Isle of Wight NHS Trust

Updated 23 September 2021

The Isle of Wight NHS Trust is the only integrated acute, community, mental health and ambulance health care provider in England. Established in April 2012, the trust provides a full range of health services to an island population of about 143,000 people.

Overall, the trust provides 23 core services for acute, community, mental health and ambulance services.

Acute services are based at St Mary’s Hospital Newport with 245 beds. Services include emergency department, urgent care service (by referral only), emergency medicine and surgery, planned surgery, intensive care, paediatric services, a special care baby unit (SCBU), and maternity care services. Along with diagnostic and screening, pathology and pharmaceutical and outpatient services.

The community division provides a variety of supported care services within patients' homes, community settings, GP practices and clinics, as well as providing physiotherapy, occupational therapy and podiatry support within the acute setting. The community clinical provision is based in three localities of the Isle of Wight: Northeast, West and Central, and South Wight, with district nursing provision in each area. There is also support offered for children and young people through the paediatric therapy, occupational therapy, physiotherapy and speech and language therapy services.

The mental health division provides community learning disability services; inpatient and community based mental health care. With 32 beds for working age and older adults, supported by a home treatment team and a community mental health team for adults and child and adolescent mental health services.

The ambulance service division includes operational delivery units for the 999 emergency ambulances, NHS111 and patient transport services based at the St Mary's Hospital site.

We carried out this announced inspection of a range of the mental health, acute and community services provided by this trust as part of our continual checks on the safety and quality of healthcare services. We did not inspect ambulance service division on this occasion. At our last inspection we rated the trust overall as requires improvement and remained in quality special measures. No use of resources review was carried-out for this inspection.

We inspected the following core services and rated them individually for the five key questions of safe, effective, caring responsive and well led. We also inspected the well-led key question for the trust overall. We rated 11 out of 11 services inspected as good.

At this inspection, overall, we rated safe, effective, caring, responsive, and well-led as 'good'. Our separate rating of well-led for the trust was good.

Acute

Diagnostic Imaging: all five key questions were rated good. Good overall

Medical Services: all five key questions were rated good. Good overall

Surgical Services: safe, effective responsive and well led were rated good, with caring rated as outstanding. Good overall

Gynaecology Services: safe, effective, caring and responsive were rated good and well led rated was rated requires improvement. Good overall

Children and Young People: all five key questions were rated good. Good overall

Mental Health

Acute wards for adults of working age and psychiatric intensive care units: Effective, caring, responsive and well led rated good with safe rated as requires improvement. Good overall

Wards for older people with mental health problems: all five key questions rated good. Good overall

Community based mental health services of adults of working age: safe, effective, caring and well led rated good with responsive rated as requires improvement. Good overall

Mental health crisis services and health-based places of safety: effective, caring, response and well led rated as good with safe rated as requires improvement. Good overall

Community

Community adults: safe, effective, responsive and well led rated as good with caring rated as outstanding. Good overall

Community inpatients services: safe, effective, responsive and well led rated as good with caring rated as outstanding. Good overall

On this occasion, we did not inspect the ambulance service division. In rating the trust, we took into account the current ratings of the 11 core services we did not inspect this time but had rated previously.

Our rating of well led improved. We rated them as good because:

The trust leadership demonstrated the delivery of improvement plans over time and had plans for a strategy refresh to progress the quality of care delivery for the future.

There was a clear vision for now and the future of healthcare on the island.

Across the trust teams were determined to meet the needs of patients and the public.

The executive team showed the drive to make the trust a better place for staff to work in.

Staff were mostly satisfied with working at the trust which was the island’s main employer.

Staff were able to directly influence the quality of services and make changes in their own areas.

There were quality improvement objectives and audits to identify progress and next steps.

Recruitment internally and externally, including from overseas, had benefited the trust services.

Engagement with staff, patients, partners and the system were much improved and were effective.

New approaches for communication were introduced and there was renewed vigour to continually improve the communication for patients and their relatives.

There were established systems and partnership working for the sustainability of the organisation which was for the benefit of the population of the Isle of Wight.

The partnership links were contributing to the success of supporting patients to have good care and treatment on the island.

The culture, enthusiasm and energy for the quality of patient care showed significant improvement.

There was a greater patient focus than seen before.

There was established support for staff care and wellbeing as confirmed by the improved staff survey outcomes and as seen throughout all areas inspected.

The strategy for equality and inclusion was far more developed and was working towards meeting the needs of people with protected characteristics.

