Archived: North West Boroughs Healthcare NHS Foundation Trust

Updated 9 October 2020

• We rated three of the five services we inspected as good overall. Of the 12 core services provided by this trust, 10 were rated good overall following this inspection. We rated well led for the trust overall as good.
• There was effective leadership across the organisation. The trust had an experienced leadership team with appropriate skills and abilities. The board and senior leadership team had set a clear vision, values and behaviours that were at the heart of all the work within the organisation. The newly developed trust strategy was linked to the vision and values. Staff in most services knew and understood the provider’s vision and values and how they were applied in the work of their team. There was a clear five year plan to provide high quality care and financial stability. This included a plan of the trust being acquired by another health and social care provider.
• Staff provided care that was personalised, holistic and recovery-oriented. Staff treated patients with compassion and kindness. Staff in most services supported and involved patients, families and carers.
• The services had enough nursing staff, who knew patients and received statutory and mandatory training to keep patients safe from avoidable harm. In most services, staff regularly assessed and managed risks to patients and themselves and achieved the right balance between maintaining safety and providing the least restrictive environment possible in order to facilitate patients’ recovery.
• The trust made sure that it included and communicated with patients, staff, the public, and local organisations. The trust was focused on improving engagement with a new engagement strategy. Patients and carers were able to give feedback and contribute to improvements. The trust was committed to improving services by learning from when things go well and when they go wrong.
• There was a values-based culture which was positive and open. Work on equality and diversity had progressed and workforce race equality was monitored. Staff were able to speak up and were supported with their well-being. Staff felt respected, supported and valued.
• The trust had effective governance structures, systems and processes. Committees worked well with set agendas and had the ability to be responsive if additional items needed to be reviewed. The board had oversight of risk. Teams had access to the information they needed to provide safe and effective care and used that information to good effect.
• The trust had systems in place to identify learning from incidents, complaints and safeguarding alerts and make improvements. There had been recent improvements in investigating serious incidents. Staff understood how to protect patients from abuse and the services worked well with other agencies to do so.
• The trust had appropriate arrangements in place in relation to Mental Health Act administration and compliance. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.
• Information on service quality and sustainability was used and reviewed. Staff could access the data they needed and had the information technology to undertake their roles. The trust had invested in information technology through being part of the Global Digital Exemplar programme.

However,

• On the ward for people with a learning disability or autism, there was not the sufficient range of staff with the required skills to provide safe care and treatment in line with best practice or national guidance. The service did not involve patients and their families in their care and staff did not always review risk in line with trust policy. There were occasions where the inspection team observed staff did not give patients help, emotional support and advice when they needed it or maintain patients’ confidentiality.
• In the mental health crisis services and health based places of safety, there was a lack of clear and consistent policies and procedures to support safe care and treatment. The environment at Atherleigh Park did not maintain the privacy and dignity of patients when caring for two patients at the same time. Staff did not always complete patient records in line with trust policy. There was a lack of specialist training for staff and learning was not shared across the service.
• In the specialist community services for children and young people, waiting times from referral to treatment were too long and not meeting trust targets.
• Vacancies for medical staff had improved but remained high and were having an impact on some services. Not all staff had access to clinical supervision. Some teams had not met the trust target for non-medical staff appraisals. Complaints were not always responded to in a timely way.

Updated 10 October 2018

Our overall rating of this service stayed the same.

We rated it as good because:

• Staffing levels within the community nursing service were sufficient and staff had the right qualifications, skills and training.
• The service prioritised patient protection and there were defined systems, processes and standard operating procedures to keep people safe and safeguarded from abuse.
• There was good compliance with mandatory training in most services however a few services were significantly below trust target in some areas of training.
• We saw evidence of an open and transparent culture in relation to incident reporting. Staff were able to learn from the feedback received from managers and were comfortable reporting their concerns or any near misses.
• Staff treated patients in compassionate, dignified, and respectful ways. Staff were hard-working, caring and committed to delivering a good quality service. They spoke with passion about their work and were proud of what they did.
• Staff reported that managers were available, visible, and approachable. They also told us that leadership of the service and staff morale were good, and staff across the services felt supported and valued by their peers and managers.
• There was an effective governance structure for formal escalation of risk where appropriate.
• Staff were competent, knowledgeable and responded to the needs of patients and of their patients carers.
• Staff understood their roles and responsibilities under the Mental Capacity Act. They could describe when to use it for patients who appeared to lack capacity to make decisions about their care.

