The NHS trust at the centre of the UK’s biggest ever mental health inquiry has been downgraded after staff were caught falling asleep when they were meant to be observing patients.
The Care Quality Commission (CQC) has dropped the rating for Essex Partnership University NHS Foundation Trust (EPUT) from “good” to “requires improvement” following inspections in November and January. This followed a warning note the trust was issued last year following an inspection of its acute wards for working-age adults and psychiatric intensive care units (PICU).
EPUT provided data from June 1 to December 23 last year, with incidents of staff sleeping on duty, and there were 20 incidents during this time, according to the CQC report.
One patient reported a staff member falling asleep while they were supposed to be carrying out an “enhanced observation with the patient kept within line of sight”. During this observation, it was intended that the worker could “engage with, and maintain contact with the patient to ensure their well-being, safety, and safety of others”.
The report said the trust “must ensure that staff do not fall asleep when undertaking patient observations”.
Essex mental health services have been under the spotlight for years. An inquiry launched into the deaths of up to 2,000 patients under NHS care in the county over a 20-year period was recently awarded statutory status after pressure from MPs and bereaved families.
EPUT was formed in April 2017 following a merger of two other trusts in Essex. It provides support, treatment and advice to people experiencing poor mental health, including people detained under the Mental Health Act.
In its latest inspection, the CQC found people were not always cared for by staff who knew them and the service well, due to a high usage of agency staff. On acute wards, there were not always enough staff to keep people safe. The trust had plans to respond to staffing issues but these were new and had not had time to embed.
Inspectors also found that leaders did not always support staff through regular supervision to improve the care they gave to people. Staff did not always follow the trust’s processes to safely store, prescribe and give people medicines and there were not always enough pharmacy staff to support with this.
The trust had recently created a new complaints system, but some old complaints were still unresolved. People mostly said they felt safe, valued and respected, but some people on acute wards said staff on night shifts were uncaring.
However, patients’ loved-ones said staff were compassionate and knowledgeable when things went wrong, inspectors found. Leaders understood the need to design services suited to the local population’s needs and included people’s feedback in their decisions and staff said the workforce culture was improving.
Rob Assall, CQC’s director of operations in London and the east of England, said: “We were very disappointed to find people’s safety being affected by many of the same issues we told the trust about at previous inspections. This is because leaders weren’t always creating a culture of learning across all levels of the organisation, meaning they didn’t ensure people’s care was continuously improving or that they were learning from events to ensure they didn’t happen again.
“We found multiple incidents where staff had fallen asleep or didn’t interact with people during observations. Yet senior leaders believed observations had improved because their data wasn’t always accurate. Despite these issues, leaders recognised the need to develop a learning culture and were implementing many programmes to do so.
“However, many of these improvement programmes started long after issues were identified and it shouldn’t have taken them this long to address things affecting people’s safety and well-being.”
The CQC said it would continue monitoring the trust to ensure it is providing safe care and treatment and return to check that leaders have followed through with their improvement programmes.
A spokesperson for EPUT said: “We’re committed to working with CQC and partners to improve the quality of care that we give to our patients and those who use our services. While we are naturally disappointed by the overall rating change, as the CQC acknowledged, we’re already working on a number of areas to improve services for those who rely on us, so that they receive the compassionate care they deserve.
“In the six months since the CQC inspection significant progress has been around the scale and pace of change across the Trust, working with patients, service users and their families to jointly transform all aspects of care.”
