The Isle of Wight NHS Trust is an integrated trust providing acute, ambulance and mental health services, and community services. Mental health services are provided to a population of approximately 140,000 people living on the Island. Services include community mental health services, which includes Early Intervention in Psychosis, inpatient acute and rehabilitation services, community child and adolescent mental health services (CAMHS), a tier 3 drug and alcohol service,  a memory service, a community learning disability service and an intensive outreach service for residential and nursing care homes.

We carried out this comprehensive inspection because the Isle of Wight NHS Trust is an aspirant Foundation Trust, prioritised by Monitor for inspection. We inspected this core service as part of our second phase of the new comprehensive inspection programme introduced for mental health services.

The announced inspection took place between 4 and 6 June 2014, with an unannounced visit on 21 June between 4pm and 11pm.

Overall, we rated the Isle of Wight NHS Trust mental health services as ‘good’. The trust was good for providing safe, effective, caring and responsive services. Leadership at a service level was good, but the overall trust leadership of services ‘requires improvement’.

All services were rated as “good” with the exception of community mental health services which were rated as “requires improvement”.

Key findings related to the following:

• People told us that they were involved in their care, and that staff were caring and working within their capacity, and treated them with dignity and respect. However, people being treated by community mental health services had less involvement in their care, and little information about the services available to them.
• We received 26 comment cards from people who use the mental health service. All were negative and people felt staff were oppressive and controlling.
• Staff were aware of the safeguarding processes and most had received safeguarding training.
• The majority of people who used the services, and were treated by staff, said they felt safe; however, there were examples of people stating that, at times, low staffing numbers affected people’s care and treatment.
• Staffing levels were considered to be adequate in most areas, but there were concerns about capacity on Shackleton Ward and in community mental health services. Staff reported that no action around recruitment had been taken for some time in these areas. A staffing review had just been completed by the trust, and a recruitment plan had been produced and signed off by the executive board.
• Incidents were reported, and lessons were learned and shared across services, to minimise risks and prevent reoccurrences. However, staff in community mental health services were under-reporting incidents because of limited staff capacity within the service.
• People were treated according to national guidelines, and had good access to psychological therapies and activities in inpatient settings.
• Outcomes of care were monitored and reported, both nationally and locally, to improve the effectiveness of services. However, this was not evident in community mental health services, where patients were not monitored or reviewed appropriately to assess their progress or recovery.
• There was effective multidisciplinary working, and innovative working in some services with social care, housing, employment, the police and GPs to co-ordinate people’s recovery and support their independence and self-care.
• Staff told us that they received appropriate training; however, the uptake of this training required improvement in some areas.
• Clinical, managerial and caseload supervision was offered and taken up in most areas, with the notable exception of the Rehabilitation and recovery team in community mental health services , where improvements are required.
• People received care and treatment at the right time, although there were long waiting times for assessment and treatment in community mental health services.
• People had good access to advocacy services.
• The complaints procedure was clear, and understood by staff and people using the service.
• Processes for staff to deal with incoming issues, concerns and complaints were understood, and trust-wide learning from complaints was cascaded in a variety of formats to all service areas.
• Staff generally felt supported by their line manager and peers, but felt isolated and disconnected from the trust in some services. The trust had governance structures in place, which included the mental health services, but it was observed that the flow of information did not always cascade to ward and community staff.
• Staff said they could approach their manager with any concerns, and said they thought any concerns would be addressed. Risks were appropriately managed, but in some services, risk issues were sometimes not addressed, or not always acted upon in a timely manner.
• Mental health services did not have an overall clinical strategy, and did not have appropriate representation on the trust board to reflect the workings of an integrated trust.

Mental Health Act Responsibilities

• The Mental Health Act records we reviewed were comprehensive and in order.
• People’s mental health capacity was assessed at ward reviews, and recorded in the trust’s electronic recording system.
• The Mental Health Act manager kept the ward staff up to date with any actions that may be required, such as adherence to the conditions of a Section 47/49, and the need to liaise with the Ministry of Justice (MOJ).
• Reminders were also fed into the ward round process, so that the multidisciplinary teams could review Mental Health Act sections, ensuring good governance processes, in line with the Code of Practice (CoP).
• There were posters displayed in the ward informing people of the Independent Mental Health Advocacy service (IMHA). We spoke with the ward manager, who told us that any person detained under a section of the Mental Health Act would automatically be referred for an Independent Mental Health Advocate.

We have identified areas of outstanding practice. However, there were also areas of poor practice, where the trust MUST make improvements, and other areas of practice where the trust SHOULD take action to improve. These are identified in this report.

Professor Sir Mike Richards

Chief Inspector of Hospitals

August 2014