Wednesday, 25 February 2015

I'll take the P please Bob



I don’t know if it’s still going or in what guise, but those of a certain age might remember the kids’ TV quiz show Blockbusters, hosted by Bob Holness. Contestants had to choose a letter to get across the board, with the height of hilarity being for a contestant to smirkily ask “Can I have a P please Bob?” So, on the back of three recent CQC inspections which included inpatient services for people with learning disabilities, here’s a multiple choice quiz to help you work out which of these three organisations are taking the P. One point per question if you identify all three organisations correctly.

CQC inspection reports:


1)      Which organisation’s inpatient services for people with learning disabilities were:
a.       Rated overall as ‘Requires Improvement’.
b.      Rated overall as ‘Requires Improvement’.
c.       Not rated overall as the organisation refused to allow the ratings to be made public

2)      Which organisation’s inspection report included the following:
a.       There were potential ligature points in rooms that people who use services have unsupervised access to.
b.       Care was not always being provided in safe physical environments. At the [unit] and [unit] work was needed to address ligature points… We noted that there was only one set of emergency resuscitation equipment across the two units which was stored on [unit 1]. This meant that if a person on [unit 2] needed this equipment staff would need to pass through three locked doors, posing a potential risk.
c.       Not all wards had resuscitation equipment. There were a number of locked doors, stairs and potentially an unpredictable patient group, which may impact how quickly the equipment arrived where it was needed.

3)      Which organisation’s inspection report included the following:
a.       We found that there were not always enough members of staff to care for people safely. Some staff and patients told us that they did not always feel safe on the wards.
b.      The [organisation] relied heavily on agency and bank nurses to staff the wards. On some shifts none of the nursing staff were permanent employees.
c.       All the services were facing challenges in filling all their staff vacancies, but regular agency staff were being used and safe staffing levels maintained. The [organisation] should consider whether it is safe for staff to start working at the [unit] prior to their disclosure and barring checks being in place.

4)      Which organisation’s inspection report included the following:
a.       Contrary to current Department of Health guidance, nurses sometimes restrain people in the prone (face-down) position as a planned intervention to manage disturbed behaviour.
b.      Seclusion facilities were being routinely used for deescalation and time out and not recorded as seclusion.
c.       The seclusion room on the [unit] did not support patient privacy and dignity as there was no separate area for the toilet which was in full view of a large window. There was poor recording of seclusion on [unit]. Seclusion records we reviewed covered a range of time periods from 15 minutes to nine hours which took place one year ago. The longest period of seclusion had no record of a medical review taking place throughout the whole period. There was no evidence the patient had been given the opportunity afterwards to record their views of their experience of seclusion.

5)      Which organisation’s inspection report included the following:
a.       We found that patients had detailed health action plans which had been informed by a number of assessments. However we found one person who had epilepsy did not have a care plan in relation to this despite having a seizure in 2014.
b.      External professionals (NHS England commissioners) told us they were satisfied with the quality of interventions provided by the staff at [unit].
c.       Just two of 33 records that we reviewed contained a health action plan.

6)      Which organisation’s inspection report included the following:
a.       Patient care and risk was not assessed, planned and managed based on individual needs. There was an emphasis on generic, restrictive risk management processes, including restricting visitors and leave, which are not in line with current Department of Health guidance, the principles of the Mental Capacity Act or the Mental Health Act code of practice.
b.      Concerns were raised about the use of the Mental Capacity Act and the exclusion of relatives from decision making.
c.       Ten of 20 care records that we reviewed showed that staff had not adhered to one or more of the requirements of the MHA.

7)      Which organisation’s inspection report included the following:
a.       We found two cases where the best interest decision had been made before the mental capacity assessment had been recorded.
b.      We checked the T2 (certificate of consent to treatment) and T3 (certificate of second opinion) forms. We found that these were not always accurate. Some specified medication the person was no longer taking, or did not always represent the dosage of medication the person was taking, which was over the British National Formulary (BNF) recommended limit.
c.       Whilst medicines were stored securely, the facilities for the storage of controlled drugs were not in accordance with [organisation] policies.

