Agenda item

Purpose of report: Scrutiny of Services and Performance Management.

This report updates the Committee on the outcome of our CQC inspection and the work we have undertaken to respond to their feedback.

Declarations of interest:

None

Witnesses:

Jo Young, Deputy Chief Executive/ Director of Quality (Nurse Director), Surrey and Borders Partnership NHS Foundation Trust

Dr Rachel Hennessy, Medical Director, Surrey and Borders Partnership NHS Foundation Trust

Don Illman, Governor, Surrey and Borders Partnership NHS Foundation Trust and Surrey Coalition of Disabled People

Mike Rich, Chief Executive Officer, Healthwatch Surrey

Key points raised during the discussion:

1.    The Committee asked why more than 50% of residential care homes operated by Surrey and Borders Partnership (SABP) are not compliant with Care Quality Commission (CQC) standards. The Deputy Chief Executive of Surrey and Borders Partnership (DCE) advised the Committee that many of the issues raised by the CQC in relation to the residential care homes related to ‘should do’ as opposed to ‘must do’ compliance actions and so the areas where residential care homes operated by SABP did not fully comply with CQC standards were found to have had a minor impact on the quality of care being provided to residents. It was, however, highlighted that SABP does aspire to be fully compliant with all CQC standards across the residential care homes it operates. The DCE indicated that through supported leadership programmes SABP was working to shore up safety standards and make standards consistent across the various health and social care services that it provides.

2.    Members drew attention to training that SABP provides for staff and requested further information on how the training mentioned in Appendix A had progressed since the CQC inspection. The Medical Director (MD) indicated that steady progress was being made towards meeting targets for providing statutory and mandatory training for staff and the hope is to complete this by the end of the fiscal year (31 March 2015). It was highlighted that personalised training packages had been developed for staff which had led to some delays but that online training has been introduced to meet the challenges of providing training for an organisation which covers such a wide range of health and social care services across a number of locations. The DCE further advised the Committee that it was primarily refreshing of mandatory and statutory training for staff where improvements are required and that resources were being dedicated to ensure that these improvements are delivered.

3.    The Committee expressed particular concern with staff training on restraint methods for patients with mental health issues and asked whether all relevant staff were now fully up to date with training in this area. The DCE confirmed that relevant permanent staff were now fully up to date on this training with the exception of one person where it has not been possible so far. In regard to temporary members of staff, the expectation is that the agencies provide fully trained staff. To circumvent this problem, the policy of creating a rota at the beginning of each shift has been introduced to determine those on shift who have the training. The DCE advised the Committee, however, that staff pursue a policy of avoiding restraining patients where possible.

4.    Members highlighted the significant number of frail and elderly patients with mental health issues cared for by SABP and asked what provision is in place to attend to physical deterioration among these patients. The MD indicated that a physical health nurse had been appointed to identify signs of physical deterioration in frail and elderly patients in their services. The physical health nurse has also been asked to train relevant staff on identifying the signs of physical deterioration in patients. The Committee were further advised that SABP are exploring the possibility of employing more staff with general nursing qualifications and have commissioned a GP to do some work on whether there is a need for these practitioners. The DCE also highlighted that the safety cross system had been instituted across SABP’s services to help staff identify signs of physical health risks such as falls.

5. The Committee asked when SABP would be fully compliant with all ‘must do’ compliancy requirements highlighted by the CQC. The DCE advised the Committee that SABP hoped to be fully compliant with all CQC ‘must do’ requirements in late autumn of 2015 with the delay resulting from the development of a new Section 136 assessment suite at the new Guildford Road site which would meet all CQC requirements on staff safety. Section 136 is used when the police consider a person has a mental illness and is in need of care and so takes them to a place of safety.
6. Members were advised that making the necessary upgrades to existing suites would render them unusable until after the work was completed at Guildford and this was seen as counter-productive. It was indicated that additional work has been done on ensuring staff safety until after the new suite had been completed.

7.    The DCE drew Members’ attention to the success of SABP in reducing the number of individuals with mental health issues being detained in a police cell for their own safety when not appropriate. The Cabinet Member for Public Health and the Health and Wellbeing Board confirmed that there had been a steady decrease incidence of individuals with being detained by police in Surrey inappropriately in custody from 19% to 5% and that this downward trend is set to continue.

8.    The Committee drew attention to the recommissioning of child & adolescent mental health services (CAMHS) contract and asked whether this could be used to tackle some of the issues around the provision of child mental health services. The MD indicated that she was unable to comment on the recommissioning of the CAMHS contract specifically but advised the Committee that the service had been reconfigured to create a rigorous, multiagency service placing an emphasis on prevention and early intervention. Members further queried the extent of multi-agency communication for the new CAMHS strategy. The DCE advised that there was some concern among members of the public around data-sharing especially in relation to mental health but highlighted that SABP is working with partners to develop a system for sharing the right information at the appropriate time to create a joined mental health service for young people in Surrey.

9.    Members asked whether there is someone at SABP with oversight of staff training particularly in the areas of IT training and the provision of English language training for those whom English isn’t their first language. The MD indicated that she has responsibility for staff training at the strategic level and works with managers to ensure that staff are given the appropriate training for their position. The Committee were advised that the introduction of competency-based appraisals allowed managers to identify training needs and create personal development plans for members of staff and that computer literacy and English language training were provided if required.

10.  The Committee enquired about NHS care services for children with mental health issues and asked whether SABP were able to find long term placements for children in their care. The MD highlighted that finding long term placements for children with mental health issues in Surrey was broadly similar to the national picture and that the difficulty in commissioning local services had caused problems in securing NHS beds for children close to home on a long term basis. Members were advised, however, that SABP was working with NHS England and local partners to improve access to in-patient services available locally which would lead to a reduction in the number of out of county placements. It was further indicated that increased emphasis had been put on providing appropriate intensive support services which had led to a reduction in the number of beds required.

11.  Members requested more information on the aspirations for SABP arising from the CQC Inspection. The DCE stated that the inspection represented a learning curve by SABP, which is why they volunteered for the inspection, and that the results from the inspection have provided invaluable feedback for inclusion in SABP’s Quality Improvement Plan. It was further indicated that, while future CQC inspections may yet yield some criticisms or compliance actions, the aspiration was for SABP to be rated ‘outstanding’ by the CQC.

12.  The lay Governor of SABP was asked to provide his perspective on the progress made by the organisation from the perspective of service users. The Committee were advised that CQC patient surveys indicated that basic issues still existed around the extent to which SABP are involving patients in they care that they receive such as a lack of involvement in their own care plans or the type of medication they are prescribed. Attention was also drawn to the performance of Crisis Line and Members were advised that this also required improvement. It was concluded that SABP was generally improving the quality of care it delivered but that these improvements needed to be instituted more quickly. The MD responded by stating that SABP scrutinises the services it delivers through its own feedback forms which provide real time feedback on the Trust and that these surveys indicate that SABP is making more progress against their aspiration of an ‘outstanding’ CQC judgement in the future.

Recommendations:

None

Actions/ further information to be provided:

·         SABP to provide an update on the findings of the external governance review to the Health Scrutiny Committee.

·         SABP to provide the Health Scrutiny Committee with a briefing on the reconfigured CAMHS.

Committee next steps:

·         Committee to consider results of external governance review at a future committee meeting.