Regulator calls on Devon Partnership NHS Trust to ensure mental health services for older people are up to standard

The Care Quality Commission today (Wednesday) committed to use its new regulatory powers to ensure that older people in Devon are able to receive modern and effective mental healthcare.
In publishing the findings of a detailed investigation into older people’s mental health services, CQC says Devon Partnership NHS Trust has already made significant improvements to its services for older people.

But it says that a history of inadequate supervision of staff had allowed poor practice to continue unchallenged until 2008. The report highlights a failure to properly manage medicines, leading to medication being administered inappropriately in one unit, the Harbourne Unit in Totnes, until November 2008. The unit was closed last year.

The Care Quality Commission says it is satisfied that effective arrangements are now in place in Devon to protect the safety of patients, and that the trust is continuing to work on improvements.

The concerns about standards of care were first raised in November 2008, when a member of
staff reported poor practice on the Harbourne Unit, a ward for up to 10 people with mental health needs such as dementia.

The trust instructed its medical director to review care on the unit, looking specifically at the care of six people who died between October 2007 and November 2008.
The review did not find that poor care caused any of the deaths. However, it did find serious concerns relating to the inappropriate use of opioids, with drugs routinely used to control people’s behaviour, rather than treat their illnesses. It also found a failure of medical and nursing care, poor record-keeping and lack of care planning.

The trust informed the regulator (then the Healthcare Commission), which conducted inspections of the unit in December 2008.

The trust acted immediately to ensure the safety of patients by restricting the use of some medications and introducing closer supervision of clinical staff on the Harbourne Unit. The unit was permanently closed in July 2009.

In May 2009, at the request of the trust, the Care Quality Commission began a detailed investigation, reviewing care at all older people’s mental health units across Devon.
CQC conducted announced and unannounced inspections at nine units; investigating pharmacy arrangements and interviewing 172 current and former trust staff, as well as patients, relatives and carers. CQC also commissioned a review of case notes by external consultants.

The report concludes that the level of problems which were found on the Harbourne Unit did not exist in other units. However, it did find that units providing older people’s mental healthcare were isolated, with insufficient supervision of staff. As a result, the trust was not in a position to prevent things going wrong until a member of staff reported their concerns.

The report says that there were insufficient clinical governance arrangements to monitor safety and reduce risks in older people’s mental health services in Devon.

The Commission says the trust lacked a clear vision of the services being offered in its older people’s mental health units, with variations in standards of assessment, care and treatment. In particular there were no trust policies to manage challenging behaviour in patients with dementia or consistent systems to provide palliative and end of life care.

Amanda Sherlock, CQC’s deputy director of Operations, said: “The trust acted openly when allegations of poor care came to its attention and took prompt action to ensure the safety of its patients.

“After a thorough investigation, we found no evidence to suggest that the poor clinical practice found on the Harbourne Unit existed on the trust’s other wards.

“But it is clear that the trust should have been able to spot and address those problems earlier. Our report found that until these problems came to light, the trust appeared to have no oversight, leaving highly dedicated staff to cope without clear policies or guidance from the centre. The trust did not know whether standards of care were adequate or not.

“At an early stage of this inquiry we shared our findings with the trust, to give them the earliest opportunity to begin to make improvements. To their credit, Devon Partnership have moved swiftly to improve mental health services for older people without waiting for the publication of our report before beginning a programme of redesign and improvement.

“We will now continue to monitor that improvement through our new registration process, returning to the trust at regular intervals to ensure that this pace of improvement continues. We will use our powers to the full, if necessary, to ensure that older people in Devon receive modern and effective mental healthcare.”

Care Quality Commission inspectors have already begun work on a follow up review to establish if the trust is meeting new essential standards which came into force this year.

Under the new system of regulation, CQC registered the trust to provide services from 1 April on the condition that it took immediate action to improve its systems for the supervision and appraisal of staff.

CQC staff will now follow up that requirement and specific concerns highlighted by the report to identify whether further action needs to be taken to ensure that the trust complies with the new standards.