Agenda item

A report on the recent CQC report on SPFT services.

9.1       Neil Waterhouse, Sussex Partnership NHS Foundation Trust (SPFT) Service Director for East Sussex, attended for this item.

9.2       The committee discussed how best to scrutinise the recent Care Quality Commission (CQC) inspection report of SPFT services and SPFT’s Quality Improvement Plan in response to the report. It was agreed that the initial work in this respect should be undertaken via the informal joint committee of Sussex HOSCS. Cllrs Ensor and Wincott are the East Sussex HOSC representatives on this committee.

9.3       Committee members were invited to suggest areas of concern for the joint committee to focus on. Areas suggested were:

·         Standards of ward-based care

·         Bed availability - for both adult mental health and Children & Adolescent Mental Health Services (CAMHS)

·         Services for people with Learning Disabilities (LD)

·         Data on in-patient admissions, length of stay, discharge and re-admission rates (concerns that financial pressures mean that it is too hard to access in-patient beds, that patients are discharged too early, and that re-admission rates may be higher than they should be)

·         Suicide prevention (both in terms of strategic planning for the population of Sussex and in terms of managing in-patient risk at SPFT units)

·         Access to CAMHS

9.4       Mr Waterhouse told the committee that it is crucial that mental health receives the same parity of esteem as physical health, and that there have been positive recent developments towards this goal. In terms of the CQC report, the inspectors identified many areas of good practice across the trust, but also some areas of concern. It was particularly disappointing that aspects of services for the most vulnerable people were found to be unsafe.

9.5       Recent changes to the management of SPFT mean that services are increasingly delivered on a ‘locality’ basis. However, the CQC did not report separately on services in East Sussex, West Sussex and Brighton & Hove and it is difficult to use the report information to determine how each locality is performing, although it is evident that performance across Sussex is variable. For example, the use of out of area beds has been a problem for the trust in some localities, but not a significant issue in terms of East Sussex.

9.6       Mr Waterhouse noted that there had been a good deal of recent work to enhance CAMHS provision. For example partners have focused on improving services for young people detained for assessment by the police (under section 136 of the Mental Health Act), so that there is no inappropriate use of policy custody suites. This is in line with the recently agreed Crisis Care Concordat.

9.7       Mr Waterhouse told members that SPFT would be happy to talk about trend data, noting that East Sussex services performed well in terms of re-admission rates.

9.8       With regard to suicide prevention, the HOSC Chair, Cllr Ensor, wished to record his thanks to all agencies involved in this work, particularly the Beachy Head chaplaincy service, coastguard and ambulance services, and the Samaritans. The Chair specifically wanted to commend the work of Cllr Beryl Healey, who as well as being a founder HOSC member, had been Chair of Eastbourne Samaritans for a number of years.

9.9       In response to questions about SPFT’s CQC rating of “requires improvement” for leadership, Mr Waterhouse told the committee that this specifically concerned arrangements for holding data centrally and communicating it to the trust board. These concerns were being addressed. In terms of whether the trust was too large to function effectively, the move to a locality system of service provision, with local service and clinical directors, was intended to address this issue. Amanda Philpott added that, although East Sussex CCGs have expressed concern at the size of SPFT, the new trust leadership has been very active in building good relations with local commissioners, and the CCGs are confident that SPFT is both committed to, and in a position to successfully undertake, the necessary reforms.

9.10     In answer to a query about referrals to the Crisis Resolution & Home Treatment team (CRHT), Mr Waterhouse told members that East Sussex GPs have expressed concerns that some of their referrals to the CRHT have been turned down. This may be principally due to SPFT staff and GPs having differing views on what constitutes a high risk patient. These issues will be actively addressed as part of the East Sussex Better Together (ESBT) programme to which SPFT are committed.

9.11     In response to questions about safety at SPFT in-patient units, Mr Waterhouse told the committee that the changes indicated by the CQC had already been made at the East Sussex rehabilitation unit. The CQC rating of “inadequate” was based on conditions at the Hanover Crescent unit in Brighton which has subsequently been closed. Hanover Crescent was in any case scheduled for closure, and patient numbers were being run-down. East Sussex rehabilitation services have recently received good feedback from the CQC, and SPFT is confident that services are good. There are more serious concerns about conditions on older people and dementia wards. The trust has plans in place to improve these facilities, which include long term works to estates. There is also a short term improvement plan.

9.12     In answer to queries about the cleanliness and privacy & dignity (in terms of gender segregation) of SPFT wards, Mr Waterhouse told members that all East Sussex wards are clean, although some ward environments are not as good as they should be. Gender segregation is a challenge, given the estates that the trust has to work with, which do not always permit single-sex wards. SPFT does the best that it can here, ensuring that all bays are single-sex and that female patients need not pass through male bays in order to access washing and toilet facilities.

9.13     RESOLVED – that the committee agrees to scrutinise the issue of the CQC inspection report of SPFT services initially via the informal joint Sussex HOSC.