NHS trust that provides mental health services in Cornwall rated ‘requires improvement’

Cornwall Partnership NHS Foundation Trust has been rated 'requires improvement' following an inspection in March, which flagged up concerns around staff shortages and leading to delays in treatment times.

The Care Quality Commission carried out a short-notice announced comprehensive inspection of the trust's acute wards for adults of working age and psychiatric intensive care unit (PICU), community services for adults of working age, specialist community mental health services for children and young people and child and adolescent inpatient wards of this trust.

Inspectors also looked at management and leadership of the trust to answer the key question: is the trust well-led? They also carried out a comprehensive inspection of the emergency operations centre.

Breakdown of ratings

Following the inspection, the rating for the acute wards for adults of working age and psychiatric intensive care units have moved from good to requires improvement overall. The rating for safe changed from good to inadequate; effective, responsive and well-led have dropped from good to requires improvement; caring remains good.

The rating for community-based mental health services for adults of working age has dropped from good to requires improvement. Effective, responsive and well-led has dropped from good to requires improvement; safe remains requires improvement and caring remains good.

The rating for specialist community mental health services for children and young people remains inadequate for being safe, requires improvement for being effective and good for being caring; responsive and well-led have moved from inadequate to requires improvement.

This was the first time inspectors looked at the child and adolescent mental health wards which are now rated good overall and good for being safe, effective, caring and well-led; responsive to people's needs was rated as outstanding

Overall, the rating for the trust has now dropped from good to requires improvement. The trust's overall rating for effective, responsive and well-led have also dropped from good to requires improvement. Safe remains requires improvement and caring remains outstanding.

Inspectors identified three main concerns

Karen Bennett-Wilson, CQC's director of operations for the south, said: "During our inspection of Cornwall Partnership NHS Foundation Trust, we found staff were providing outstanding patient care. This is to be applauded especially considering how badly affected Cornwall was by the COVID-19 pandemic.

"However, we found three main concerns emerge which the trust does need to rectify rapidly.

"The trust's estate was in a state of poor repair, which they didn't always have the power to do anything about as some buildings were rented. Because of this, some wards weren't fit for purpose.

"Next, we found that staff were doing their utmost to provide safe and effective care, going above and beyond the call of duty to treat patients with kindness and dignity. However, the lack of permanent staff on the wards was a risk, with some departments and teams facing high vacancy rates. The trust tried to manage the situation by hiring agency and bank staff to fill in the gaps. However, staff told inspectors agency staff sometimes faced delays in obtaining access to the electronic record keeping system. This meant some newer agency staff didn’t always have access to patient records and couldn’t update them in a timely way, which could be a risk to patient safety.

“This lack of staffing meant teams or individuals couldn’t always access essential training look at lessons to be learned because there was no time, despite local managers doing their best to mitigate this.

“Lastly, the staffing issues lead to long delays in treatment time, particularly in the specialist services. While we saw some improvements, especially in departments like the specialist community mental health services for children and young people, there were clearly not enough staff available to effectively reduce the waiting list in this team. Parents and carers told inspectors there were longs wait for therapy and they had to push to be seen.

"We have told the trust to make improvements in these areas and we will continue to monitor and review progress to check that sufficient improvements are made and fully embedded".

Breakdown of inspection findings

Inspectors found:

The environments at a number of the locations were in a poor condition and not fit for purpose. This was a safety risk for patients using these services.

• In the acute wards for adults of working age and psychiatric intensive care unit, the ward environments were not well maintained which caused staff difficulties in safely managing patients within the environments. This included ligature risk assessments not always being kept up to date on one ward and on two of the wards there were blind spots.

• In the community-based mental health services for adults of working not all of the locations inspected were fit for purpose and required maintenance work to be undertaken.

• The trust was facing workforce issues and a number of the teams visited did not have enough staff. The community mental health teams for adults of working age teams had high vacancy rates. This meant long lists of patients to be seen and long waits for a range of therapies due to a lack of clinical psychologists and occupational therapists.

• The specialist community mental health services for children and young people had similar issues with a shortage of staff meaning the teams were not always able to provide treatments as they didn’t have the full range of specialist staff.

• People's escorted leave or activities were often delayed or cancelled as there weren't enough staff to facilitate these. In addition, the wards could not always provide people with timely access to the full range of treatment and therapy options due to a lack of clinical psychologist.

However, inspectors also found:

• The specialist community mental health services for children and young people with eating disorders offered home remote health monitoring for children who had a high level of risk. This method proved successful over the pandemic and the team had 63 home monitoring kits for families across the county to use. This meant that some hospital admissions were avoided as young people did not need to go into hospital to perform this function.

• The specialist community mental health services for children and young people offered appointments at the beach. This gave them the opportunity to connect with young people who found it difficult to engage with the service.

'We must do better for patients and communities'

Debbie Richards, Cornwall Partnership NHS Foundation Trust's new CEO, started in October 2021.

She said: "We are taking these findings very seriously and we must do better than this for the patients and communities we serve.

"Overall, the report's findings are very disappointing, and we are very sorry.

"While we have being doing a huge amount to accelerate recruitment, improve retention and development of staff and improve the operational delivery and culture in the last 18 months, we need to do much, much more.

"Certain problem areas have already been addressed and it was good to see acknowledgement that some issues are not within our complete control, such as the repairing of rented buildings.

"Equally encouraging was the praise of initiatives such as the remote health monitoring for young people and offering appointments on beaches for those who find it difficult to engage with our services.

"I am very proud of our staff who have done outstanding work during the difficult times of Covid-19 and operational pressures.

“But there is still much to improve. We must do better and know we must do better. For every aspect of the organisation criticised in the report, we have put an action plan in place to sort out those issues that are hindering us from being the very best we can. Every single member of CFT staff has a part to play because we are all in this together and everybody can make a difference".

The report into Cornwall Partnership NHS Foundation Trust can be found on the Care Quality Commission's website.

• cornwall partnership nhs foundation trust
• care quality commission