Health trust which looks after Sheffield's most vulnerable residents 'requires improvement'

The Care Quality Commission says its rating of Sheffield Health and Social Care Trust has gone down since its last inspection in 2015.

Secure wards, psychiatric intensive care units and mental health crisis services all ‘require improvement’.

But community based mental health services for older people were rated as ‘outstanding’ and services involving substance misuse, people with learning disabilities and long term mental health problems were ‘good’.

The CQC said the trust had recently had a major reconfiguration of services at the same time as restructuring the management.

It said: “The senior leadership of the trust had not recognised a deterioration in safety of some services during these changes.

“The reconfiguration of community services led to some patients having lengthy waits for services and staff were concerned about their ability to provide a safe and effective service.”

Staff were not always aware of, or adhered to, all policies and procedures or reflected national guidance and good practice.

They did not receive regular clinical supervision and this was significantly lower than the trust target in most core services inspected.

It adds: “Trust managers did not ensure that learning from the investigation of incidents was shared effectively.

“There were not enough staff to provide safe care in three core services. This resulted in high caseloads in community teams, leave and activities being cancelled and a high use of agency staff.

“This meant that one core service did not always have enough appropriately trained staff on duty.”

Inspectors says the leadership team were aware of the challenges and were addressing them.

Patients were positive about the care provided and felt that staff helped them in a respectful, caring, and compassionate way and helped them to understand and manage their own condition, care, and treatment.

Inspectors also found that its psychiatric intensive care units suffered from a lack of nurses and staff who did not manage medications correctly or have regular supervision.

CQC said a high number of posts for qualified nurses were unfilled and there was a reliance on agency staff to maintain safer staffing numbers.

They said: “Despite the use of agency staff, there was not always the required number of staff on duty to undertake physical interventions safely. Demand on staff time and staffing levels remained a constant challenge.

“Staff did not always manage medications correctly and did not receive regular clinical supervision.

“Patients subject to restrictive interventions, such as seclusion or rapid tranquilisation, did not always receive appropriate monitoring or support.

“Safeguarding procedures for children visiting the service were not always robust.

“The service was not always well led and did not effectively use its systems and processes to ensure actions were identified and change was implemented.”

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The CQC rated the trust’s mental health services for older people in communities as ‘outstanding’. They found that staff were kind and caring towards service users and carers and were highly praised as empathetic and sensitive.

The report said: “Staff had reached out to harder to reach communities. There was a strong emphasis on maintaining patients’ links with the local community with lots of groups for older people and an active service user group who made decisions and gave feedback on proposed changes to the service.

“Mandatory training for the team was above 80 per cent and staff received meaningful supervision and appraisal on a regular basis.”

The report added that assessments were comprehensive and people were seen quickly from being referred.

There were strong links with services such as care homes and GPs and staff met regularly to discuss people with complex needs.

Staff feedback about the support they received from managers was universally positive.

Community based mental health services for people with learning disabilities, autism and for adults were also rated ‘good’ by inspectors.

Staff dealing with mental health services for adults treated people with kindness, dignity and respect and were polite, caring and compassionate.

The service ensured that patients had access to advocacy, signers, translators, spiritual support and speech and language therapists.

Staff responded quickly when patients’ health deteriorated, prioritised urgent referrals, encouraged patients to attend healthcare appointments and to lead healthier lifestyles.

With mental health services for people with learning disabilities or autism, people said they felt involved in their care and decisions and staff were interested in their well-being, were polite, respectful and caring.

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People were happy with the services they received.

The trust was found to struggle with the volume of calls to a mental health crisis service, with significant waiting lists and an inadequate telephone system.

The report said: “Staff were struggling to deal with the volume of calls to the mental health crisis service.

“The team had no way of knowing how many people had not been able to access the service. It had a significant waiting list and the telephone system was not fit for purpose in that people could not always get through.

“There was a significant delay in patients receiving a timely Mental Health Act assessment. At the time of the inspection there were 13 people awaiting an assessment.

“Staff were not always given the time to fully review triage/risk information before providing care, treatment and support. Patients had to repeat information or answer the same questions during assessments.”

The report said care and treatments were not always documented in a written care plan.

Team meetings took place regularly but ‘their effectiveness was limited’.

There was no clear focus and meetings were held at the same time as assessment appointments, which meant that some staff could not attend.

The report adds: “There was mixed staff morale across the teams. Some did not feel valued or supported by the trust.”

But inspectors say the trust has made improvements. Staff are now completing risk assessments and carrying out physical health checks and observations as required.

Although some staff did not feel valued, senior managers were aware. Staff were up to date with training and receive regular supervision and appraisals.

Staff carry out an initial triage for all new referrals. Any emergency referrals are offered an assessment within four hours and any routine assessments are allocated to an emotional well-being service. All records reviewed contain a risk assessment.

The issues with the telephones had been escalated and the trust says it has put measures in place to support the system.

The Trust has been approached for a comment. The full report can be read here: https://www.cqc.org.uk/provider/TAH

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