North Devon District Hospital is in Barnstaple, North Devon. The hospital has both acute and mental health services on site provided by two different NHS trusts. This inspection looked at the mental health services only, which are run by Devon Partnership NHS Trust. These services support approximately 158,000 people in North Devon and Torridge local authority districts, which are predominantly rural areas. North Devon District Hospital provides a full range of inpatient, outpatient and community services.

We found good areas of practice and many positive findings across adult and older adult inpatient services in North Devon. The adult acute admission wards, Ocean View and Moorland View, were safe, met patients’ needs and improvements had been made through learning from incidents. Patients held staff in high regard and felt them to be committed, compassionate and caring. Patients confirmed there was a recovery approach to their care and support, which they found responsive to their needs and experienced at all stages of their hospital stay. For example, a patient described Moorland View as being “A gift to my recovery”. The culture on both admission wards was inclusive and the atmosphere was calming. We found restraint, seclusion and rapid tranquilisation was rarely used because staff were skilled in using de-escalation strategies.

Meadow View is an inpatient ward providing assessment and treatment for older people with mental health needs, such as depression, anxiety and psychosis. Patients here also experienced a recovery approach. We saw patients experienced compassionate person-centred care and support. Potential risks associated with ageing, such as falls, were well managed and meant patient health was promoted. Again, the culture on Meadow View was inclusive and the atmosphere was calming and supportive.

All areas of the hospital were clean and staff followed good infection control practice. The design of all the wards created some limitations regarding the line of sight, which meant there was an increased safety risk. However, this had been identified on all of the wards and was mitigated by several measures. Staff were allocated to certain areas and the positioning of patients in bedrooms was made according to known and potential risks. There were high levels of engagement with patients to monitor their mental wellbeing. The hospital environment was satisfactory and patients’ privacy and dignity needs were met. Patients confirmed the accommodation was comfortable and commented it had a non-institutional feel.

All of the inpatient teams were well-led, with strong leadership which promoted best practice. Staff morale was good and they worked well together in multi-disciplinary teams. There was an open culture on all three wards and staff were confident in raising concerns. The governance arrangements were effective and monitored the performance of the services. Staff were empowered to make decisions and knew how to make changes or get problems solved.

There were four main areas, where improvements need to be made. These relate to the accuracy of the documentation used for Mental Health Act, responsiveness of the service, monitoring of the use of restraint and seclusion and quality of food.

All the documentation used by the trust should be clear regarding the detaining authority. There also needs to be a record made about the discussions between second opinion appointed doctors and statutory consultees.

The trust had systems in place to manage beds but we found that at times up to a third of the patients admitted to North Devon District Hospital could come from other parts of Devon. This meant local patients sometimes experienced being admitted to another hospital within the trust, and then moved closer to home once a bed became available. The other hospitals run by the trust are a considerable distance away and we heard about the impact this has on the frequency of visits patients have from their carers, friends and others. Similarly, patients from other areas of Devon and Torbay experienced these same issues when admitted to North Devon District Hospital until being moved back to their local hospital.

The recording of physical interventions, including restraint and seclusion, need to be reviewed to ensure this is happening in line with guidance and enables the trust to monitor their use across all their services.

Patients told us the quality and quantity of food provided was very poor. The trust has a service level agreement with the acute trust, Northern Devon Healthcare, to provide food to the mental health unit. Managers had escalated patient concerns about the quality and quantity of food to the Northern Devon Healthcare Trust manager responsible for overseeing the contract with the external provider. We were assured by these actions, but progress with addressing this issue needs ongoing monitoring.