CQC monitoring report about Cumbria Partnership NHS Foundation Trust Mental Health Services

These routine reports, called Intelligent Monitoring Reports, are usually published every quarter, and they provide an assessment of services and provide useful feedback to NHS Trusts to help them continuously improve services for the benefit of patients, carers and staff.  The CQC uses the inspection framework and 5 Key Questions in these reports; the themes are Safe, Effectiveness, Caring, Responsiveness and Well Led. A previous report published earlier this year showed an overall risk rating for the Trust of 2, the current report shows the Trusts overall risk rating has remained unchanged at 2. The CQC uses four risk bands to categorise NHS Trusts, these bands range from 1 to 4, with 1 being the highest level of risk and 4 being the lowest.

The routine monitoring report highlighted five areas as risks and recognised a further area as an elevated risk. This further area is in relation to existing work around governance that the Trust is undertaking with its regulator, Monitor. The five areas identified as risks were the consistency of reporting to the National Reporting and Learning System, use of the Central Alerting System, frequency and structure of staff appraisals and ensuring that patients in our mental health inpatient services have direct access to independent advocacy services.

Monitor Risk Rating

In relation to the elevated risk rating for governance, in January 2014, Monitor, the Trusts regulator, issued the Trust with enforcement undertakings following a breach of the Trust’s provider licence. The enforcement undertakings followed concerns identified through the Trust’s Annual Planning Review arrangements about its governance processes, organisational structure and culture. 

Since the enforcement undertakings were issued, the Trust has worked closely with Monitor and has commissioned other specialist external organisations to ensure the successful implementation of effective actions which address the risks to quality identified by Monitor. Actions implemented to date include the introduction of new operational service delivery arrangements, enhanced quality governance systems embedded throughout the Trust and changes to the structure of the Board level committees and the way they operate.

Monitor has acknowledged the improvements made and together with the Trust has agreed to undertake an external review of the Trust’s arrangements against the Monitor Well Led Governance Framework. The aim of the review is to gain assurance that the improvements are fully embedded and have achieved the desired outcome. The Trust is currently in the process of procuring a partner to undertake the review which is expected to take place during July and August 2015. The outcome of the review will be presented to board directors and shared with Monitor. For more information on Monitor you can visit this link.

National Reporting and Learning System

In relation to use of the National Reporting and Learning System (NRLS), it has been identified that there was a problem with the frequency of uploading of information to the national system due to changes to organisational structures. This change meant that organisational hierarchy in risk management system was updated to accurately reflect the correct key individuals, teams and services. The system has also been updated to ensure that there is accountability across the organisation for the review, appropriate investigation, sign off of incidents and the management of risk.   The issue which has been identified by the CQC in this report has been addressed; we now upload information to NRLS on at least on a monthly basis, which is the national standard however internally we aim to upload on a fortnightly basis.

Central Alerting System

The Central Alert System (CAS) is an electronic cascade system developed by the Department of Health and is the key route to communicate and disseminate important patient safety and device alerts information within the NHS. The issue that has been identified by the CQC is that there has previously been a delay in the internal closing of alerts which have been issued to the Trust for action. The internal CAS system has recently been reviewed and the policy and associated standard operating procedure updated to reflect the improved process. Closer joint working with colleagues across the organisation has been developed to ensure the effective and timely response, action and closure of all alerts.

Staff Appraisals 

With regards to the opportunity to improve the frequency and structure of staff appraisals, the Trusts National NHS Staff Survey results for 2014 show the percentage of staff appraised and that having a well-structured appraisal is below the national average, placing CPFT in the lowest 20% of Trusts in the country. Staff engagement scores have historically been below average. In response to this last year the Trust commissioned the support of an experienced external advisor and embarked on a programme of staff led engagement that has been used with other NHS Trusts entitled Listening into Action (LiA).

Through a series of conversations between the Chief Executive and staff we identified a number of themes that were holding staff back in delivering their work. Appraisals were one of those themes and a small working group was developed to engage further with staff to identify and take forward improvements to the appraisal process. As a result of this work:

  • The appraisal policy has been reviewed and a greater emphasis placed on monthly one to one meetings between employees and their managers / appraisers
  • The appraisal portfolio and guidance notes have been refreshed
  • A rolling programme of training for appraisers has been designed and implemented
  • Our children’s services team introduced an appraisal ‘window’, concentrating their effort to cascade key messages and objectives. Informally staff have reported the benefits to understanding the bigger picture and a formal evaluation is currently being undertaken. Staff personal development plans are being used to develop a learning plan for the service.

This year the Trust has adapted the approach taken in children’s services and launched ‘You and the Big Picture’, a series of conversations starting with the Chief Executive and cascading through the business units to tell a consistent story about the purpose, direction and values of the Trust. This is being followed up by a focus on developing team and individual objectives with a drive to complete appraisals by the end of September 2015. Reports for managers will be issued on a monthly basis to indicate the number of appraisal completed.

LiA pulse check surveys and the themes from the Friends and Family Test have provided rich information on the experience of staff which has been used to guide the development of the Trust’s People and Organisational Development Plans. Staff engagement and advocacy have been identified as the key measures of the plans success.

Direct Access to Independent Mental Health Advocate Service (IMHA)

This relates to ensuring that all patients in our inpatient mental health services have direct access to IMHA Service. CPFT can confirm and demonstrate that all wards have access to this service and that the majority of our wards have an auto referral programme whereby all qualifying patients are automatically referred to this service on admission. Any issues which have been previously highlighted by the CQC during Mental Health Act Commissioner Visits have been addressed.

Further Information

The Care Quality Commission (CQC) is the government appointed regulator for all health and social care services in England.  For further information about who the CQC are please follow this link CLICK HERE

The Cumbria Partnership NHS Foundation Trust is the NHS Trust responsible for providing mental health and community health services across Cumbria. For further information about the Cumbria Partnership Trust please follow this link CLICK HERE