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Agenda item

Sheffield Health and Social Care Trust - CQC Improvement Plan Progress Report

Report of the Sheffield Health and Social Care NHS Foundation Trust.



The Committee received a progress report and presentation on the Care Quality Commission (CQC) Improvement Plan.  An update had been requested by the Committee to enable Sheffield Health and Social Care NHS Foundation Trust (SHSC) to demonstrate the progress being made in relation to the delivery of its Improvement Plan following the 2020 CQC inspection and subsequent report in August, 2020.




Present for this item were Dr. Mike Hunter, Executive Medical Director and Beverley Murphy, Executive Director of Nursing, Professions and Operations (Sheffield Health and Social Care NHS Foundation Trust).




Mike Hunter introduced the report and presentation and stated that following improvements, the inpatient care team had been able to ensure that patients were now receiving better mental health care than there were previously receiving.  Staff were being trained to deal with a range of conditions, such as diabetes and the management of symptoms from the withdrawal from drinks and drugs.  He stated that overall mental health care was better now than it was 12 months ago.  He said that one of the main factors that contributed to mental health issues was smoking and smoking cessation was very important to stop people dying 20 years earlier than they would have done had they not smoked, and the introduction of the smoke free wards had proved successful.  Dr. Hunter said that some patients admitted onto smoke free wards that were smokers, left the ward as “vapers”, and although there were some concerns around vaping, it was thought that vaping would ultimately make a difference to life expectancy.  Safeguarding issues have improved across the board, and a report published in October stated that safeguarding issues had been addressed and improvement seen across the board and patients were receiving better care with dignity and privacy.  Two wards within the Unit were now single sex wards.  Psychologists were working alongside psychiatric nurses to offer a highly integrated approach to specialist mental health care. Although in-patient wards were where the serious patients were seen, the vast majority of mental health care was carried out within the community so there was a need to work together to fix problems by getting specialist mental health care out into communities and plan for the future.




Beverley Murphy stated that progress had been made to ensure safe staffing levels on inpatient wards and that the Trust was rated highest nationally for Adult Acute Registered Nurses and the Ward Manager and Assistant Ward Manager roles had improved, ensuring that junior nursing staff received a high standard of leadership, ensuring patients received better care. She said that a recovery plan had been developed to include a daily oversight of patient flow to reduce the average length of stay on acute wards and although there had been significant challenges due to Covid 19, which  had created an increase in the number of “out of area” placements of older adults due to a lack of beds within the city, the older adults’ wards had now reopened, and work was ongoing to return patients back to Sheffield as soon as possible.  Work had also been carried out to eradicate dormitory wards and improve inpatient services.  Beverley Murphy said that “step down” beds had been introduced which offered patients the choice of where they received care in accordance with their individual needs. However, there were plans to improve inpatient services so that all acute inpatient units would see significant improvement.  She said that there had been a number of Covid related absences, which had caused significant challenges, but due to the vaccine programme rollout, the recovery plan was now back on track. It was acknowledged that there were still risks and the need to mitigate and manage those risks. There were still issues around access to care and the length of waiting lists but these were being addressed. Ms. Murphy stated that investment was required into providing additional posts and improving the IT infrastructure. She stated that the Trust was working with NHS England to model what the future demands look like to flex the service.




Members of the Committee made various comments and asked a number of questions, to which responses were given as follows:-




·                The overall rating of the Sheffield Health and Social Care NHS Foundation Trust (SHSC) remained inadequate. As stated in the report, the Trust had been reinspected in August, 2020 and a report published in October had listed very clear, significant improvements, in part because of Covid and in part because there were parts of the service that had not been inspected and re-rated.  The Care Quality Commission (CQC) were content and comfortable to let the Section 29A Warning Notice temporarily lapse based on finding improvement.




·                Covid had raised many challenges with over 100 members of staff, at some point, being absent, either due to testing positive for the virus or shielding due to health issues so it was difficult to fulfil their commitments. However some staff members who were shielding were able to use technology to facilitate continuity of care and assess service users, look into their specific needs and looked for changes to identify people who needed to be seen regularly and routinely. The Trust tailored clinical interventions to facilitate individual patient needs and have taken a patient-centred approach to match individual needs.




·                The acute inpatient wards based at Forest Close, Middlewood, had been rated as good by the CQC and the rehabilitation team based there have won Positive Practice Awards for Mental Health Services.  The challenges facing these longer-term rehabilitation wards were known and was thought to be in good shape.




·                Refurbishment works were underway with the development of 10 single bedrooms with en-suite facilities, being made available for those in distress to ensure their privacy and dignity was maintained and the possibility of preventing patients going into a NHS acute hospital bed, and the Trust along with the third sector were working to manage the service to assist with recovery and de-stigmatisation of mental health.  A White Paper on the reform of the Mental Health Act was out for consultation and currently going through Parliament, and part of that reform was to offer more single bedroom facilities which offer privacy and dignity to patients.




·                The Trust was keen to work with Healthwatch to collect equality data. Two main areas of concern had been identified as patients being unable to access the mental health service and restrictive intervention methods that were used to restrict the movement of an individual or limit their freedom to act independently.  The Trust needs to understand the best way of serving communities and currently there was no data to convincingly assure the Board of Directors there weren’t any access issues.




·                With regard to the delivery model, the evaluation report looked at staff and service users to make sure that the Trust had the right technical abilities so that it doesn’t fall back on the organisation’s preferences for offering treatment as it had been found that some clinicians were keen to return to offering face-to-face treatment because that was the way they had worked historically, but there was a need to understand during the initial assessment process, what type of treatment the patient preferred and improve the service offer.




·                One group who were often digitally poor and excluded, were asylum seekers and it should be borne in mind the terrible trauma these people had experienced on their way to safety in this city and the impact on their mental health such experiences would have taken, and there needed to be a link to these people so that they do not remain digitally excluded.




·                Sheffield Psychology Board, whose membership included the voluntary and community sector, the Children’s Hospital, the Teaching Hospitals and partners working in the psychological wellbeing service, had agreed to carry out a review across all services from the perception of clinicians having concerns about whether the digital offer was safe in all cases, and to assess risk to children when adults remain in the room, and to look at the impact of the digital service on offer and carry out a risk assessment and process what was suitable.




·                Data which was gathered last summer formed part of the report on the next item on the agenda for this meeting. Included within the report were details from several different groups, and different people across the city, who felt excluded from mental health services and support.  Gaps are being identified and by speaking to different groups, some of those gaps were being filled.




·                One solution to improve the Improving Access to Psychological Therapies (IAPT) services was to get specialist care staff into primary care.  IAPT was a specifically designed service.  There was enthusiasm amongst clinical directors and primary care networks to work collectively on this to resource the alignment of primary and secondary care services to fill the gaps in mental health services.




RESOVED: That the Committee:-




(a)      thanks Mike Hunter and Beverley Murphy for their contribution to the meeting; and




(b)      notes the contents of the report and responses to the questions raised.


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