Secure mental health wards 'require improvement'

Staff shortages are causing issues on secure wards, CQC inspectors have ruled

Patient's care is being negatively impacted by staff shortages at secure mental health wards, a watchdog ruled after a surprise inspection.

The Care Quality Commission (CQC) said Avon and Wiltshire Mental Health Partnership NHS Trust "must improve after an over-reliance on agency staff", who were not familiar with people’s individual needs, was causing issues.

Staff shortages were impacting patient’s freedom to use public spaces, and some staff were not always respectful.

The trust said since the inspection, it has cut its agency numbers by 53%.

Avon and Wiltshire Mental Health Partnership NHS Trust serves a population of about 1.8m people across Bath and North East Somerset, Swindon and Wiltshire, and Bristol, North Somerset, and South Gloucestershire.

Inspectors said "little had been done" to improve people's care since their previous inspection in July 2023.

The unannounced inspection in January 2024 was sparked by people using the service and their loved ones who were concerned about the quality of care being provided.

The trust's overall rating for its forensic inpatient and secure wards across Bristol and Wiltshire was unaffected after the inspection, and remains requires improvement.

'Over reliance on agency staff'

The CQC added staff told inspectors they were "anxious about reporting incidents and speaking up when things went wrong, due to concerns about their job security if they did so".

However leaders at the trust said they were "taking steps" to address the issues.

CQC deputy director of operations in the south Catherine Campbell said: “We saw people’s care was being impacted by staff shortages, which was causing an over-reliance on agency staff who weren’t as familiar with the service or people’s individual needs.

"Nurses in charge of the ward told us they often had to ask staff to stay on past their shift to cover short notice absences of other staff and that the quality of some agency staff was poor which added extra pressure for permanent staff."

However inspectors said the service "had the right policies and procedures in place to handle incidents".

They added staff understood "duty of candour and were open and honest with people and their families when things went wrong".

The trust said it has launched an "extensive training programme for staff, and invited external organisations into the service to carry out independent reviews".

“We value everyone who works with us but also acknowledge the impact a high use of agency staff can have and addressing this has been a trust-wide priority leading to a sustained reduction overall.

“While we recognise that there remain challenges within the service, we are confident these measures are now improving the overall standards of care for our patients," a spokesperson added.