Mental health services for children, young people, and older people must improve, says independent regulator

Between July and September 2021, the Care Quality Commission conducted an unannounced inspection specialist community mental health services for children and young people, and eight wards for older people with mental health problems.

Avon and Wiltshire Mental Health Partnership NHS Trust provides mental health services for approximately 1.8 million people across Bristol, North Somerset, South Gloucestershire, Bath and North-East Somerset, Swindon, and Wiltshire.

The trust's overall rating remains the same as after its previous inspection, requires improvement.

The CQC's report is based on a combination of information, including what was found during the inspection, and information given from people who use the service and the public. Trusts or services are assessed in five areas: whether they are safe, effective, caring, responsive to people's needs, and well-led.

The current ratings for the whole trust (and the rating change since each service was last inspected) are:

• Safe: requires improvement (no change)
• Effective: good (no change)
• Caring: good (no change)
• Responsive: requires improvement (no change)
• Well-led: good (up one rating)

The well-led rating relates to the trust overall, not just the services that were inspected for this report.

Following the inspection, the CQC told the trust it must take action to bring services into line with nine legal requirements.

Specialist community mental health services for children and young people must:

• ensure risk assessments are updated when young people's risk changes
• ensure waiting lists are monitored and reduced
• ensure there are enough trained staff to meet the care and treatment needs of young people
• ensure all premises are safe and clean

Wards for older people with mental health problems must:

• mitigate environmental risks, such as blind spots
• ensure patient risk management plans are individualised and updated
• ensure individualised care plans manage the risk of self neglect and show that the least restrictive options for managing patients have been considered
• ensure that staff treat patients with dignity and respect when interacting with them and entering personal areas such as bedrooms.

Specialist community mental health services for young people

The CQC said that within these services, they saw that 'staff treated patients with compassion'. Children and young people that the CQC spoke to said that staff 'treated them well and behaved kindly', and there were examples of positive feedback from young people. However, two young people said they had to wait a long time to access services.

• Safe: requires improvement (down one rating compared to previous inspection)
• Effective: good (no change)
• Caring: good (no change)
• Responsive: requires improvement (down one rating)
• Well-led: good (no change)

Despite praise for staff, the safe rating went down because the CQC found that places where young people received care were not always safe, clean well-equipped, well-furnished, well-maintained, and fit for purpose. 

The North Bristol and South Gloucestershire teams had enough nursing and support staff to keep young people safe, but in North Somerset, both vacancy rates and caseloads were high.

Similarly, the North Bristol and South Gloucestershire teams completed and reviewed risk assessments, but some young people under the North Somerset team did not have risk assessments or a crisis plan in place. 

The responsive rating also went down: all locations had long waiting lists for assessment. These were in the region of 490 for North Somerset, 70 for North Bristol
and 110 for South Gloucestershire. The report also said that the design, layout, and furnishings of treatment rooms did not support young people's treatment, privacy, and dignity.

Wards for older people with mental health problems

The CQC said that the carers they spoke with 'told us staff listened to them.' Carers also felt involved and informed by staff, had been given opportunities to join meetings, and received regular updates. Carers said that staff were considerate of their needs during discharge planning and when organising visits.

• Safe: requires improvement (no change compared to previous inspection)
• Effective: good (no change)
• Caring: requires improvement (down one rating)
• Responsive: good (no change)
• Well-led: requires improvement (down one rating)

While the wards areas in the main were clean, well-furnished, and had enough staff, the rating for safe went down one rating as the CQC raised concerns about environmental risks, such as ligature spots and blind spots.

The caring rating also went down, as although patients and carers told the CQC that staff treated them with kindness, some staff were observed behaving and interacting in ways that were not respectful of patients' privacy and dignity, such as entering bedrooms without knocking.

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