The Isle of Wight NHS Trust has been placed in Special Measures following damning report by the Care Quality Commission (CQC).
Bullying, poor management and leadership, staff shortages and inadequacies with mental health services and the Ambulance Service have all been highlighted in the damning report.
Overall, the CQC has rated the Isle of Wight NHS Trust as Inadequate. Acute services provided at St Mary’s Hospital and Community Health services, were rated as Requires Improvement. Ambulance Services and Mental Health services were rated as Inadequate.
However, the care provided by staff was rated as good by the professional body.
The decision follows a recommendation from the Chief Inspector of Hospitals, Professor Sir Mike Richards, following an inspection in November last year.
The integrated trust which provides acute, ambulance, community and mental health services to around 140,000 people living on the Island will now receive a support package from NHS Improvement to help them make the necessary changes for patients.
As part of the package of support, NHS Improvement has already appointed an Improvement Director – Phillippa Slinger – who will work ‘three or four days a week’ with the trust to help make quick and long lasting improvements for patients and exit special measures as quickly as possible.
Last month, Karen Baker, the former Chief Executive of the Isle of Wight NHS Trust, stood down from her role and Executive Medical Director, Dr Mark Pugh, has been appointed Acting Chief Executive.
The Trust Board said it expects to confirm the appointment of an interim Chief Executive ‘very soon’ and will then begin the process of recruiting a new, permanent Chief Executive.
CQC carried out the inspection over five days in November and January to check on the trust’s progress since its last inspection and to follow up new areas of concern that had been identified from ongoing monitoring of the service.
Acting Chief Executive, Dr Mark Pugh, said:
“We now have to ensure that we improve leadership throughout the organisation from board level through to service level.
“We are receiving valuable assistance from our new Improvement Director, Philippa Slinger, who has been appointed by NHS Improvement to support the Trust and we have already begun work on the development of a robust and achievable plan for major and rapid improvement.
“We will ensure that staff are clear about their role and actively involved in the delivery of meaningful improvement. We will be seeking the support of partners on the Island and mainland to help us.”
Inspectors found that despite the pressures, there were many areas where staff were dedicated and committed to patient care. Staff did their upmost to provide care that was compassionate, involved patients in decision making and provided good emotional support to patients and those close to them.
Leadership was rated as Inadequate. The vision for the trust was not clearly articulated by the senior team and staff. The executive team did not always have the necessary experience, or capability to lead effectively. It was a matter of concern that there was no representation of mental health services at board level.
Staffing shortages within the ambulance service were affecting staff morale and the service’s ability to provide a safe service and meet response times. Inspectors found throughout the trust a culture of subtle bullying from staff working in old fashioned ways and holding up barriers to change. Staff said morale was low, with people leaving and sickness rates going up.
The ambulance station was not found to be secure. The mobile data terminal used to provide staff with patient information and navigation was unreliable. Confidential information, medicines and cleaning products were not always securely stored in the urgent and emergency care service.
Inspectors found the trust’s mental health and community services were facing serious challenges and were unable to safely meet the needs of patients. This meant that the service was unable to respond consistently and effectively.
Not all staff had the skills and knowledge required to undertake their role. Some nursing staff in acute medicine services did not have key competencies to care for patients.
Immediately after the inspection, CQC placed conditions on the registration of the trust to minimise the risk of patients being exposed to harm. CQC told the trust that it must operate an effective system to prioritise patients who urgently need access to community mental health services.The trust was also required to carry out an urgent assessment of the physical environment on the mental health wards at St Mary’s Hospital, with a comprehensive assessment of ligature points and a plan to deal with the risks.
The inspection has identified a number of areas where the trust must improve, including:
- The trust must ensure that leadership improves at all levels from board to service level.
- The trust must ensure that there are arrangements in place for identifying, assessing and managing risk at all levels and that staff are appropriately trained in this.
- Improvements must be made to partnership working with the local hospice and local authority, to improve patient flow and access to services as they need them.
- The trust must put in place effective staff engagement and work to progress organisational development and culture change, so that candour, openness and challenges to poor practice are improved.
- The trust must agree a comprehensive community mental health services improvement plan. There should be the necessary external advice and agreement for this improvement plan. The plan should ensure demands on the service are appropriately escalated, assessed and managed.
- The trust must operate an effective escalation protocol in community mental health services. This escalation protocol will need to ensure patients are prioritised appropriately in response to service demands and pressures.
- The trust must ensure there are sufficient numbers of suitable qualified and competent staff, and managers, to provide a safe, effective and responsive ambulance service.
- The trust must implement actions in response to the investigation reports and improve the ambulance service culture.
Inspectors also found an area of Outstanding practice, including:
- A new initiative in place ‘Post discharge medicines optimisation support to reduce readmission’, known as MOTIVE, resulted in a significant reduction in readmissions.
The Chief Inspector of Hospitals, Professor Sir Mike Richards, said:
“The Isle of Wight NHS Trust is unique in England as an integrated provider of acute, ambulance, community and mental health services.
“Since our last inspection in June 2014 we have found a number of significant concerns particularly in the mental health and ambulance services, which is why I have made a recommendation to NHS Improvement that the trust should be placed into special measures.
“My inspectors found people were exposed to unacceptable risk of harm. On the mental health wards staff did not always report safeguarding incidents to their local teams and wards were not holding local records of ongoing safeguarding concern. There was poor communication of safeguarding concerns when patients were transferred between services.
“Since this latest inspection we have been assured by the trust that there have been changes to their safeguarding procedures to ensure that incidents are properly reported and investigated.
“I am aware that since the inspection NHS Improvement have been working with the trust to make sure that our concerns are appropriately addressed and that progress is monitored.
“We will return in due course to undertake further inspections, including unannounced visits, to check that the necessary improvements have been made.”
The Isle of Wight NHS Trust Chair, Eve Richardson, said:
“This report is highly critical of the health services provided by this Trust. I want to be clear that the Trust accepts this report without reservation.
“We have let down our patients and our local community and on behalf of the Trust board and our staff I apologise unreservedly for this failure.
“Our sole focus now is to absorb the lessons contained within this report, to develop, with our partners, an effective and comprehensive improvement programme and to ensure it is implemented as swiftly as possible.”
The full reports and ratings are available HERE.