The Care Quality Commission (CQC) has published a report following an inspection of services at The Newcastle upon Tyne Hospitals NHS Foundation Trust in November and December.
CQC carried out an unannounced focused inspection in medicine, surgery, and critical care at the Freeman Hospital and the Royal Victoria Infirmary (RVI). Inspectors also looked at urgent and emergency care and maternity services at the RVI. This was to look at the quality and safety of care provided to people with a mental health need, a learning disability or autistic people across all of these services. CQC also looked at the key question of well-led for the trust overall.
Following this inspection, CQC served the trust with a warning notice as the trust needed to make significant and immediate improvements in the quality of care being provided. This included assessment and management of mental health risks, as well as compliance with the Mental Capacity Act and Mental Health Act. The warning notice also requires the trust to ensure people with a learning disability and autistic people receive care which meets the full range of their needs.
As this was a focused inspection which did not include all of the key lines of enquiry for each key question in each core service, CQC did not re-rate services following this inspection and the trust remains rated as outstanding overall. Inspectors will be returning to the trust to carry out an inspection of these services in due course to ensure the trust has taken the necessary action to improve.
Sarah Dronsfield, CQC deputy director of operations in the north, said:
“When we visited The Newcastle upon Tyne Hospitals NHS Foundation Trust, we found staff working hard under pressure, and having kind and caring interactions with people in the services we visited. However, the trust didn’t have effective systems and processes in place to ensure people with a mental health need, a learning disability or autistic people received care that met their needs.
“Across all services we found staff hadn’t carried out and recorded assessments for people who presented with a mental health need. For example, in the trust’s emergency department, we found staff hadn’t completed mental capacity assessments or recorded decisions made about people who had presented with a mental health need, and at times they were prevented from leaving the department. The trust must make improvements to ensure staff provide care that is respectful of people’s individual rights to keep them safe and ensure they receive the appropriate care relevant to their needs.
“Additionally, the trust needs to improve the quality and experience of people with additional needs or where reasonable adjustments are required due to people’s learning disabilities. We found staff were strongly focused on providing care to meet physical health needs rather than a holistic approach to care that met all of their needs.
“Following this inspection, we wrote to the trust to share our concerns and we’ve asked the leadership team to take immediate action to improve the quality and safety of services. They’ve taken our feedback on board and have provided details of the immediate steps they’re taking to improve the quality of care.
“We will continue to monitor the trust and will return to check on progress to ensure improvements have been made and embedded, so people receive the safe and effective care they have a right to expect.”
The inspection found:
- The trust did not have effective systems and processes to ensure people consented to their treatment, or ensure staff adhered to the requirements of the Mental Capacity Act. In all services staff had not undertaken and recorded assessments of mental capacity and decisions made in people’s best interest for people subject to the Deprivation of Liberty Safeguards. Staff knowledge and awareness of the Mental Capacity Act was inconsistent between different wards and services
- Staff did not maintain complete and appropriate records to evidence adherence to the Mental Health Act. The records of people detained under the Mental Health Act did not consistently include copies of detention papers, or proof of authorised leave under Section 17 of the Act, or papers required to authorise medication and treatment under the Act
- Multiple examples of gaps in people’s records in relation to mental health, mental capacity and learning disabilities. This included details of additional needs and reasonable adjustments, applications for Deprivation of Liberty Safeguards, mental capacity assessments and best interest decision, and forms to evidence compliance with the requirements of the Mental Health Act. Our inspection team was supported by trust staff to review people’s records and our inspection showed staff repeatedly struggled to find the evidence required.
- Across the trust staff were committed to providing compassionate, caring interactions for people with a mental health need, or a learning disability or autism.