However:

• Although the trust monitored and had taken action to address delays in referral to treatment, some services were not achieving the referral to treatment targets.
• The servicing of equipment was not always performed and consumables were not always within date.
• Staff were not supported by the systems and processes in place to consistently monitor and mitigate patient’s risks.

Updated 1 February 2016

We gave the community health services for children, young people and families an overall rating of good.

The level of incidents reported show low risk of harm and safe systems for care and treatment of patients. Staff understood how to report incidents. There were processes in place to help staff provide patients with safe care and support in clean and suitably maintained premises. There were enough staff with the right mix of skills to meet patients’ needs.

The community health services provided effective care and treatment that followed national clinical guidelines. Staff knew how to use care pathways effectively. The services participated in national programmes, such as the healthy child programme.

Most patients experienced positive outcomes following their care and treatment. However, breastfeeding initiation and six week continuation rates were below national averages. The services planned to improve compliance through engagement at baby clinics and breastfeeding peer support sessions, and through raising awareness of these services.

Patients received care and treatment by trained, competent staff that worked well as part of a multidisciplinary team. Staff sought consent from patients before delivering care and treatment. However, the immunisation team did not always apply the Gillick competency principles when providing treatment for young people in special schools and routinely sought consent from their parents or carers instead of identifying whether the young person had the capacity to consent.

Patients’ relatives spoke positively about the care and treatment provided by staff. Staff treated them with dignity and compassion. Staff kept patients and their families or carers involved in their care. Patients and their relatives were supported with their emotional needs, and there were bereavement and counselling services in place to provide support for staff, patients and their relatives or carers.

Services were planned and delivered to meet the needs of local people. Complaints about the service were shared with staff to aid learning. Most patients received care and treatment in timely manner. However, the trust target to treat patients within 18 weeks of referral was not always achieved by the speech and language therapy and occupational therapy / physiotherapy teams. A service transformation plan was in place to improve the delivery of services.

The trust vision and values had been cascaded and staff understood them. There was clearly visible leadership in place through local team leaders and business managers and staff were positive about the culture and support available. Routine meetings took place to review incidents, key risks and monitor performance.

Updated 15 November 2016

We rated Community end of life care services at 5 Boroughs Partnership NHS Foundation Trust as good because:

• The service had made significant improvements since our last inspection and had addressed all areas of concern effectively.

• Staff delivered end of life care in the community setting that was caring, compassionate and supportive of patients and their families.

• The service had a comprehensive and credible framework and strategy for end of life care and this was monitored through regular meetings.

• The advanced care plan document developed to replace the Liverpool Care Pathway in July 2014 was comprehensive and person-centred.

• The trust had appointed a board member and non-executive board member with a specific lead role for end of life care and staff were aware of who these executive leads were.

• Safety was a high priority and there was routine measurement and monitoring of safety and performance within the service.

• Risks were appropriately managed and identified.

• We found that the care delivered to patients was evidence-based and in line with key documents such as National Institute for Health and Care Excellence guidance and priorities of the dying person, particularly personalised care.

• There was routine monitoring of patient outcomes of care and treatment, and patient feedback was actively sought on a regular basis.

• The training for staff involved with the delivery of end of life care was appropriate and provided on a regular basis.

• The end of life care team worked effectively and engaged with other professionals to ensure patients received the required level of care and support.

• Staff appraisals were completed and staff had sufficient clinical supervision.

• Staff spoke positively about the support they were given by seniors and management.

• Staff worked with local hospices, hospitals, GPs and specialists to seek advice when needed.

• When we talked with patients and staff and observed care, we found that staff were passionate and committed to providing good end of life care.

• There was a strong culture of innovation and improvement and staff were actively encouraged to put forward ideas for improving the service.