There was a developing research team and projects underway.

However:

Delays in mandatory training delivery, such as for safeguarding and resuscitation, could impact on patient care.

The trust had identified information technology systems needed new investment, the continued delays affected the cohesiveness and modernisation of the trust’s information management.

The trust’s non-executive directors lacked visibility in some services which had previously been identified before the pandemic restrictions.

Recruitment to some key roles was filled on an interim, fixed term or locum basis reducing the stability of the trust.

The trust application of the equality and inclusion strategy across the range of staff and patient protected characteristics was better in some departments than others.

The referral to treatment times waiting lists, both pre- and post-pandemic, remained a challenge for the trust.

The fit and proper person checks for directors were not always completed in a timely way.

There needed continued investment in the estate to ensure appropriate care and support was provided to all patient groups.

How we carried out the inspection

During the core service inspection, we visited the location and sites for the 11 core services inspected, and we spoke to a range of staff, patients and key stakeholders. We also inspected the well-led key question for the trust overall. We conducted well-led interviews remotely.

You can find further information about how we carry out our inspections on our website: www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

Updated 4 September 2019

Updated 4 September 2019

Updated 9 September 2014

The CAMHS provided by the Isle of Wight NHS Trust were delivered in a safe and caring manner. We found that staff were kind, friendly and delivered care which demonstrated a responsive manner when working with children, young people and their families. We observed that children and young people received a good service.

The team was in the process of moving from hard copy records to electronic records, and this had created some difficulties regarding how some of the information was being transferred and recorded. Information about assessments and care could not be easily located. Incidents were reported and some lessons learnt, but not all information on reported incidents was fed back to teams.

Staff demonstrated a good understanding of how to follow the local safeguarding policy and procedures for safeguarding children, and worked well with other trust teams and external agencies, to provide care that best met the needs of children and young people. The team worked collaboratively as a multidisciplinary team with a varied skill mix. The use of outcome measures of effectiveness was routine, and information was shared nationally and locally.

The CAMHS had an understanding of the specific needs of the population they served, and delivered care which was largely responsive to people’s needs. Children did not have long waiting times for care and treatment, although some children who required inpatient services for a longer period of time were placed off the Island.

Children could provide feedback to the service and this was acted upon. Staff told us that they felt supported by their managers, and were proud of their team and to work for the trust. The quality of the service provided was monitored, and necessary measures were taken to improve performance.

Updated 23 September 2021

Updated 4 September 2019

Our rating of this service improved. We rated it as good because:

• We noted positive changes since our last inspection in January 2018.
• There was openness and transparency about safety, and continual learning was encouraged. Staff were supported to report incidents, including near misses.
• Staff were clear about their safeguarding responsibilities and if there was a concern about a child’s wellbeing safeguarding procedures were followed and understood. All staff we spoke with had completed the appropriate level of training in safeguarding.
• Care was planned and delivered in line with evidence-based guidance, standards and best practice and the individual needs of the child and family were met through the careful care planning.
• Staff received annual appraisals and new staff were supported when completing their competency assessments, helping to maintain and further develop their skills and experience.
• There was good multidisciplinary team working evident across the service including working with external agencies.
• Parents and children gave feedback about the care and kindness received from staff, which was positive. All the children and their carers we spoke with were happy with the care and support provided by staff. We observed staff treated children, young people and their families with compassion, kindness, dignity and respect. Staff worked in partnership with children, young people and families in their care.
• Guidance on how to make a complaint was readily available across the community children and young people’s service and was on the trust’s website.
• Managers at local levels in the trust had the right skills and abilities to run a service providing high-quality sustainable care.
• In general staff gave clear advice in line with national guidance on health promotion.

However:

• The service did not always have oversight of medicines management.
• Some environments were not, in their design, child friendly and the service had not adapted them to meet the needs of the child and young person. However, patient’s privacy and confidentiality was not always maintained in the sexual In two areas of the service, staff did not consistently perform daily checks of a resuscitation trolley and a grab bag as per trust policy.
• The services IT systems did not all alert staff if a child, young person or family were on a child protection plan or if there was a risk to practitioners for home visiting. Therapy staff did not always complete a safeguarding assessment when meeting a child, young person or family.
• The 0-19 service did not have standardised protocols for recording visits on the electronic records system to ensure consistency across the service.
• Staff did not always provide advice to children, young people and their families based on national guidance for bottle feeding.

