Care regulator tells Devon Partnership NHS Trust to improve or face formal enforcement action

CQC inspectors find mental health trust failed to address all concerns raised by investigation into care and treatment of patients.

The Care Quality Commission has told Devon Partnership NHS Trust that it must improve its systems of staff supervision and appraisal - or face the prospect of formal enforcement action.

When CQC introduced a new registration system in April, Devon Partnership NHS trust was one of 22 NHS organisations that were registered with conditions because they were not meeting essential standards of quality and safety.

Devon Partnership NHS Trust had been subject to an in-depth investigation by CQC, which found that the trust’s failure to supervise and appraise staff had led to serious concerns about the inappropriate administration of medicines in one unit.

Today CQC has published its findings on progress made by the trust to meet the condition on its licence:

• The registered provider must ensure that there are systems in place by 31 March 2010 for the supervision and appraisal of staff and for the keeping of proper records of that supervision and appraisal. Evidence must be available to demonstrate this from 1 April 2010.

Inspectors made two unannounced visits in June to older people’s mental health units at Abbotsvale in Bideford and St John’s Court in Exmouth. They spoke to people who use services, and to relatives and staff.

Inspectors said there had been significant improvements since the investigation. These include higher staffing levels, changes to the environment to improve privacy and dignity for patients and safety improvements in the management of medicines and in end of life care.

However, CQC said the trust had failed to make all the improvements to supervision and appraisal of staff that were required under the condition.

It said that while arrangements for routine supervision have improved, the trust’s own records show that only 22% of their staff had been appraised in the previous nine months. Almost all staff working in older peoples mental health services interviewed by inspectors reported they had not received supervision or an appraisal in the last 12 months.

The regulator has demanded that the trust provides detailed plans within 28 days, outlining how it will implement all necessary improvements. CQC warned that if the improvements are not made, the next step is legal enforcement action.

CQC has also required detailed plans in relation to its concerns with nine other essential standards of quality and safety. Inspectors identified concerns with record-keeping, missing documentation, assessments which did not reflect individual people’s needs or preferences, limited choices of food, incomplete knowledge of safeguarding processes, and poorly-completed care plans.

CQC will closely review the trust’s plans and inspectors will return to the trust later in the year to undertake a full review of all 16 standards of quality and safety to check that improvements are made.

Ian Biggs, Regional Director of CQC in the South West said the regulator would take a flexible, but tough approach to using its new enforcement powers, which start with a warning notice and escalate to fines, prosecution, restrictions on activities or in extreme cases, closure.

He said: “In taking any kind of enforcement action our main consideration is the need to drive improvements which will benefit people who use services.

“We know that the problems over the inappropriate use of medicines in the Harbourne Unit stemmed from a history of inadequate supervision of staff, which allowed years of poor practice to go unchallenged. It was only when concerns were raised in 2008 that the trust managers intervened.

“If doctors and nurses aren't being properly supervised and supported, this can have a significant effect on the quality of care that people experience.

“Throughout this report, we have identified many different ways in which Devon’s services for older people have improved recently. It is clear that the staff have made real progress in a wide range of areas, from management of medicines to layout of wards facilities as well as day-to-day care.

“For this reason it is all the more disappointing that the trust has not taken the action which all agreed was required at the time of registration in April.

“We are now giving notice to the trust, as well as to the South West strategic health authority and to NHS Devon who commission their services, that we are on the verge of legal enforcement action. It is a decision we do not reach lightly.”