Essex Partnership University NHS Foundation Trust

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We rated safe as good because: The wards had enough qualified, skilled and experienced staff to keep people safe. Staff reported a positive culture of safety where concerns were listened to. Staff learned lessons to continually identify and embed good practices. Staff worked with the local authority to ensure that patients were protected from abuse. Patients felt safe on the wards. Staff worked in collaboration with patients to manage risk and promote their independence wherever possible. The managers continually reviewed restrictive practices and worked hard to reduce the use of physical restraint. Staff safely managed patients' medicines. The wards were safe and clean. The service was in the process of refurbishing each ward. Aurora ward had just been refurbished at the time of the inspection and patients fed back that they felt it was spacious and clean.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We spoke with 13 patients and 8 carers and relatives. Patients and carers said they knew how to raise concerns about the service. Patients said they felt confident to do this and that staff would listen to them if they felt unsafe on the ward.

We spoke with 12 staff members. Staff learned lessons to continually identify and embed good practices. Staff were able to tell us about recent incidents and the learning from them. Staff said they reported things such as inappropriate behaviour between patients, incidents of short staffing, verbal or physical aggression and medication errors. Staff said learning from incidents was done well and action was taken to improve safety. There was evidence that changes had been made because of feedback. After a serious incident occurred on Forest Ward the year before, senior nursing staff completed an action plan to identify areas of improvement. Actions included improvements to handover and communication with patients to encourage them to share information with staff.

The service had a good incident reporting culture. In the last 6 months staff had reported 577 incidents through the trust electronic recording system. Most incidents (403) took place on Fuji ward because this ward took new admissions with a higher acuity.

Patients said they knew about their discharge plan. However, 2 patients described feeling frustrated because their discharge from the service was delayed due to challenges in finding an appropriate onward placement. Patients said they had access to an advocate and knew what to do if they would like to speak with them.

Staff described proactively working with staff at services where patients planned to be discharged to, to ensure safe discharge planning and minimal delay. Staff made referrals to other health professionals when needed and supported patients to attend specialist healthcare appointments.

Senior leaders attended referrals and allocations meetings with the locality provider collaborative to ensure a smooth transition pathway for patients.

Senior staff from Brockfield house met three times a week to discuss discharges, incidents of seclusion and long-term segregation. Further meetings were held every Monday and Friday to discuss security and safety. Patient care records showed discussions about their discharge plans.

We spoke with 13 patients and 8 carers during the assessment. Patients said they felt safe on the ward, including from sexual harassment. However, 4 patients on Causeway and Fuji ward said they did not feel safe. Patients felt that when they had raised this with staff, nothing had been done. Patients said that they felt unsafe with other patients. Carers reported feeling their loved ones were kept safe whilst on the ward. We observed staff ensuring patient safety and protecting people from abuse.

Staff worked with their partners to ensure that patients were protected from abuse. Staff shared concerns quickly and appropriately. Staff met with patients where there was a safeguarding concern. Staff also discussed the outcome from investigations with patients. The service had multiple dedicated social workers who supported staff to report safeguarding concerns and liaised with the local authority.

The trust had signed up to the NHS sexual safety charter to promote a zero-tolerance policy to any inappropriate, unwanted or harmful sexual behaviors within the workplace. As part of this staff discussed whether they felt sexually safe at work during one to one conversations with their line manager. This had resulted in an improved reporting of sexual safety incidents and support provided to staff and patients. Staff kept a safeguarding action log to ensure safeguarding concerns were reported and monitored. In the last 9 months 21 safeguarding concerns were reported across the wards. These included safeguarding concerns such as violence and aggression between patients, financial abuse and self-harm.

Patients told us they understood what their risks were. They knew about the different observation levels that staff placed them on and understood why staff may observe them. However, they said that observations were disruptive at night. Patients said they could go outside and had a good amount of leave. Patients said they also had access to the gardens, but the doors were kept locked, and they had to ask staff to open them if they wanted to go out in the garden.

