The Care Quality Commission
  • Mental Health
  • NHS mental health service

Archived: Trust Headquarters

Jenna House, Avon Way, Langley Park, Chippenham, Wiltshire, SN15 1GG (01249) 468000

Provided and run by:
Avon and Wiltshire Mental Health Partnership NHS Trust

All Inspections

Other CQC inspections of services

Community & mental health inspection reports for Trust Headquarters can be found at Avon and Wiltshire Mental Health Partnership NHS Trust. Each report covers findings for one service across multiple locations
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24, 27, 31 January and 4 February 2014

During an inspection looking at part of the service

We reviewed recovery services in June 2012 and again in May 2013. At the time of our first review we had a number of concerns, which were largely attributable to a re-design of the service in 2012. This had resulted in significant staff movement, relocation and re-branding of teams. Patients were not well informed about the changes to the service or how the changes would affect them. Many patients were dissatisfied with the service; they had experienced numerous changes which had affected the continuity of their care and they were anxious and distressed by this. The service was not fully staffed and this meant that some people did not receive the level of service they required.

When we returned in May 2013 we saw some improvements; however in some areas, teams were still under-staffed, due to both vacancies and high levels of sickness absence. Caseloads were too high, causing stress to staff and a disrupted service for some patients. Some patients were dissatisfied with infrequent contact with the service and lack of continuity and some still experienced difficulty contacting the service.

We returned to check whether further improvements had been made. Although we reviewed performance trust-wide we visited three recovery teams in North Wiltshire, Bath and North East Somerset (BaNES) and North Bristol. We spoke with 28 staff, either in person or over the telephone. We spoke with 16 people who used services and a carer by telephone. We attended a meeting facilitated by a local commissioner, attended by people who used services. We reviewed feedback from people who used services, captured by the trust. We also reviewed a sample of care records and trust performance data.

Most of the staff in the three teams we visited felt that staffing levels had improved and caseloads were now more manageable; however some staff, particularly in North Wiltshire told us that they were still concerned about their workload and the effect this had on them as workers and on the service they could provide.

We received mixed views about the service. Some people were happy with the frequency of their visits/contacts and felt the service was reliable. They spoke positivity about the staff. In some areas, most notably, North Wiltshire, some people were dissatisfied with infrequent or irregular contact with the service and the lack of continuity. Some people still experienced difficulty accessing the service and some people were very anxious about the prospect of being discharged and not being able to access support.

18, 19 November 2013

During a routine inspection

We spoke with eight members of staff and eight people who used the service. We observed three group therapy sessions.

People who used the service felt they were treated with respect, They felt they had influence over how the service was provided

People were appreciative of the care and treatment that was provided. They felt there was someone to contact with if they needed to talk and that someone would listen to you. 'They are not judgemental', 'we can talk openly' and 'they do have a laugh and that is important too' were comments that were made to us.

Avon and Wiltshire Mental Health Partnership NHS Trust (AWP) worked in co-operation with a wide range of other providers in often difficult circumstances brought on by the large catchment area which crossed both county and national boundaries. This enabled people to receive coordinated care and treatment

Staff felt support by their managers in training and supervision, to enable them to provide appropriate care and treatment to people who used the service.

There were effective systems in place to monitor how the service was being delivered.

2, 8, 13, 17 May 2013

During a routine inspection

We last reviewed recovery and intensive services in June 2012. The service was at that time undergoing a re-design. This had resulted in significant staff movement, relocation and rebranding of teams. Patients were not well informed about the changes to the service or how the changes would affect them. Many patients were dissatisfied with the service; they had experienced numerous changes which had affected the continuity of their care and they were anxious and distressed by this. The service was not fully staffed and this meant that some people did not receive the level of service they required. Caseloads were too high and some people were not allocated a care coordinator.

During our last review we found that care records had not been completed to a high standard and we could not be assured that people's needs and risks had been properly assessed. For some people, care plans had not been developed or had not been shared with them. Some people had not been allocated a care coordinator and did not know who to contact for support.

We also found that systems put in place to manage the change process were not sufficiently robust to ensure that the service continued to be delivered safely and to a high standard. We issued compliance actions in four outcome areas and the trust was required to provide us with an action plan to address our concerns.

We conducted this follow up review to see whether the service had improved. We visited eight teams (five recovery and three

13, 20 June 2012

During a routine inspection

We visited 11 community teams in Bristol, South Gloucestershire, Bath and North East Somerset, Swindon and North Wiltshire between 13 and 28 June 2012. We spoke with 21 people who used services. Some people were spoken with over the telephone; others were spoken with in person. We also looked at satisfaction survey data, and data relating to complaints and enquiries received by the trust in the preceding six months. The trust participated in the national NHS community health service users' survey, commissioned by the CQC and published in August 2011. The trust also conducted monthly 'real time' surveys, to capture people's views, although these yielded only a very small number of responses.

We received mixed views about the quality of service. The service was undergoing a redesign which was not yet complete. This had resulted in significant staff movement, relocation and rebranding of teams. Some people told us that staff changes had caused them distress and anxiety. One staff member told us they thought that some people had felt 'abandoned' through this process. One person told us 'It is frustrating when you have to keep repeating yourself over and over again, telling people what your problems are'. We had serious concerns about the significant number of people served by the North Bristol recovery team, who had not been allocated a care coordinator following the formation of the new team. Assurance processes put in place to ensure people's safety during this period of change had not been effective. Due to the level of concern we raised a safeguarding alert with Bristol City Council, the lead authority for managing safeguarding matters.

People were not well informed about the changes to the service and how theses change may affect their care and treatment. One person told us 'I don't really know what the changes were all about or why they were made, all I know is that it has affected my treatment'.

Some people said that they were sometimes frustrated that they could not get hold of their care coordinators and they did not always ring them back promptly. Information provided to us by the trust confirmed that a significant number of complaints and enquiries were received from people who were unhappy about staff changes, a lack of contact from teams and difficulties contacting teams.

Most people told us that they knew who to contact out of hours if they needed support and they felt that the intensive service responded quickly to their needs. We were concerned however to find that most care plans we looked at contained no contact details for the intensive service and people did not have contingency or crisis plans in place in the event that their mental health deteriorated.

Most people said that staff were caring and supportive and understood their needs. They spoke positively about their care coordinators. One person said 'my care coordinator is like my second mum.' Another person told us 'my care coordinator has been absolutely exceptional, they have been so supportive, they listened to me and totally understood my needs'. However staff and managers told us that teams were not fully resourced and some people had care coordinators 'in name only'.

We looked at people's care records. They were mostly incomplete and did not reflect people's views and preferences. They lacked important detail, and risks to people were not always assessed in a timely way. Monitoring systems such as staff supervision, caseload management and audit were not fully developed or embedded in teams.