Mental health trust told to improve its secure mental health and forensic inpatient wards
Fromeside is an 81-bed medium secure service located at Blackberry Hill Hospital in Bristol, provided by Avon and Wiltshire Mental Health Partnership NHS Trust (AWP). It cares for people with a mental illness and/or personality disorder who also have a criminal history or have risks and behaviours that mean they cannot be treated in mainstream mental health services.
The Care Quality Commission (CQC), the independent regulator for health and social care services, inspected Fromeside in July 2023. The overall rating for AWP's secure mental health and forensic inpatient wards has gone down one rating, from good to requires improvement.
The CQC assesses services in five areas:
- Is the service safe? Requires improvement (down one rating at this inspection from good)
- Is the service effective? Good (no change)
- Is the service caring? Requires improvement (down one rating from good)
- Is the service responsive? Good (no change)
- Is the service well-led? Requires improvement (down one rating from good)
The rating for the Trust as a whole is also requires improvement.
You can download a full copy of the report below.
Downloads
Key findings
- Staff were not following procedures for when clinic room temperatures were above the recommended guidance.
- Substantive (also known as bank) staff were not having regular line management supervision. Temporary staff were not fully engaging with patients.
- There were blanket restrictions. Patients had access to fresh air for 15 minutes every hour and when garden doors were open all other doors to communal areas were closed. Restrictions were then imposed on patients not having access to fresh air.
- Activities were not always meaningful, consistent or regular.
- While audits assessed and monitored systems to ensure patient safety, the findings had not been used to make improvements. Some audits had not fully assessed and monitored systems. For example, levels of noise from staff keys, use of mobile phones on wards and the conduct by temporary staff.
However:
- The trust was responsive to complaints raised by patients.
- Training was encouraged and there were opportunities for progression.
- The trust was taking steps to develop community relationships to support the smooth transition of patients into discharge.
- There was a patient representative on wards.
- Patients cared under Mental Health Act (MHA) section were told about their rights and their Section 17 (planned) leave was rarely cancelled.
- The service provided safe care and wards were safe and clean.
- Staffing levels were maintained with regular bank and agency staff.
- Staff managed medicines safely and followed good practice with respect to safeguarding patients.
Sarah Jones, Director of Nursing and Quality at AWP, and Sarah Constantine, Medical Director at AWP, said:
"Since the inspection we have made good progress in addressing many of the issues which were highlighted, for example:
- We have started a project to reduce noise on the unit and provide calming, sensory spaces for patients to use;
- Reviewed the activities available for patients on the wards; and,
- Improved access to outdoor spaces and other communal areas
"The report also makes consistent reference to an over-reliance on temporary/agency staffing and its impact on the overall service we provide.
"While workforce challenges remain for many NHS services including in mental health, our use of agency workers on Fromeside has reduced over recent months.
"We have also made improvements to how we train and integrate temporary workers on the Unit, and where we need to use temporary/agency staff, we are looking to have people on longer-term placements to improve consistency and continuity of care.
"The reports also says that patients told inspectors they ‘felt safe’ on the ward, and the CQC said that the service ‘provided safe care’ and that wards were ‘safe and clean’. There was also positive feedback about the way the service was run, and for the leadership team we have in place.
"We are disappointed with the overall outcome of the inspection and recognise there is more to do, but believe we have made good progress since, and are committed to working with our staff to ensure those improvements continue and are sustained."