Staff undertook a risk assessment on every patient at initial triage. Patient risk assessments were updated regularly after an incident. Staff completed patients Historical Clinical Risk Management 20 (HCR-20) each month. This is a risk assessment used by mental health professionals to assess the risk of violence in people with offending behaviours. Staff said that patients were involved in reviewing their risk assessments at ward rounds. Staff said the service had procedures for security, staff completed a 2-week training course in which security was an integral part, restricted items were not allowed on the ward. Staff said talking therapy and distraction techniques were used for de-escalation. Staff on Aurora ward worked with patients to manage risk and be least restrictive. For example, patients had their medication in their flats and were risk assessed to self-medicate. Senior staff said that patients were involved in reviewing their risk assessments at ward rounds and MDT meetings.

Staff recorded risk management plans to help reduce the risks to patients. We looked at 13 patient risk assessments. Staff used a daily risk assessment tool for things such as section 17 leave and restrictions so that risks can be assessed at the time. Seclusion records were completed and then reviewed by the multi-disciplinary team (MDT) during a patients' episode of seclusion. A second independent MDT review of the seclusion care plan and process was also completed. Staff monitored patients physical health. For patients assessed as having physical health risks, staff used the national early warning score (NEWS) system to record patients’ physical health observations. We looked at patients’ NEWS records. They showed that staff completed these observations weekly and escalated any high scores to clinicians. This reduced the risk of patients’ physical health deteriorating rapidly unnoticed. Staff followed the provider’s policy and procedures when carrying out patient observations. Patients were on different observation levels according to risk. Patients were searched when they came back from leave and random searches took place. The trust had a reducing restrictive practices programme. In the last 6 months, staff had reported 53 incidents of restraint. One of these was reported to be in the prone position and 7 in the supine position. These 8 incidents occurred on Fuji ward. There had been 2 incidents requiring the use of intramuscular rapid tranquilisation on Fuji ward. Seclusion was infrequently used. In the 6 months prior to the inspection there had been 4 episodes of seclusion – one on Alpine ward and 3 on Fuji ward. Managers reviewed all restraint and seclusion incidents at the clinical governance meeting.

Patients said the bathroom, toilets and kitchen were clean. Patients gave mixed feedback about the décor, furnishings and fittings. This was because the service was currently being refurbished. On Aurora ward, which had recently undergone refurbishment, patients gave positive feedback about the facilities.

Staff knew the processes and procedure in place for reporting potential risks in the care environment. Staff were aware of environmental risk assessments, including ligature risks. Staff knew about the auditing of these. Staff felt they had the technology needed to carry out their roles.

The ward areas and the clinic room were secure. Clinic rooms were fully equipped, with accessible resuscitation equipment and emergency drugs that staff checked regularly. Equipment included an emergency grab bag, oxygen cylinders, an automated defibrillator and a breathalyser. Staff carried out daily safety checks for the clinic room equipment and emergency medicines. Staff monitored the temperature of the medicine fridges. However, on Alpine ward the assessment team found issues with some equipment and the facilities. Things such as the eye wash found in the medicines cupboard had passed the expiry date, the handwashing facilities had a faulty tap that was leaking and labels on the handwash liquid, sanitiser and lotion had faded, making it difficult to know which was which. We raised this with the trust at the time and they took immediate action. There was space on the ward to safely manage the number of patients and if restraint needed to be carried out there was sufficient space for this to take place. The ward was clean and tidy, and the décor well maintained. Aurora ward had recently undergone a refurbishment and the other wards were due to be refurbished shortly afterwards. There was a seclusion room on Alpine ward and Fuji ward. The rooms allowed for clear observation and two-way communication and had toilet facilities and a clock visible to patients.

Ligature risk assessments were up to date and included the ligature fixtures and fittings and how the risks were mitigated. The service was going through a refurbishment plan at the time of the site visit, to improve safety across the wards.

Patients said there was enough staff on the wards to keep them safe. However, they said that activities were cancelled all the time due to staffing. Patients said the number of activities had been dropping since Christmas. A patient on Causeway ward said that staff were forever changing, and they were not there long enough to develop supportive therapeutic relationships with patients.

