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/
Brilliant.
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