The Care Quality Commission (CQC) has rated community-based mental health services for adults of working age in Leicestershire as requires improvement following an inspection in May.
Leicestershire Partnership NHS Trust operates seven community mental health teams across Leicester, Leicestershire and Rutland. Inspectors visited eight sites during this inspection, which hosted community mental health teams, psychosis intervention and early recovery, assertive outreach, and medicines clinics.
CQC carried out this inspection as part of its Adult Community Mental Health Programme, which contributes to CQC's commitment to inspect the standard of care in community mental health services across the country.
CQC found breaches of regulations at the previous inspection, but inspectors found that in this inspection some improvements had been made to address these in relation to medical equipment and making people aware of their rights. However, inspectors identified three new breaches of regulation related to waiting times, caseload management, and management of the service.
CQC also issued a warning notice following the inspection to highlight the significant improvements needed to reduce the time people waited for outpatient appointments. CQC told the trust to submit an action plan showing what action it is taking in response to these concerns, which the trust has submitted.
CQC has upgraded the ratings for how safe and effective the service is from requires improvement to good. How responsive the service is has again been rated as requires improvement. How well-led the service is has been downgraded from good to requires improvement, and how caring the service is has again been rated good.
Ceri Morris-Williams, CQC deputy director of mental health in the midlands, said:
“While it was encouraging to see Leicestershire Partnership Trust had made improvements in some areas, our inspection team still had concerns about community mental health services in Leicestershire. Some people waited a long time to receive the outpatient appointments they needed, which could potentially have had negative effects on their mental health.
“Some people told us they struggled with waiting to access support. The service’s waiting lists were long, and in one community mental health team people waited 599 days on average to start psychology sessions. The adult community mental health service hadn’t seen 718 people in the 12 months prior to the inspection, and staff hadn’t carried out 2,149 follow-up appointments in the target timeframe.
“Leaders relied heavily on bank and agency staff due to consultant and nursing vacancies, however there were safe staffing levels. Staff told us that some teams had high caseloads, and although the number of people being supported may include people not receiving regular support, leaders recognised this could create a barrier to care and treatment for some people.
“However, many people told us that when they did receive support, staff were kind, supportive, and treated them with dignity and respect, which had a positive effect on their mental health. The service had also improved links with partner organisations, which resulted in better experiences for people. We also identified positive practice in relation to the delivery of evidence-based care and treatment by staff, and evidence that staff worked well together in team and services.
“We have told leaders at Leicestershire Partnership Trust where they need to make urgent improvements. In response, the trust has proactively provided information about the work undertaken and underway to address these issues since the inspection, and we will continue to monitor the service to ensure people receive safe and timely treatment.”
Inspectors found:
- Leaders had processes in place to identify risks, however the plans in place didn’t always address these in the depth or have the timeframes needed to reflect the steps and make necessary improvements.
- Although the trust had initiatives in place to support people while they waited and plans to reduce waiting lists, people were waiting too long for treatment.
However:
- Staff reported safety events and incidents, and leaders investigated these thoroughly to identify learning opportunities to share with staff.
- Staff worked closely with people to help them live healthier lives with as much independence as possible. For example, staff ran occupational therapy-led walking groups for people to join.