Chief Inspector of Hospitals rates Tees Esk and Wear Valleys NHS Foundation Trust as Good
England’s Chief Inspector of Hospitals has rated the services provided by Tees, Esk and Wear Valleys NHS Foundation Trust as Good following an inspection by the Care Quality Commission in January 2015.
The trust provides a range of mental health, learning disability and substance misuse services to a population of 1.6 million people in County Durham, Darlington, Teesside, and North and West Yorkshire.
A team of inspectors, which included a variety of specialists and experts by experience, visited hospital wards and community based mental health services over a period of five days. They also made unannounced visits as part of the inspection. Full reports including ratings for all of the provider’s core services are available at: http://www.cqc.org.uk/provider/RX3
Inspectors judged the care provided by staff to be good across all the core services. Staff fully supported patients, treated them with dignity and respect and involved them in their care and treatment.
Dr Paul Lelliott, CQC’s Deputy Chief Inspector of Hospitals, said:
“People are entitled to services which provide safe, effective, compassionate and high quality care. Tees, Esk and Wear Valleys NHS Foundation Trust provides good and some outstanding services to a large population. We found a committed and caring workforce that was meeting the needs of its patients.
“The staff we met were positive about their work and proud to be employed by Tees Esk and Wear Valleys. They trust the leadership team to manage the uncertainties, and lead the organisation in a way that enables them to concentrate on developing the services and delivering high quality care.
While our overall finding is that the trust provides a Good service, we did find some areas for improvement. The trust has told us they have listened to our inspectors’ findings and we are confident that the executive team, with the support of their staff, will work to deliver those improvements on behalf of all of their patients. We will return in due course to check that the improvements have been made.”
CQC found that the trust had a strong leadership team that promoted the delivery of good quality care with a clear statement of vision and values. The team was leading by example in focusing on quality and safety while improving the experience of staff working at the trust. Morale across all staff groups was high and staff felt engaged in the continuous improvement of services across the trust.
The trust provided effective services that met people's needs in line with national guidelines. It monitored information routinely about patient care, treatment and outcomes to improve the quality of care and staff fully understood their responsibilities to raise concerns and report incidents.
There were good systems in place for multidisciplinary working between the staff and with other agencies in all of the core services. This was particularly evident in relation to the safeguarding of vulnerable adults, children and young people. The trust regularly reviewed its staffing levels to keep people safe and published these on their website.
Although staff planned services in consultation with health and social care partners and commissioners, some patients remained on the trust’s learning disability wards longer than necessary because there were no suitable places for patients to move to.
Inspectors found safe management of medicines across trust sites. However, on wards for older people where some medicines were administered covertly (disguised by mixing with food or drink), authorisation for this was not always recorded in patient notes in line with trust policy. On two of the trust’s long stay rehabilitation sites and two acute wards, inspectors also identified some environmental risks and ligature points which posed a risk to patients.
The reports highlight several areas of good practice, including:
- The learning disability and autism service had a steering group and champions for positive behaviour support. The role and purpose of the group and champions was to embed teaching and learning across the locations to ensure positive behaviour support was an effective tool to manage complex behaviours which challenged.
- The implementation of a programme, within the substance misuse services, to provide emergency medical treatment for those identified as high risk of opiate overdose. Staff had been told that the programme had prevented a number of deaths in the community.
- In the wards for older people service, and specifically on Springwood and Rowan Lea, staff were using specialist computer programmes to enable them to interact with people with memory problems in a positive way.
- Excellent examples of some crisis teams encouraging patients to develop advance directives to help them determine their future crisis care needs.
- The pharmacy team had worked with some of the wards to develop and implement robust step down procedures to support patients in managing their own medicines in preparation for when they moved on from the ward.
Inspectors said that the trust must improve in some areas, including:
- The trust must take action to review the covert administration of medication without reference to the pharmacist or through a best interest meeting on Ceddesfeld and Hamsterley Wards. It must also ensure that on Hamsterley Ward staff sign medication administration records for patients as medication is administered.
- The trust must ensure that in the acute wards, intervention plans are in place which clearly outline measures to manage any risks to patient safety.
- The trust must ensure that all staff on Ward 15 are given clear guidance on the management of ligature risks and current risks posed by patients and make the appropriate adjustment to observation levels.
- The trust must ensure that each patient in the learning disability wards has a comprehensive discharge plan which is holistic and person-centred.
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Notes to editors
Tees, Esk and Wear Valleys NHS Foundation Trust provides a range of mental health, learning disability and substance misuse services for the people of all ages living in County Durham; Darlington; the four Teesside boroughs of Hartlepool, Stockton, Middleborough and Redcar and Cleveland; Scarborough, Whitby, Ryedale, Hambleton, Richmondshire and Harrogate districts of North Yorkshire and the Wetherby area of West Yorkshire.
The trust provides the following core services:
Mental health wards:
- Acute wards for adults of working age and psychiatric intensive care units.
- Long stay/rehabilitation mental health wards for working age adults.
- Forensic inpatient/secure wards.
- Child and adolescent mental health wards.
- Wards for older people with mental health problems.
- Wards for people with learning disabilities or autism.
Community-based mental health and crisis response services:
- Community-based mental health services for adults of working age.
- Community-based mental health services for older people
- Mental health crisis services and health-based places of safety.
- Specialist community mental health services for children and young people.
- Community mental health services for people with learning disabilities or autism.
- We also inspected the following services that the trust provide:
- Substance misuse services
- Adult social care services
The Care Quality Commission has already presented its findings to a local Quality Summit, including NHS commissioners, providers, regulators and other public bodies. The purpose of the Quality Summit is to develop a plan of action and recommendations based on the inspection team’s findings.
Under CQC's inspection model, the Chief Inspector of Hospitals, Professor Sir Mike Richards, is leading significantly larger inspection teams than before, headed up by clinical experts, specialist inspectors and trained members of the public. Whenever CQC inspects it will always ask the following five questions of every service: Is it safe? Is it effective? Is it caring? Is it responsive to people’s needs? Is it well-led?
Since 1 April, providers have been required by law to display their ratings on their premises and on their websites so that the public can see their rating quickly and easily. This should be done within 21 days of publication of their inspection report. For further information on the display of CQC ratings, please visit: http://www.cqc.org.uk/content/display-ratings