Agenda item

Learning from Firshill Rise CQC Inspection

Report of Richard Bulmer, Head of Service, Rehabilitation and Specialist Services, Sheffield Health and Social Care NHS Foundation Trust.



The Sub-Committee received a report informing Members of lesson Learned from the inadequate CQC Rating of the Assessment and Treatment Service (ATS) at Firshill Rise.




Present for this item were Richard Bulmer (Head of Service, Rehabilitation and Specialist Services, Sheffield Health and Social Care NHS Foundation Trust), Heather Burns, Deputy Director of Mental Health, Learning Disability, Autism and Dementia Transformation, NHS South Yorkshire Integrated Care Board) and Greg Hackney ((Senior Head of Service, Sheffield Health and Social Care NHS Foundation Trust).




Richard Bulmer referred to the report and stated that in 2020 a new leadership structure was introduced to the learning disability service and following on from this, concerns surfaced about the care and treatment at the Assessment and Treatment Service (ATS), which led to immediate actions and an external review by the Care Quality Commission (CQC), who found that the Service was inadequate.  An external review and the CQC review resulted in consideration and actions relating to accountability.  Richard Bulmer said that a new leadership structure was then implemented which strengthened multi-disciplinary leadership. This included recruitment to a new matron role, a clinical director who was an experienced Learning Disability Consultant Psychiatrist and a general manager.  He said that the Sheffield Health and Social Care Foundation NHS Trust had reviewed and enhanced governance arrangements since receiving the inadequate rating from the CQC.  He said the Service had engaged with service users and carers to support service transformation and develop current practices and design new models of care, adding that a clinical and social care strategy had been developed across all services.  Finally, Richard Bulmer said that a project to oversee the strategic direction of learning disability services in Sheffield had been established and the main focus of this was to avoid re-admittance into hospital, change where people were treated and try to ensure that the good quality care could be given within the community.




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




·                A future report would provide detailed feedback from service users. The Service had met with all services users at the time, and it was important to hear their views and experience of the Service so that we could see how we could improve what was available to them, both as inpatient patients and those being offered support at home.  It should be noted that not all feedback currently received was negative, some service users were very supportive.  The Service had identified that some staff at the Unit were very supportive to the service users.




·                It was acknowledged that many staff had left following closure of the Unit, development and support had been given to those members of staff to help them find employment in other areas of the Trust.   It was noted that in the past there had been a failure to ensure that staff were supervised and now they were receiving effective supervision for practice development, on a regular basis. 




·                The evidence base was crucial to building the right support to service users and offering alternatives to admitting people straight into hospital. Best practice was to keep people in a lessrestrictive place and be closeto home. There is a gap in out of hours provision therefore it was hoped to enhance the services that were already available Mondays to Fridays 9.00 a.m. to 5.00 p.m. for specialist learning disability services into the evenings and weekends.




·                ·          As identified in the report, training needs to be improved. .  Regarding the service user who was an inpatient for two years at the Assessment and Treatment Service (ATS), it was found that the needs were greater than the Unit could provide. After concerns were raised, it was acknowledged that more should have been done and the South Yorkshire Integrated Care Board (SYICB) have now put in place six weekly health checks for anyone in a hospital placement.  Unfortunately, it was thought that hospital was always the safest place, it was easy for service users to get institutionalised. The Service was working hard to prevent service users being admitted into hospital and provide more care in the community.




·                When Service Users were discharged, they were supported within the community and work was ongoing where necessary to provide the right support to them and their families.  The Trust had worked with a national organisation called Respond, a charity providing therapy and specialist support services to people with learning disabilities, autism or both who have experienced abuse, violence or trauma and support had been individually tailored for all ex patients.




·                From a wider Trust perspective, following on from the inadequacy rating, improvements have been put in place. The Learning Disabilities Unit was a standalone Unit, however the Trust has tried to ensure that all services were accessible to give the right level of support where appropriate.




·                The Green Light Toolkit was a framework and self-audit toolkit for improving mental health support services for people with learning disabilities. It provides a picture of what services should be aiming to achieve, including quality outcomes, and a self-assessment checklist. There was a need to make sure that care was person-centred and that it promoted  dignity, privacy and human rights and that staff were skilled and enabled.  It was necessary to make sure that care was needs-led so that someone could access the care that necessary to them.




·                Investment was being made to train an Autism Crisis Nurse, and although not available around the clock, they would be able to give expertise and advise staff on other wards. When someone was being admitted into care, there needed to be a full review of their needs and part of that would be to identify what would be the best place for this person.  A meeting was to take place with the Acting Chief Nurse to look into autism training and progress had been made over the last 12 months and improvements had been made on the wards. The key was to avoid admission.




·                It was challenging to get the right provision in the community, placements were monitored and reviewed, as it was not always easy getting together the correct multi-agency teams to get people into the right provision and offer the right options available for people. 




·                The ethos was to improve and offer more intensive care into the community. 




·                A lot of work had been carried out with the Quality Directorate to ensure that staff received training in learning disability and autism, including how to interact appropriately with autistic people and people who have a learning disability. Whilst improvements had significantly been made to meet the needs of these people, there was still more work to be done.  The Community Intensive Support Team is a specialist health service for people with learning disabilities, and their carers, living in Sheffield and works closely with the Community Learning Disability Team and Firshill Rise ATS (inpatient service).  It provides intensive support to people who are very unwell and may be struggling with mental health problems.




·                The service users were supported by mainstream services, but there needed to be more wraparound services and better trained staff. The Trust had developed a Clinical and Social Care Strategy based on its values and the recovery principle, delivering care that is Person-Centred, Strengths-Based, Evidence-Led and Trauma-Informed to help those who were accessing secondary care services and looking at how to support those who have suffered trauma and how they were supported.




·                Within the NHS Sheffield ICB there was a Physical Health Improvement Group which was made up of partners of all health organisations, primary care and social care, and had a number of projects aimed at improving peoples access to health care and a couple of examples of this were there had been a 19% increase in women with a learning disability accessing breast screening, similarly a 28% increase in access to bowel screening.  The Group was seeking to improve access and quality of access.  There were Learning Disability Nurses employed by Sheffield Teaching Hospitals, who look at the experiences of people with learning difficulties when being admitted into hospital. Sometimes if someone was non-verbal going into hospital, it could be difficult for staff to understand their needs, which can be variable.




·                The SYICB members go out and visit on a regular basis to meet service users who had experience of using the service. They spend some time talking with them and report back on their findings.  The Freedom To Speak Up (FTSU) model was in place at Firshill Rise and had been strengthened, which encouraged people to talk about their experiences and raise issues either openly or in private and any concerns would be looked into and acted upon.  The Trust welcomed applications from anyone who had learning disabilities or autism and was developing roles specific to those who have had lived experience to offer peer support.




RESOLVED: That the Sub-Committee:




(a)      thanks Richard Bulmer, Heather Burns and Greg Hackney for their attendance at the meeting;




(b)      notes the contents of the report; and




(c)      a report on the feedback received from users of mainstream services would be distributed to Members via email.


Supporting documents: