neighbourhoods reduced travel for people and reduced barriers for people to gain support. Staff gave examples of initiatives such as the chief executives blog and the presentation of the valued star award. 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