Updated 20 February 2020

Our rating of this service stayed the same. We rated it as good because:

• The service provided safe care. Clinical premises where patients were seen were safe and clean. The number of patients on the caseload of the teams, and of individual members of staff, was not too high to prevent staff from giving each patient the time they needed. Staff managed waiting lists well to ensure that patients who required urgent care were seen promptly. Staff assessed and managed risk well and followed good practice with respect to safeguarding.
• Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment and in collaboration with families and carers. They provided a range of treatments that were informed by best-practice guidance and suitable to the needs of the patients. Staff engaged in clinical audit to evaluate the quality of care they provided.
• The teams included or had access to the full range of specialists required to meet the needs of the patients. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation.
• Staff understood the principles underpinning capacity, competence and consent as they apply to children and young people and managed and recorded decisions relating to these well.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
• The service was easy to access. Staff assessed and treated patients who required urgent care promptly and those who did not require urgent care did not wait too long to start treatment. The criteria for referral to the service did not exclude children and young people who would have benefitted from care.
• The service was well led and the governance processes ensured that procedures relating to the work of the service ran smoothly.

However,

• Two services were outside the trust targets for referral to treatment time so patients had to wait for their treatment.
• At Knowsley, the reception desk was open plan exposing the clinical staff office directly behind the receptionist. Visitors to the service had a clear unobstructed view of the office and could hear staff talking.
• Staff only had access to personal alarms at two locations. Staff at Wigan told us they felt particularly vulnerable as the design of the building meant consultation rooms were away from staff offices.
• The number of staff receiving appraisal and supervision was below the trust target of 90%.
• Not every location had a functioning young person’s group and there was no consultation group for adults.

Updated 1 February 2016

We rated community mental health services for people with learning disabilities and autism as good because :

Staffing levels were adequate to meet the needs of people who use the service. Staff had access to additional bespoke training in learning disabilities. We saw systems and processes for staff to ensure the safety of services.

Staff completed risk assessments and kept them up to date and relevant to the people who used the services.

Staff were able to identify abuse and safeguarding concerns and follow the correct procedures for their service. Staff knew how to report incidents or harm or risk of harm, and were aware of lessons learned from other areas of the trust when things had gone wrong

People who use the service were involved in their care planning. Staff understood the individual needs of the people using the service and knew how to support them and involve them in their care using a variety of communication aids to maximise their involvement.

Care pathways gave clear guidance on referral and assessment We saw evidence that National Institute for Health and Care Excellence guidance and best practice was followed and shared within the teams.

Staff from a wide variety of disciplines worked in the teams and communication between them was effective.

People detained under a community treatment order were told their rights in a format that they understood.

People who use the services and their carers spoke positively about the care received and interactions they had with staff. People said that advocacy services were available should they want to access them.

The trust and the teams sought feedback from people and carers in a variety of ways.

There was a responsive triage/ duty system that allowed people to have contact with the service for advice and support when needed. People referred to the service were seen the same day if their need was were urgent.

Team managers monitored waiting lists and there was a clear rationale for those waiting more than 10 weeks for care.

Facilities were accessible for people with physical disabilities. Easy read information was available on noticeboards in waiting areas.

People and carers we spoke to said they would feel able to make a complaint if they had one and felt that they would be listened to. We saw team meeting minutes that showed lessons were learned from complaints.

The core values of the trust were used as part of the appraisal process. There were good governance structures for reporting up to the trust and staff knew how to use the system.

The service level leadership and management structures were good. Teams felt that they were well led and supported and there were good monitoring systems for training, supervision and appraisals.

We saw clear commitment to improving services through research and audit. There was also open communication with commissioners to develop key performance indicators metrics focused on learning disabilities.

Updated 1 February 2016

We rated community-based mental health services for older people as good because:

Both the community mental health services (CMHS) we visited had safe, clean facilities that were suitable for delivering care to older people. There were robust systems to ensure security and safety for patients and staff.

Managers planned and reviewed staffing to ensure patients received safe care and treatment. They ensured caseloads were manageable and staff received support to deal with complex issues.

Staff understood their responsibilities regarding safeguarding patients from abuse and the process for reporting safeguarding concerns.

Staff knew what constituted an incident and how to report it. They told us they felt supported and would take responsibility for incidents of harm or risk of harm. After high-level incidents, the trust sent out safety alerts to ensure that staff were aware of incidents and risks and learning was shared.

