The Care Quality Commission (CQC) has rated Oxford Health NHS Foundation Trust ‘good’ in three out of five quality measurements – caring, responsive and well-led and ‘requiring improvement’ in the remaining two, effective and safe. This gives Oxford Health an over-all rating of ‘requires improvement’ [satisfactory] based on weighted scoring across all services inspected. No enforcement notices were issued and the majority (11 out of 15) of the trust’s services were rated ‘good’ (10) or ‘outstanding’ (1). We are very pleased that the ‘outstanding’ rating was for our children and young people’s community service, which includes school health nurses, health visitors and children’s community nurses.
As the body that assesses the quality of NHS services in England the CQC found that Oxford Health NHS Foundation Trust was well-led with: accessible visible management at all levels and good working governance systems. It was responsive to people’s needs across services especially in a crisis, including reducing the need for police involvement in mental health crises, and in providing emotional support and counselling, especially for end of life care and bereavement. Patients and staff knew how to raise concerns and there was good learning from incidents and complaints. Perhaps most importantly from the trust’s perspective, staff were found to be caring.
“In most services, we found that staff were committed, dedicated and passionate about the work they did. Patients and their carers spoke positively about the care they received and felt they were treated with dignity and respect.” In some services caring was rated ‘outstanding’… “Luther Street medical practice, CAMHS community services and community children’s services … showed passion, enthusiasm and received overwhelmingly positive feedback.” (CQC Oxford Health NHS Foundation Trust Quality Report p10).
Improvements are required in safety to ensure that across all trust services the same high standards are observed. Inspectors noted “On the whole services were safe, but the trust received a rating of requires improvement because we found pockets of poor practice.” They also noted that some of our older estate, especially inpatient mental health settings at the Warneford Hospital, was outdated for the delivery of modern mental health care. The trust has long been aware of the challenge of operating from Victorian buildings and in recent years has developed the Whiteleaf Centre in Buckinghamshire and the Highfield Adolescent Unit, Warneford Hospital as exemplars of purpose built 21st century mental health care. A working group is currently developing options for future development of the Warneford Hospital site in particular to better address modern health care needs. Other areas of for further work are around:
- Improving how we record and demonstrate patients’ involvement in their own care planning
- Ensure consistent high quality records of care plans and assessments
- Continuing our work to implement a new end of life care pathway and monitoring the impact of this work
- Continue to monitor and respond to increasing demands on staff specifically in community services
- Review ‘blanket’ restrictions on some wards for example allowing all patients free access to garden areas
- Tighten monitoring arrangements around equipment including resuscitation equipment and trust labelling for ‘To Take Out’ medicines
- Continue to work with staff to ensure all mandatory training specifically resuscitation is completed.
Inspectors noted that: “Across all services trust staff were good at recognising safeguarding and reporting incidents. Teams learnt from incidents and there was shared learning across services, through regular ‘briefing notes’ and “staff had good access to mandatory training and good induction programmes, as well as opportunities for continuous professional development.”
Oxford Health has a strong track record of working in partnership with others and providing integrated services, inspectors noted. “The trust is clearly committed to services that are multi-agency and multi-disciplinary and this was evident from the board discussions we observed and how staff at the frontline described the care.”
Effectiveness was rated as requiring improvement, due to known issues. The main area is about involving patients in planning and reviewing their care and noting it on their records. A major piece of work on developing a new Patient Involvement and Engagement Strategy, in collaboration with patients and people who care for them is underway and due for completion by Spring 2016. The second area for improvement is around embedding more consistent patient assessments to evaluate pain (although timely administration of pain relief was reported positively by patients) and swallowing difficulties; and the third area is continuing to implement and assess the impact of our new end of life care pathway.
Stuart Bell, Oxford Health NHS Foundation Trust chief executive comments:
“There are some very positive messages about the Trust over all from the inspectors in the reports, particularly about three of the five domains (caring, safe, effective, responsive, well-led). “Caring, responsive, well-led domains have all had really good reviews. There are some areas where we think we need to do more, around ‘safety’ and ‘effectiveness’ in particular. The vast majority of the areas for improvement were things we recognised and had plans in place to address. I’m pleased to say that the trust has received no enforcement actions and that inspectors found that National Institute for Health and Care Excellence (NICE) guidelines were followed.
“I am tremendously proud of our caring staff for contributing to delivering and improving our services before, during and after the CQC inspection. We began this journey of improvement before the inspection and we value the insights that our own preparations and the inspection process have given us. All of this helps our learning and is part of our ongoing drive to work together to improve our services to benefit the people we serve.”