Mental health wards in Cumbria not up to standard
MENTAL health wards in Cumbria are still not up to standard, with inspectors ordering further improvements.
The rating follows unannounced visits by the Care Quality Commission (CQC) to units in Carlisle, Whitehaven, Kendal and Barrow.
Issues included concerns about medical cover at night and on weekends, staff training and key record-keeping.
The watchdog had previously told the Cumbria Partnership NHS Foundation Trust (CPFT) improvements were needed following a detailed inspection back in November 2015.
But a follow up visit, in February this year, found it had failed to do enough to move from 'requires improvement' to 'good'.
The sites inspected included the Rowanwood Psychiatric Intensive Care Unit and Hadrian acute mental health inpatient unit at Carlisle's Carleton Clinic and Yewdale Unit at West Cumberland Hospital.
Of the five areas assessed by the CQC, three were rated 'requires improvement' and two 'good', resulting in the overall rating. It was a slight improvement on last time, when there was just one 'good'.
Dr Paul Lelliott, deputy chief inspector of hospitals and mental health lead, said: “We found a number of concerns about both the safety and effectiveness of services, and how well-led they are.
“We found there were not always enough doctors covering during evenings or at weekends on some of the wards and units.
" Inspectors were unable to find records of consent to treatment for detained patients, and it was unclear if clinicians were completing capacity assessments during consultations.
“We will continue to monitor these services closely and work with partners to ensure the safety of people using them. We will return in due course to check on progress."
Andrew Brittlebank, medical director and consultant psychiatrist, said they are taking action in all of the areas identified.
In relation to staff cover at nights, he said they are looking at how they can overcome geographical challenges.
"The issue is that providing medical cover in a large dispersed rural county is different from what they (the CQC) are used to seeing in a concentrated urban environment," he explained.
In more highly-populated areas, junior doctors provide much of this out of hours cover. But Dr Brittlebank said there are not enough in Cumbria to do that, so they have a consultant psychiatrist on call - but this can mean travelling between sites a significant distance apart.
Dr Brittlebank said the CQC has organised a summit with other local health leaders to see what other options are available.
Asked whether the trust might look to centralise services, he said that was not on the agenda. "What that would do is jeopardise one of the areas where we are good - accessible services. We wouldn't want to solve one problem by creating another."
Another area flagged up was in the recording of whether detained patients were able to consent to treatment.
Dr Brittlebank insisted these assessments were being carried out, but clinicians were not always recording that properly.
He said that is largely to do with time demands, so they were looking at how they can better balance doctors' paperwork. He said this was already being addressed at the time of the visit.
Staff training and appraisals were also a concern, so he said they are looking at bringing in extra staff to free up time for appraisals and bringing some training onto or nearer to wards.
They are also training nurses to deliver psychological evaluations - saying a national shortage of clinical psychologists makes them hard to recruit - to address gaps flagged up by the CQC.
Dr Brittlebank stressed that there were many positives in the report, particularly in relation to the quality of care patients receive.
"I think we should be celebrating that. It's really important patients are well cared for and we deliver patient-centred treatment.
"Even within the areas that require improvement there has been some progress, if not enough to tip the judgement," he added.
The inspection also included Kentmere Ward in Kendal and Dova Unit in Barrow.