Updated 23 September 2021

Updated 9 September 2014

The CLDT services provided by the Isle of Wight NHS Trust were delivered in a safe and caring manner. We found that staff were polite, and delivered care which demonstrated good skills when working with people with learning disabilities and their families. We observed that delays were experienced in receiving psychological therapies, but on the whole, people received a good service.

The team was in the process of moving from hard copy records to electronic records, and this had created some difficulties regarding how some of the information was being transferred and recorded. Information about assessments and care could not be easily located. Staff told us this was work in progress and it was taking a lot of their 'hands on' time.

Staff demonstrated a good understanding of how to follow the local safeguarding policy and procedures for safeguarding vulnerable adults, and they worked well with other trust teams and external agencies to provide care that best met the needs of people. The team worked as a robust multidisciplinary team with a diverse skill mix. The use of outcome measures of effectiveness was routine, and information was shared nationally and locally.

There were systems in place for people to give feedback to the service, and this was acted upon. Staff told us that they felt supported by their managers, and were pleased to work for the trust. Quality was monitored, and the team took necessary measures to improve their performance.

Updated 9 September 2014

We found that the Island Drug and Alcohol Services (IDAS), provided by Isle of Wight NHS Trust, were delivered in a safe and caring way. We found that staff were respectful, and delivered care which demonstrated good skills for working with people who misuse drugs and alcohol, and their families. We observed that care and treatment was delivered in a timely manner; there were no people on waiting lists.

We found that the team were concerned about the service going to tender in July 2014. This meant that staff were worried as to whether the Isle of Wight NHS Trust would continue to provide the service, or whether it might be given to another provider.

Staff demonstrated a good understanding of how to follow the local safeguarding policy and procedures for safeguarding vulnerable adults and children, and worked well with other teams, within the trust and outside organisations, to provide care that best met the needs of people. There was good use of national guidelines to treat patients, and outcomes were monitored routinely to improve the service.

People who used the service were able to provide feedback and also knew how to complain. The majority of staff told us that they felt well supported by their managers, and were pleased to work for the team and the trust. However, one staff member felt that the senior management did not listen to their concerns.

We found that the team had arrangements in place to monitor the quality of the service provided, and took necessary actions to improve performance.

Updated 4 September 2019

Our rating of this service stayed the same. We rated it as requires improvement because:

• The emergency operations centre was still in the early stages of embedding new governance structures, systems and processes into the service. Therefore, it was too early to fully establish whether new strategies and quality improvement programmes were effective or working well.
• The service did not always meet the Ambulance Response Programme quality indicators for the time to answer each call. We found there was no long-term service planning or solution identified to tackle increased demand. Resources were deployed by dispatchers by 9.30am on both days of our inspection, causing delays to treatment.
• There was still a lack of sustainable staffing levels for clinical support staff on the night time shift and this had not improved since our last inspection.
• The audit team did not have access to the new CAD system within their department, so had to move when asked to assist with taking calls.

However:

• The service had introduced a new CAD system, and this meant better quality real time information was now available for the service to monitor trends and themes. This was an improvement since our last inspection.
• The service had recruited more performance support officers, clinicians and dispatchers. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. Staff assessed risks to patients, acted on them and kept good care records. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
• Staff cared for patients with compassion and took account of their individual needs. Feedback from patients confirmed that staff treated them well and with kindness.
• The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and monitor the effectiveness of the service. This was an improvement since our last inspection.
• Staff had received training in the Mental Capacity Act 2005 and the compliance rate for mandatory training was 90%. This was an improvement since our last inspection.
• The service policies were up to date and standard operating procedures (SOP) had been reviewed and updated. This was an improvement since our last inspection.
• There was a new meal break policy and staff now received 30 minute meal breaks during their shifts. This was an improvement since our last inspection.

Updated 6 June 2018

Our rating of this service improved. We rated it as good because:

• Staff had access to up to date, accurate and comprehensive information about children and young people in their care and treatment plans. They ensured that care plans and crisis plans were up to date and comprehensive, assisting the teams’ deliver of safe care and treatment to young people. Staff members ensured there was an effective system in place to assess the risks to all young people
• The staff team had reviewed and improved the way they reported incidents. They ensured incidents were consistently reported and there was learning from each incident.
• Staff involved children and young people and those close to them in decisions about their care and treatment. Children and young people spoken with were very positive about the care and treatment they received. The team listened to feedback from parents and young people, supported them and made changes because of the feedback.
• There was no waiting list for the service and young people were seen quickly.
• Staff were well trained to carry out their roles. There was suitably skilled and experienced staff to support children and young people’s needs.
• The manager promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values. Staff morale was good and staff felt positive about their team.