The care records we saw were of good quality. They included the patient’s views, covered the full range of the person’s needs and were recovery based. Physical health care was well planned and documented.

Although the teams had access to a range of disciplines to support patients, there was no input from clinical psychologists as recommended by the National Institute for Clinical and Health Excellence (NICE).

We found examples of practice designed to improve services; for example, the memory service was accredited by the Royal College of Psychiatrists and there were good examples of work being carried out to meet patients’ diverse needs.

The staff were clear about their responsibilities in undertaking assessments of patients’ mental capacity to make decisions about their treatment. They understood how to ensure that patients were able to understand and agree to decisions or that decisions made by others were in the best interests of the patients.

Staff demonstrated good knowledge and understanding of patients. We observed staff treating patients with respect, kindness and dignity, and it was clear they had a good understanding of their needs. We saw people were comfortable both in the services we visited and when staff visited them at home. Patients we observed taking part in activities appeared relaxed.

The patient, carers and family members we spoke with all told us they felt involved in planning care. They told us staff listened to their views and included them in the care plan. The care records we saw showed that patients and their carers were involved in making decisions about care. Carers said they were offered support when they needed it.

People were supported to maintain their independence as far as possible; for example, by attending neighbourhood groups.

The teams focused on helping people to remain in the community and avoid being admitted to hospital where possible. They made efforts to meet people’s individual needs, including their cultural, language and physical needs. We saw staff engage with patients with kindness and respect. They made plans for people’s continuing support from the start of their treatment.

Patients and their carers and families were involved in planning care and treatment and in making decisions. They told us staff listened to them and supported them. Issues people raised were shared with the teams so they could learn from people’s experiences.

We saw clear examples of strong local leadership. Staff told us they felt respected, valued and supported. They were clear about the vision and direction of the service and about how their work linked into the trust’s vision and values.

Updated 20 February 2020

Our rating of this service went down. We rated it as requires improvement because:

• The trust did not have a specific observation policy for the use of the health-based places of safety. Staff described how they would manage observations whilst patients were in the places of safety, but this was not consistent across the three locations visited. This meant the trust could not be assured that staff were completing observations and managing the places of safety safely.
• The trust did not have a policy or process that staff managing the health-based places of safety should follow when medication had been administered to patients within the places of safety, in terms of observing and monitoring the effects on patients. Staff managing the places of safety did not receive specific training to safely support patients when medication had been used or restraint was required.
• The trust stated that the health-based place of safety at Atherleigh Park was at full capacity with two patients. The place of safety could be split so that patients were kept separate although there was only one bedroom which is not in line with Code of Practice guidance. The trust did not have a written process in place for managing multiple patients in the health-based place of safety. It was not clear how the trust was assured that the place of safety would be safe during these periods. The walls were not sound-proof and it was not clear how the trust was assured that the privacy and confidentiality of patients was maintained in these situations.
• The teams responsible for managing the health-based places of safety at Atherleigh Park and Hollins Park were based at offices off-site. This meant there could be avoidable delays in staff attending the places of safety when needed. The Wigan Assessment team were under pressure at the time of the inspection.
• We observed inconsistent recording in care and treatment records. The 136 records at Atherleigh Park had not been fully completed. At the assessment and home treatment teams, care plans, crisis plans and capacity assessments had not been completed in some of the records reviewed.
• Governance processes were not always operating effectively at team level and performance and risk were not always managed well.

However;

• The mental health crisis teams included or had access to the full range of specialists required to meet the needs of the patients. Managers ensured that these staff received training and appraisals. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation.
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• Staff treated patients with compassion and kindness and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
• The mental health crisis service and the health-based places of safety were easy to access. Staff assessed patients promptly. Those who required urgent care were taken onto the caseload of the crisis teams immediately. Staff and managers managed the caseloads of the mental health crisis teams well. The services did not exclude patients who would have benefitted from care.

Updated 20 February 2020

Our rating of this service stayed the same. We rated it as requires improvement because:

• The service did not provide a range of treatments suitable to the needs of the patients cared for in a ward for people with a learning disability (and/or autism) and in line with national guidance about best practice.
• Leaders did not ensure that the ward team included the full range of specialists required to meet the needs of patients on the wards. Staff did not receive specialist training for their role.
• There was an occasion where staff did not protect the confidentiality of patients, by talking about them in front of other patients.
• Staff did not always understand the individual needs of patients.
• Staff did not inform and involve families and carers appropriately and keep them updated on their loved one’s care.

