Avon and Wiltshire Mental Health Trust told to improve

There were issues with the way Avon and Wiltshire Mental Health Partnership stored and monitored medication

An NHS trust providing community-based mental health services has been told it must make improvements due to failings in the way it handles medication.

The Care Quality Commission (CQC) made the finding following an inspection of Avon and Wiltshire Mental Health Partnership NHS Trust in February.

The CQC found the service was good in many areas, but warned its approach to prescriptions was potentially unsafe.

The trust said it was "committed" to quickly driving up standards.

Avon and Wiltshire Mental Health Partnership works with patients in Bristol, Bath and parts of Somerset, South Gloucestershire and Wiltshire.

It offers community-based treatments, psychological support and interventions, a range of assessments and also offers advice and dispenses medication.

The service was rated as "good" following its last full assessment in May 2016, but its rating has since been downgraded because of issues with medicine management, which the CQC blamed on poor leadership.

Inspectors found examples where staff had administered medication to people with an expired prescription.

At a site in north Bristol there was an excessive amount of medication being stored that should have been collected or disposed of.

'Reliable processes'

Serena Coleman, CQC deputy director of operations in the south of England, said: "We found deterioration in how well the service was being led.

"Our experience tells us that when a service isn't well-led, this has a knock-on effect on the quality of care being received by people."

Ms Coleman said the service had been unable to maintain some of the improvements implemented in the wake of the last inspection, and there were new issues with medication.

"The trust need to implement and sustain reliable processes to provide and record people's medication, and leadership need to have better oversight of how medicines are managed," she said.

"Without these processes, people might not receive the right medication at the right time."

A report published on Friday said the partnership did not always use "robust" systems to administer, record and store medicine.

It found staff did not always complete medicine records accurately or keep them up to date, nor was there a formal audit process of how medication was prescribed, administered and stored.

There were also concerns that learning from incidents within individual teams was not being shared across the trust.

The CQC said proper processes for sharing learning "could have prevented incidents or complaints" occurring elsewhere.

Avon and Wiltshire Mental Health Partnership was found to be good in many areas

'Committed to improving standards'

But the inspectorate found the trust was performing well in other key areas.

Staff treated patients with care and compassion and actively involved them and their families and carers in decision making to redevelop recovery-orientated care plans.

It found teams provided a range of treatments that were informed by best practice, and responded promptly to a decline in a sudden deterioration in a service-user's health.

The report also said most teams were monitoring people on waiting lists to detect and respond to increased levels of risk, and were well-trained in safeguarding issues and worked with other agencies to protect people from abuse.

A spokeswoman for Avon and Wiltshire Mental Health Partnership said: "The CQC has acknowledged that our adult community mental health services remain caring and responsive, which is a testament to our staff during this challenging period.

"However, it is disappointing that the overall rating for the service has declined to requires improvement.

"We are committed to quickly bringing all areas back up to a suitable standard across every CQC domain."