However:

• Young people could not always access the service when they needed it. There was no out of hours provision for young people. Young people admitted to hospital at the weekend had to wait until the following Monday before being assessed by CAMHS staff.
• The service did not deliver all the psychological therapies recommended by NICE.
• There was no provision for young people with attention deficit hyperactivity disorder or autism spectrum disorder. Whilst there were discussions with the clinical commissioning group about the pathway, these young people were excluded from the service and had been for several years.
• The service did not ensure that the premises were safe for children and young people. They had access to domestic knives in the unlocked kitchen.
• The manager did not ensure staff were competent for their roles because staff members did not all receive sufficient regular one to one managerial supervision.
• The staff team did not treat all complaints seriously because they did not investigate verbal complaints from children, young people or their families.

Updated 6 June 2018

Our rating of this service stayed the same. We rated it as good because:

• There was evidence that the waiting list was monitored and patients were assessed and prioritised according to risk. Staff could see Service users quickly if there were any concerns about any deterioration in their presentation.
• Staff delivered a range of evidenced based care and treatment interventions that were suitable for people with a learning disability. Care plans were personalised, holistic and considered the service user’s needs.
• Staff discussed risk in multi-disciplinary team (MDT) meetings and responded promptly to the service users need. Risk assessments were individual to each service user.
• Staff demonstrated a clear focus on service users physical health needs and considered its impact in their interventions in all records reviewed
• All staff had received an annual appraisal. Staff appraisals included conversations about career development and how it could be supported.
• Service users we spoke with said that staff treated them with dignity and respect and understood their care needs. Staff involved families and carers to understand service users likes, dislikes and specific needs where appropriate. All service users and carers reported feeling involved in their care.
• All areas were clean with good furnishings.

However:

• Service users were not having standardised risk assessments completed. A clear picture of a service users risks was not immediately apparent in the electronic notes. Information was not easily accessible on the electronic records system and was stored in different areas. Clinical information about the service user was difficult to find.
• Regular management supervision which included caseload supervision was not formally documented. Management supervision was not completed monthly in line with the trust supervision policy.
• Mental Health Act (MHA) specific training was not provided.
• Staff had not been involved with the transformation plan. Staff reported feeling out of the loop and did not know what was happening.
• Conflicts between staff were not managed quickly by senior managers
• The service was not taking positive action to support the national Transforming Care programme

Updated 23 September 2021

Updated 4 September 2019

Our rating of this service stayed the same. We rated it as requires improvement because:

• The service did not always provide safe care to patients. For example, patients admitted to the ward that should have been cared for on acute wards did not always receive an assessment of their needs and risk before admission, and their risk assessments did not recognise and mitigate for all the risks present within the environment. The service had no protocols or policies to support Woodlands staff to manage acute patients. Staff were experienced in caring for patients with mental health needs, but staffing numbers did not always enable staff to provide adequate support to both the acutely unwell, and rehabilitation patients present on the ward.
• Patients did not receive the full range of recommended care and treatment interventions suitable for patients requiring rehabilitation care and consistent with national guidance on best practice. For example, patients were not able to store medicines in their room and self-administer in preparation for discharge, and the ward had only recently recruited a psychologist, and was yet to embed psychological input into the wards treatment programme .
• Ward teams did not have access to the information they needed to improve the service and provide effective care. For example, the service did not have any clinical key performance indicators to evaluate the wards effectiveness, and the service did not track and report when patients’ discharges had been delayed.
• Leaders did not ensure all staff received regular one to one or group supervision, and not all staff felt supported. Staff were not provided with training on how to manage and prevent violence and aggression, which at times would be required to safely manage the higher risk patients from the acute wards.

However:

• Staff treated patients with compassion and kindness, respected their privacy and dignity and understood the individual needs of patients. They actively involved patients and families and carers in care decisions. Staff developed holistic and recovery-orientated care plans.
• The ward team included or had access to the full range of specialists, having recently recruited a psychologist, required to meet the needs of patients on the ward. Managers ensured staff received an annual appraisal. The ward staff worked well together as a multi-disciplinary team and with those outside the ward who would have a role in providing aftercare. Staff engaged in clinical audit to evaluate the quality of care they provided.
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.