Staff said there was always a nurse in the ward area. However, some staff on Forest ward said nurses had at times struggled to facilitate one to one time with patients. Forest ward had been short staffed for the 6 weeks prior to the onsite assessment. The ward managers were able to bring in extra staff when needed and to seek support from senior leaders in those situations. Staff said escorted leave had never been cancelled due to staffing. However, occasionally activities had been cancelled due to staffing.

During the assessment we observed enough nursing staff present in communal areas.

The wards had an establishment of 99 whole time equivalent healthcare support workers and 75 nurses working. There were 32 healthcare support worker vacancies. For the nurses, there was 10 vacant posts. At the time of the assessment (for the wards visited) 2 of the ward manager posts were being covered by the deputy ward managers. The trust had recently appointed 2 new ward managers who were due to start soon. In the meantime, the director of specialist services was providing additional support to the deputy ward managers acting up. Ward managers used regular bank nurse and agency nurses to cover annual leave and sickness absence. The MDT comprised of psychologists, occupational therapists (OT), social workers, pharmacist, doctors and nurses. However, most wards did not have a dedicated OT working on the ward. The trust said they had since recruited 3 overseas trained OT staff to start soon. There was further work to recruit more OT staff. The service participated in a pilot of new activity coordinator roles and at the end of the pilot, these roles were removed. However, 7 new substantive roles had been created within the hospital following the pilots completion. The service had enough medical cover and a doctor available to go to the ward quickly in an emergency. The hospital had 6 full-time consultant psychiatrist working Monday – Friday during office hours. Three of these posts were covered by locum consultants to fill the vacancies. The consultants also provided out of hours support to staff when they needed assistance in a psychiatric emergency. Nursing staff had completed mandatory training. As of January 2024, all wards were over 94% complaint with mandatory training. Managers ensured staff received support, supervision and development. Psychology de-escalation support was given for managing challenging behaviour. As of January 2024, all staff had received monthly supervision, with the exception of Fuji ward where 96% of staff had received supervision.

Staff described the trust policy on handwashing. Staff knew about the importance of infection control to stop infection spreading.

The wards were visibly clean, and staff ensured cleaning records were up-to-date. Staff disposed of sharps waste appropriately.

Staff followed infection control policy. Senior nursing staff carried out monthly audits of the ward environments to minimise the risks of infection. The service had employed full time domestic staff to clean the premises. Domestic staff kept cleaning records up to date and these demonstrated that staff cleaned the ward daily.

Patients said they knew what medicines they took and had been advised about the side effects of the medicines. One patient said they always received advice and had been able to start administering their own medicines. Patients’ medicines were reviewed regularly at ward rounds, with patient involvement. Some patients were self-medicating and there was a protocol in place for this. Staff provided specific advice to patients and carers about their medicines. Pharmacy staff provided specific counselling to patients when they were discharged with new medicines to ensure that they understood how to take them.

Staff said when administering medicines they check prescription charts and consent to treatment forms. Medicines reconciliation was done by the nurse on the ward and the nurse handing over. Staff followed national practice to check patients had the correct medicines when they were admitted into the service. Staff ensured the appropriate treatment authorisation certificates were in place, in line with the requirements of the Mental Health Act 1983. Staff ensured that when rapid tranquilisation was used, the appropriate physical health monitoring was carried out in line with national guidance, to ensure patients remained safe.

Medicines including controlled drugs were stored securely and safely. We observed that medicines were given to patients in a person-centred and caring way. Patients’ medication was given in private to maintain privacy and dignity.

We reviewed 18 prescription records and found that all had allergies documented, and appropriate assessments had been completed. Staff were using insulin prescription charts to record blood glucose monitoring for Type 2 diabetes patients who were not prescribed insulin, instead of following the providers process of monitoring and documenting blood glucose levels. This could result in prescribing error especially when patients are transferred from one care setting to another. There were processes in place to investigate when medicines incidents occurred, and lessons learnt were cascaded to staff.