We have given Berkshire Health Care NHS Foundation Trust a rating of good and this was because:
We rated all community and inpatient health services as good. Of the nine core services we inspected in mental health we rated seven as good, one as outstanding and one as requires improvement.
The trust has much to be proud of and also some areas that need to improve. The trust was well led with an experienced and proactive senior leadership team and board. There were also many committed and enthusiastic senior staff throughout the organisation working hard to manage and improve services. The trust responded in an open and honest way to the findings of the inspection team. They responded to put things right immediately where we had raised concerns. They were open, transparent and not defensive.
The main areas that were positive were as follows:
- The wards and clinical team bases were clean and well maintained.
- There was good evidence that medicines were well managed across the trust.
- Staff made good use of best practice guidelines and outcome measures.
- There was a strong culture of multi-disciplinary working. Professionals, teams and agencies worked well together.
- Staff recognised and understood their responsibilities in relation to safeguarding. Staff were aware of how to raise an incident and there was a good culture of learning post a serious untoward incident.
- Patients and their carers were positive about the care and treatment they received and felt they were treated with dignity and respect.
- Staff enjoyed working for Berkshire Health Care NHS Foundation Trust. They told us that the board were visible and approachable. They also spoke positively about the opportunities for professional development and told us that managers encouraged them to attend external training and conferences.
- The trust had taken on some challenging services, particularly in primary medical services, one of which had been placed in special measures. They had managed to turn this service around and it is now rated as good.
- Community health services were all rated as good across the board.
There were two core services that required improvement. These were the wards for people with a learning disability and the Circuit Lane medical centre. The main areas for improvement are as follows:
- There was poor management of ligature points on the learning disability inpatient wards and the child and adolescent inpatient ward. A ligature point can be used by people experiencing suicidal thoughts to harm themselves. On the learning disability inpatient wards the trust had identified numerous potential ligature points, and proposed an action plan to mitigate each. However, staff did not maintain the required level of patient observation; there were an insufficient number of ligature cutters given the physical layout of the ward; and, staff had not received training in the use of ligature cutters.
- Neither the child and adolescent inpatient ward or learning disability inpatient wards met the requirements set out by the Department of Health guidance ‘Privacy and Dignity, the elimination of mixed sex accommodation’. This states that hospitals should provide accommodation which ensures that men and women are separated and have access to their own facilities, such as toilets and bathrooms. This was also a concern at the high dependency unit at Prospect Park hospital.
- Staff did not monitor people’s physical health needs adequately for people with a learning disability.
- Some staff were not communicating well with people with a learning disability, as they lacked the necessary skills and training to do this.
- The trust had not implemented or monitored changes needed in the appointment system in response to patients’ at the Circuit lane surgery. This surgery also needed to ensure that they improved access by telephone to the GP practice.
- We were concerned about the quality and safety of care on the older people’s mental health inpatient units. Not all staff were aware of the risks that individual patients faced, nor of the level of observation and support they needed to keep them safe. Not all staff knew how to prevent or care for pressure ulcers. Not all staff on these wards were receiving regular supervision.
We issued the trust with a warning notice in respect of the high dependency unit at Prospect Park Hospital. This was because the trust had failed to ensure that the rights of those people subject to long-term segregation were being met. This breached their policy and the Mental Health Act 1983 accompanying code of practice. We returned to the high dependency unit at Prospect Park on the 11th of February 2016 and were pleased to report that the trust had resolved the concerns raised in the warning notice and were fully compliant with the law.
In December 2016 we undertook a follow up inspection to find out whether Berkshire Healthcare NHS Foundation Trust had made necessary improvements to the four core services we had rated as requires improvement for the Safe key question. At the comprehensive inspection in December 2015 we issued the trust with five requirement notices that affected these four core services.
• Wards for people with learning disabilities
• Wards for older people with mental health problems
• Acute wards for adults of working age and psychiatric intensive care units
• Child and adolescent mental health inpatient ward
These related to the following regulations under the Health and Social Care Act (Regulated Activities) Regulations 2014:
• Regulation 9 Person centred care
• Regulation 10 Dignity and respect
• Regulation 12 Safe care and treatment
• Regulation 17 Good governance
• Regulation 18 Staffing
We returned in December 2016 and we found that Berkshire Health Care Foundation Trust had acted to meet the requirement notices we issued after our inspection in 2015.
We therefore rated the Safe key question as Good overall.