However:

• The service provided safe care. The ward environments were safe and clean. The wards had enough nurses and doctors. Staff assessed and managed risk well, managed medicines safely, followed good practice with respect to safeguarding and minimised the use of restrictive practices. Staff had the skills required to develop and implement good positive behaviour support plans to enable them to work with patients who displayed behaviour that staff found challenging.
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• Staff treated patients with compassion and kindness.
• Staff planned and managed discharge well and liaised with services that would provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.
• Improvements had been made since the last inspection in June 2018. Managers ensured that staff received positive behaviour support training, supervision and appraisal. The governance processes ensured that ward procedures ran smoothly.

Updated 20 February 2020

Our rating of this service stayed the same. We rated it as good because:

Wards were clean and tidy. Clinic rooms were fully equipped, with accessible resuscitation equipment and emergency drugs that staff checked regularly. Staff had completed and kept up-to-date with their mandatory training. Staff completed risk assessments for each patient on admission / arrival, using a recognised tool, and reviewed this regularly, including after any incident.

Staff developed comprehensive care plans for each patient that met their mental and physical health needs. Care plans were personalised, holistic and recovery-orientated. Staff provided a range of care and treatment suitable for the patients in the service. Staff made sure patients had access to physical health care, including specialists as required.

Patients said staff treated them well and behaved kindly. Staff supported patients to understand and manage their own care treatment or condition.

Staff made sure patients had access to opportunities for education and work, and supported patients. The service had a full range of rooms and equipment to support treatment and care. Staff and patients could access the rooms.

Staff felt respected, supported and valued. Staff felt positive and proud about working for the provider and their team.

However:

There was no ligature risk assessment completed on Tennyson ward in the last 12 months.

There was no timescale for work to be completed on Marlowe ward to reduce the risks identified in the ligature risk assessment.

Patients within the step-down service were not able to self-medicate as there was no provider policy or procedure for this.

Staff did not all have completed yearly constructive appraisals of their work.

The provider’s senior leadership team had not successfully communicated the provider’s vision and values to the frontline staff in this service.

Patients and carers were not involved in decision-making about changes to the service.

Patients and staff did not meet with members of the provider’s senior leadership team and governors to give feedback.

Updated 20 February 2020

Our rating of this service improved. We rated it as good because:

• The service provided safe care. The ward environments were safe and clean. The wards had enough nurses and doctors. Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.
• Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
• The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
• The service managed beds well so that a bed was always available locally to a person who would benefit from admission and patients were discharged promptly once their condition warranted this.
• The service was well led and the governance processes ensured that ward procedures ran smoothly.

However,

• On Golborne and Rydal wards the most up to date fire risk assessment was not in the fire folder. We requested the most up to date assessments and found that Golborne wards had been completed on time but was not in the relevant folder. Rydal wards had been delayed to facilitate a fire audit by the local fire service of the whole building. The risk assessment had been completed on 1st November 2019.
• Despite the fact the trust had worked hard to ensure that mixed sex accommodation breaches were reported, there were high levels of incidents across the service.
• Some of the furniture on Rydal ward was worn and in need of some attention.

Updated 17 September 2020

We did not rate the hospital at this inspection as it was a focused inspection of the safe key question for one ward. The previous inspection rating of good from October 2018 still applies.

• The service did not provide safe care and environmental risks were not mitigated through existing control measures. Staff assessed patient risk, however did not carry out patient observations in line with trust policy to keep them safe. A ward ligature risk assessment was completed and reviewed; however, this did not identify all the ligature risks in the environment.
• On the tour of the ward we found that when en-suite doors were closed there was a gap between the door and door frame which was a potential ligature point. These doors were of a solid construction and potentially weight bearing, and this risk was not identified individually on the environmental ligature point risk assessment.
• Staff did not record the times and intervals of observations in accordance with the trust’s observation, safety and engagement policy. The policy specifies:
• at section 2.5 ‘they avoid predictability when undertaking intermittent observations; for example, ritualistic practices i.e.’15 min checks’ are not likely to reduce risk of harm to self.
• at section 6.16 ‘all records specifically utilised in services in support of this policy must be fully completed with timed observations being captured accurately and contemporaneously’.
• These sections confirm observations should be irregular but within the prescribed window. This is to avoid patients being able to predict when they will next be observed and therefore reduce the opportunity for a patient to harm themselves or others during this timeframe.

