Mental health trust judged inadequate for safety

Humber Foundation Trust had been given an overall rating of requires improvement following an inspection in April.

Inspectors rated the trust requires improvement in the effective, responsive and well led domains, and good for caring.

They found a number of safety issues with the trust’s mental health services, and called its forensic and inpatient secure services as “inadequate”.

Issues highlighted in the report were:

• using restrictive practices in ways that did not comply with the Mental Health Act;
• proper safeguards were not in place when patients were put in seclusion or long term segregation;
• seclusion rooms and places of safety did not meet best practice guidelines;
• the rapid tranquilisation policy was out of date and staff did not always record its use, carry out the procedure safely or make the appropriate physical health checks;
• staff restrained patients in a face-down position but did not always report it; and
• forensic services staff supervised all patients when they opened their mail, two years after being told that this was inappropriate.

The trust was issued with a warning notice after the April inspection and told to take “significant steps” to improve the quality of its services. The three areas of concern in the notice were: “inappropriate” rapid tranquilisation; seclusion and segregation not being in line with legislation; and staff supervising patients opening their mail.

The CQC set out actions for the trust to take including:

• ensuring the withholding of patients’ mail is stopped;
• training all qualified staff in immediate life support;
• training all staff in the use of seclusion; and
• urgently reviewing geographical discrepancies substance misuse care pathways.

Deputy chief inspector of hospitals Paul Lelliott said Humber FT had not learned lessons from its previous inspection in 2014 and that the warning notice represented “very poor practice”.

He added: “The serving of the warning notice was necessary to ensure that the trust addressed poor practice in respect of seclusion and long term segregation, rapid tranquilisation and the inappropriate supervision of patients while opening mail.

“The trust must focus on the many areas for improvement. We have received their action plan, which will form the basis and plan for our next follow-up inspection when I hope to be able to report improvement.”

Inspectors also found the trust did not always assess risks to patients and take action to reduce or eliminate them; staff compliance with training at 61 per cent – below the 75 per cent national target; and senior managers’ approach to updating policies was sometimes “chaotic”.

Inspectors also found staff vacancy rates were high and some teams were operating below agreed staffing levels.

In a statement, the trust acknowledged the need for improvement, but stressed 10 of its 18 services had been rated as good.

It added: “We have welcomed the inspection process and the CQC’s findings and we are pleased that there are many areas of good practice highlighted and recognition of our caring, compassionate and committed staff that treat patients with kindness and respect.

“We echo Dr Lelliott’s statement that we are disappointed with our inadequate rating for safety. We would like to reassure people that this rating is in a small number of services and we have taken immediate action to address the issues.”