Mental health wards rated as 'requires improvement' after surprise inspection

Wards managed by the NHS trust in charge of mental health services for the region have been rated as requiring improvement after concerns over care were raised.

The Care Quality Commission (CQC) carried out an unannounced inspection of the forensic inpatient and secure wards run by Avon & Wiltshire Mental Health Partnership NHS Trust in January. The watchdog was sent in after concerns were raised by people who use the service, as well as their loved ones, about the quality of care being provided.

Patients had reported they were “not always treated with dignity and respect” and some staff were “anxious” over reporting incidents due to “high levels of staff disciplinary procedures”. Relatives had reported frustrations over their concerns not being taken seriously by senior leaders and having to repeatedly raise the same issues.

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One relative complained about an inpatient being admitted to hospital over their physical health after health concerns were raised to agency staff but 'disregarded'. Concerns over safety had also been reported over a lack of knowledge of emergency procedures and 'breaches of regulation in safe staffing and safe care and treatment.'

The Trust has been told it "must improve after an over-reliance on agency staff", which was negatively impacting patient care as staff were not familiar with patient’s individual needs. Overall the CQC found that little had changed since its last inspection in July.

The overall rating for Avon & Wiltshire Mental Health Partnership NHS Trust is unaffected and remains requires improvement. Catherine Campbell, CQC deputy director of operations in the south, said: “When we inspected the forensic inpatient and secure wards run by Avon and Wiltshire Mental Health Partnership NHS Trust, we found very little had been done to improve people’s care since our previous inspection in July last year.

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“We saw people’s care was being impacted by staff shortages, which was causing an over-reliance on agency staff who weren’t as familiar with the service or people’s individual needs. Nurses in charge of the ward told us they often had to ask staff to stay on past their shift to cover short notice absences of other staff and that the quality of some agency staff was poor which added extra pressure for permanent staff.

“People using the service also told us some staff weren’t always respectful towards them, which was something CQC has told the trust to address previously. Staff shortages were also impacting people’s freedom to use all of the public spaces at the service, such as not being able to use the garden at night as there weren’t enough staff to support people with access.

“However, it was positive to see blanket restrictions on people having access to the garden during the day had been removed. We found leaders had responded appropriately to a number of care concerns and suspended staff from duties whilst investigations took place.

“However, they didn’t always make sure staff followed the trust’s own policies which may avoid some of these incidents happening. Staff also told us they were still anxious about reporting incidents and speaking up when things went wrong, due to concerns about their job security if they did so.

“Leaders told us they were taking steps to address both of these issues by providing more training and staff said this was helping to improve the culture. We have informed the trust where they need to make improvements and we’ll continue to monitor them to keep people safe whilst they are doing so and we'll return to check on their progress.”

A spokesperson from Avon and Wiltshire Mental Health Partnership NHS Trust (AWP) said: “We accept the CQC’s findings and since the inspection in January 2024 have launched an extensive training programme for staff, and invited external organisations into the service to carry out independent reviews.

“We value everyone who works with us but also acknowledge the impact a high use of agency staff can have and addressing this has been a Trust-wide priority leading to a sustained reduction overall. Within forensic and secure services there has been a 52% reduction in agency use since this inspection, which means we now have a more consistent team in place.

“These plans have been supported by both our local Integrated Care Boards (Bristol, North Somerset and South Gloucestershire ICB and Bath, Swindon and Wiltshire ICB), and our commissioners, the South West Provider Collaborative, and while we recognise that there remain challenges within the service, we are confident these measures are now improving the overall standards of care for our patients.”