However

• The ward environment was clean. The ward had enough nurses and doctors. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.
• Staff developed holistic, recovery-oriented care plans informed by an assessment. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice.
• The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
• The service had experienced a high bed occupancy and had experienced admissions to the ward by people from outside Halton, though had managed beds so that a bed was always available locally to a person who would benefit from admission and patients were discharged promptly once their condition warranted this. At the time of the inspection the ward had suspended admissions following a serious incident on the ward.
• Weaver ward had experienced changes to the leadership team with a new temporary ward manager and at the time of inspection there were no deputy ward managers in place. The ward manager had introduced an action plan to address shortfalls in the monitoring of patient observations prior to the inspection.

We carried out this urgent focused inspection of Weaver ward at the Brooker Centre, Runcorn, due to concerns about the safety of patients on this ward. This was following a serious incident and complaints from patients and their families.

Prior to the inspection we requested the following information:

• staffing levels, including the expected, actual and fill rate numbers for staff on shift, a breakdown of agency/ bank and permanent staff, details of how many shifts that agency/bank staff covered on these two weeks and details of how many agency/bank staff completed a ward induction and when they completed it.
• information on bed occupancy for the weeks commencing 07 and 13 July 2020.
• the numbers of patients on varying levels of observations for the weeks commencing 07 and 13 July 2020.
• information on risk assessment/security checks of the ward environment.
• incident numbers and type of incident from 01 July onwards.
• details of complaints made by patients 01 July onwards.

During the inspection we:

• looked at the quality of the environment and observed how staff were caring for patients.
• spoke with two people who were using the service.
• spoke with the ward manager and operations manager.
• spoke with six other staff members including the clinical lead, registered nurse, health care assistant, psychologist, ward administrator and ward pharmacist.
• looked at seven care and treatment records and five prescription charts.
• carried out a specific check of the medication management, checked the clinic and treatment rooms.
• looked at a range of policies, procedures and other documents relating to the care and treatment of patients.
• requested additional individual patient records to review off site.

Updated 10 October 2018

Our rating of this service stayed the same. We rated it as good because:

• Progress had been made following the last inspection in 2015, where we stated the trust should improve in several areas. We reviewed these as part of the inspection and found staff fully understood and followed the lone working policy, staff were reviewing patients on a CPA with the introduction of nurse-led reviews in between consultant reviews, staff received regular supervision and appraisal and the medicine storage concerns at Warrington and Halton home treatment team had been resolved.
• Patients and carers that we spoke with were happy with the service they received. Progress had been made in the involvement of patients in their care, by facilitating service user groups and activities they could participate in. These included anxiety education sessions and the recovery, education and support time group to increase patients understanding of their conditions and treatment options.
• Staff were passionate and positive about their roles. They reported enjoying working for the trust and felt supported by their managers.
• Record keeping was to a good standard, with comprehensive risk assessments, care assessments and care plans in the records we reviewed. Staff had made the transition to working with the new electronic record system successfully.
• The service delivered safe care and treatment to patients, with physical health screening taking place and the treatment provided was in line with best practice and national guidance.
• Innovations were in place with the street triage service in Warrington, trust wide perinatal service and secure outreach service. Teams had changed ways of working to provide efficiency with the introduction of the telephone triage service at the assessment teams and assessment practitioners at the early intervention teams. This reduced the waiting time for patients to access the service.
• Services were well managed with regular team meetings and supervisions taking place. There were a variety of methods of sharing information. Managers were involved in reviewing their team’s performance.

However:

• We were concerned about the access and waiting times for three of the services. At the Attention Deficit Hyperactivity Disorder service, patients were waiting for up to two years for an appointment. Wigan assessment team had 319 people on the waiting list. Face to face assessment appointments were being booked in for six weeks away.