8)      Which organisation’s inspection report included the following:
a.       People using the services were cared for by staff who were very motivated and supported people with care, dignity and respect.
b.      The great majority of the people who use services that we talked to told us that they were treated kindly and respectfully by staff. The care interactions that we observed supported this.
c.       We observed little activity or interaction between staff and patients on the wards we visited. Some patients told us that they were well cared for and they had no concerns about the staff. Some patients felt angry and frustrated by how they are treated; stating that staff do not listen to them and did not always speak to them with respect.

9)      Which organisation’s inspection report included the following:
a.       The [organisation] must ensure it supports staff working in the [name of unit] so they have regular line management input, understand the changes that are taking place and receive support in an appropriate style to facilitate them to perform their roles.
b.      Some of the governance arrangement were not fully effective. This is demonstrated by: a failure to recognise and address unsafe night-time cover…; a lack of awareness of and failure to follow [organisation] policies relating to seclusion, segregation and restraint; a failure to provide adequate training for staff in the skills required…; poor adherence to the requirements of the Mental Health Act.
c.       Some staff told us that there was little engagement with senior managers or the organisation`s values. We were told that many of the governance, care and treatment processes were centrally administrated.

Organisations’ press releases:


10)   Which organisation’s press release:
a.       Welcomes the CQC report.
b.      Welcomes the CQC report.
c.       is ‘no longer available’ on the organisation’s website.

11)   Which organisation’s Chief Executive has stated that:
a.       The CQC highlighted positive examples.
b.      There are a number of areas of practice highlighted as good within the report.
c.       It has confirmed that we are right to have confidence that our services are effective, caring and responsive.

12)   Which organisation’s Chief Executive has stated that:
a.       The report also highlighted a number of areas for improvement, which we have already begun to address.
b.      A major programme of work began in the summer to address the negatives and learn from the positive and safe practice found by the CQC.
c.       The inspection has highlighted aspects which can be improved and this resonates with the things we have already identified for improvement in our immediate and future plans. 

You scored:

0-4:        What are you, some kind of person using the service or family member or something? You shouldn’t have been allowed anywhere near this quiz.
5-8:        You seem to be mistaken that inpatient services for people with learning disabilities all have similar fundamental problems.  
9-12:      An excellent score – you’re clearly been paying too much attention to be a commissioner.
13:          Congratulations, you are clearly a Chief Executive in the making!

Answers

1)      a or b: St Andrews and Southern Health                                c: Calderstones
2)      a: Calderstones                 b: Southern Health                        c: St Andrews
3)      a: St Andrews                    b: Calderstones                            c: Southern Health
4)      a: Calderstones                 b: St Andrews                    c: Southern Health
5)      a: St Andrews                    b: Southern Health          c: Calderstones
6)      a: St Andrews                    b: Southern Health          c: Calderstones
7)      a: Calderstones                 b: St Andrews                    c: Southern Health
8)      a: Southern Health          b: Calderstones                                c: St Andrews
9)      a: Southern Health          b: Calderstones                                c: St Andrews
10)   a or b: Southern Health and St Andrews                                c: Calderstones
11)   a: Calderstones                 b: Southern Health          c: St Andrews
12)   a: Southern Health          b: Calderstones                                c: St Andrews

Sources

The CQC inspection report of Calderstones Partnership NHS Foundation Trust available here http://www.cqc.org.uk/provider/RJX (quotes taken from inpatient services report).

The CQC inspection report of St Andrews Healthcare available here http://www.cqc.org.uk/provider/1-102643363 (quotes taken from services for people with learning disabilities or autism report).

The CQC inspection report of Southern Health NHS Foundation Trust available here http://www.cqc.org.uk/provider/RW1 (quotes taken from wards for people with learning disabilities or autism report).

The Calderstones full response to the CQC report is available here http://www.calderstones.nhs.uk/newsandevents/32/trust-responds-to-july-cqc-pilot.html The Chief Executive’s statement in response to the CQC inspection is on his blog here (17th December entry) http://www.calderstones.nhs.uk/aboutus/chief-executives-statement.html

The St Andrews press release in response to their CQC inspection is available here http://www.standrewshealthcare.co.uk/news/st-andrew%E2%80%99s-welcomes-care-quality-commission-report

The Southern Health press release in response to their CQC inspection is available here http://www.southernhealth.nhs.uk/news/southern-health-cqc-report/

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