Risks of strangulation and ‘visible filth’ found in Leicestershire NHS wards for mental health patients

An NHS trust which provides mental health services in the city and county has made improvements following a critical inspection report last year – but still has work to do – according to its latest performance review. The Care Quality Commission (CQC) has carried out a further inspection of Leicestershire Partnership NHS Trust after previously raising concerns about the ability of some patients to seek help and staff stepping in on changing patients.

Officials returned unannounced in January this year to inspect the trust’s adult wards and its psychiatric intensive care units. Their latest rating, published today, showed the trust’s rating for the service remains “requires improvement”.

The report noted that improvements had been made and when the score was broken down by category, the trust rating for service effectiveness, responsiveness and manner of care improved to ‘good’. It remained “requires improvement” for safety and driving.

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Inspectors found that staff in some wards did not identify all potential safety risks to patients. Discarded bamboo canes were left in a garden area, a first aid kit with a broken latch and screws were left outside and not all strangulation risks were identified.

The CQC said it found a string of Christmas lights and a cupboard containing wires from a games console was not “properly locked”. Furthermore, one patient told the inspection team that they were able to get hold of an object in the clinic that he could have used to self-harm.

The patient was unharmed as he had been seen by staff and returned the item, but patients told inspectors they did not always feel safe because they could have access to such items.

Staff reported the incident and fixed the clinic’s faulty door, according to the documents. The inspectors also said that the risks they identified during the visit were removed “as soon as” concerns were raised.

Since the last inspection, the trust has reviewed the provision of alarms and there are now sufficient throughout the service. This was no longer considered a failure by the inspectors.

Patients also told the team that most of the staff were “kind people and treated with dignity and respect”. On one ward, inspectors said there was a patient with a terminal illness and staff “took the time to know his wishes” and when the team were on the ward they saw them “doing everything they could for this patient by arranging a meaningful and fulfilling activity with his family”.

But some claimed night staff and temporary staff could be “uncaring, rude and dismissive”.

Cleanliness at the job was a mixed bag, the inspectors continued. Three wards were described in the report as “clean, comfortable and well presented”.

A fourth – Belvoir Ward – was “tired and in need of updating”. The report highlighted marks and cracks on some walls and light fixtures showing signs of “wear and tear”, but noted there was a plan for improvement.

Inspectors also found that parts of Belvoir Ward were not “clean and tidy”, despite cleanliness records being signed off. Problems included a flush toilet in an isolated room that hadn’t been used in a week, and dirt stains in the shared bathroom and showers.

Wet towels were also discarded and left in the corner of a room, the team added. They further saw “congested areas” which included “an area where a box of gloves, bags, tissues, discarded leaflets and an unused disposable urinal remained”.

An area for patients to make their own hot and cold drinks was marked ‘visibly dirty’ and ‘milk left out’. During the inspection, staff were briefed and the area was cleared, the report added.

Confidentiality was not always maintained for patients, the CQC continued. In Belvoir Ward again, inspectors found that a CCTV video feed of an isolated area, which included a view of the toilet, was visible to people on the ward. Ward management “arranged for a privacy shield to be installed immediately” after the issue was raised.

There was also a high vacancy rate within the service, with an average rate of 39% across all areas analysed. Instead, there was a low rate of staff turnover at the service, which “had access to a full range of specialists to meet patients’ needs”, the CQC said.

Inspectors said the trust was actively recruiting at the time of the visit and managers used bank and agency staff to fill gaps. It found that there were enough medical and nursing staff who knew the patients to protect people from avoidable harm.

But not all employees were aware of their training, the report continued. Compliance with basic life support training was 75% per ward, and immediate compliance with life support training ranged from 53% to 90%, depending on the ward. In another ward, only 53% of staff had up-to-date level three training – and compliance was low in half of all wards.

Managers were described as “friendly and approachable” and as having “an open door policy”. They were also quick to address risk issues, although the CQC said it was “concerned” that processes “did not allow staff to identify or act on these concerns before the inspection”.

The CQC also visited a second area of ​​the service in January: community health services for adults, which benefited largely from care provided in patients’ homes. This had previously been rated ‘requires improvement’ but improved to ‘good’ after this inspection.

Inspectors praised the service saying staff in this part of the trust kept ‘up to date with their mandatory training’, ‘understood safeguarding systems and processes and how to protect patients from abuse’ and ‘could provide examples of how to protect patients of harassment and discrimination”. They also “knew how to identify adults and children at risk”.

Permanent staff were described as “experienced, qualified and had the right skills and knowledge to meet the needs of patients”. They also kept their equipment and work area “visibly clean” and acted in a way that protected “patients, themselves and others from infection,” the team said.

Staffing levels were again identified as a concern, with inspectors saying the service “did not have enough permanent care and support staff to meet patient needs”. As of December 2023, there were 144 vacancies in this area of ​​the trust – a rate of 22 per cent.

Staff gaps were also filled by staff from the bank and agencies in this area. Managers used agency staff “from agreed suppliers wherever possible”, but this did not always meet all exchange needs, the report continued.

Where staff were used outside of agreed providers, support was provided by a permanent member of staff. However, they were not always able to access electronic health records immediately, the CQC said.

Staff followed systems and processes for prescribing and administering medicines to patients “safely”, inspectors found. They also regularly reviewed each patient’s medications and advised them and their caregivers on their medical care.

Ultimately, the CQC said “outcomes for patients were positive, consistent and met expectations” across community health services and leaders “have the skills and abilities to lead the service”.

Angela Hillery, chief executive of Leicestershire Partnership NHS Trust, said: “Quality and safety remain our number one priority and we are aware that there is more to do. I am encouraged that our continuous improvements have been recognized and it is pleasing that both inspections have highlighted improvements. These are significant achievements and I want to thank all the employees involved.

“However, the inspection team assessed that acute mental health environments were not always safe, clean, well maintained and fit for purpose.” We took immediate action in response to the concerns raised and put in place a robust plan to monitor them.

“Compulsory training rates have also improved significantly since the inspection and are now over 85% in almost all areas.”

Anne Scott, head nurse at LPT, said: “I am so proud that our staff have been recognized as caring and compassionate by CQC inspectors. In both reports there are many examples of good practice involving patients and carers, about our commitment to providing quality care and continuous quality improvement, career progression and equality, diversity and inclusion and how supported staff feel about expressing any concerns they might have. have. This reflects the significant improvements we have made to our culture and leadership, which we will continue to build on.

“The CQC noted the high vacancy rates of acute mental health services for registered nurses and that staff compliance with mandatory training was variable. Although the shortage of nurses is a national issue, we have undertaken a significant recruitment drive since the inspection and have 37 new nurses who have already started or are ready to start.

“I am also very pleased that the reports reflect our active role with partner organizations to improve the health and wellbeing of people in Leicester, Leicestershire and Rutland.”