Updated 23 September 2021

Updated 23 September 2021

Updated 12 April 2017

We rated this service as good because.

• The building was accessible, with a clean and well-maintained environment. The clinic room contained appropriate equipment for physical health monitoring; for example, there was a couch and an electrocardiogram machine to check clients’ heart rhythm and electrical activity.
• There were sufficient numbers of staff to meet the needs and safety of the clients using the service. The trust provided all staff with mandatory training. There was a robust staff induction programme and staff attended mandatory training. Staff morale was good despite recent pressures of redesign and reductions in staffing.
• Staff interacted with clients in a respectful and supportive way. Staff were warm, kind, respectful, enthusiastic and positive. Full risk assessments and risk management plans were in place. They were clear and comprehensive. Staff discussed risk with partner agencies on an ongoing basis. Staff used a robust assessment tool called ‘client evaluation of self’ at the point of referral. All the care records we reviewed were comprehensive and clear. Staff assessed the physical and mental health of the clients and continued to review and update the records. Where appropriate, staff involved clients and family members fully in care planning.

• Staff supported clients in line with ‘drug misuse and dependence: UK guidelines on clinical management (2007)’ during detoxification treatment, and followed the trust’s ‘operational guidelines for alcohol and opioid prescribing’ as well as the Royal College of General Practitioners guidelines (first edition 2011). All the guidelines for interventions and prescribing pathways were adapted from appropriate National Institute of Clinical Excellence (NICE) guidelines. Prescribers recorded appointments and outcomes on the electronic records and a client’s prescribing pathway was clear and legible.

• There was a good choice of activities to suit individual needs such as the 12-step programme, and informal group sessions designed to help clients discuss and improve skills in coping with dependency and avoiding relapse, although the service did not have access to a psychologist

• The provider had a robust incident reporting process. Staff knew how to report incidents. Staff were open and honest when things went wrong.

However,

• Although the service had a detailed health and safety environmental risk assessment, including fire risk assessments, and staff told us their policy was to review the document annually, the environmental risk assessment had not been updated since January 2015 and staff had not monitored progress against the identified actions. Staff had also not updated all other policies, including for children visiting the service.

• Although supervision took place, this was not regular and documentation was of poor quality.

• Staff did not formally document a daily handover of client information at the end of each shift, which meant staff did not evidence how they monitored client progress.

• Staff did not have a clear system in place for documenting when they administered medication

• The service operated in isolation from the rest of the trust and staff did not feel the service was an integral part of the trust.

Updated 23 September 2021

Updated 9 September 2014

There were effective procedures for staff and people using the service, to report both low-level and serious incidents. These were reported to relevant agencies, investigated, and reviewed to prevent a reoccurrence. Staff had access to training to safeguard vulnerable adults, and some staff had received training on the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The Mental Health Act (1983) was applied appropriately, and all documentation was current and in line with the Mental Health Act Code of Practice.

People were assessed and treated according to nationally-recognised pathways of care, and their health needs were being addressed. People were provided with psychological therapy, such as cognitive behaviour therapy (CBT). Staff and managers had regular supervision and appraisal, and new and temporary staff had induction. Staff worked in multidisciplinary teams to co-ordinate care, and were involved in goal setting and regular audits of care plans, but the use of outcome measures of effectiveness was not routine.

People were involved in their care and treatment; there was information on independent mental capacity advocates, and independent mental health advocates were available should people wish to talk with them.

There was a clear vision and strategy for the service; however, the unit did not have a clear understanding of the trust’s overall vision and strategies, and staff felt disconnected from the wider trust.

Updated 4 September 2019

Our rating of this service stayed the same. We rated it as requires improvement because:

• The service did not control infection risk well. Ambulances were not cleaned effectively to ensure the risk of cross contamination issues were minimised.
• Managers could not routinely monitor the performance of the service. Available computer systems did not support the collection and analysis of information to allow for the continuous improvement and delivery of a quality service.
• Risk management processes had not always identified and escalated risks appropriately to ensure mitigating action could be taken to minimise risks associated with service delivery.

However:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them.
• Staff provided good care and treatment and ensured patients had enough to eat and drink. Managers made sure staff were competent for their role Staff worked well together for the benefit of patients, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Staff treated patients with extreme compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers taking action to ensure their individual needs were known and met.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for transport.
• Leaders ran services well and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

Updated 4 September 2019

Our rating of this service improved. We rated it as good because:

• Managers at all levels in the service were developing the right skills and abilities to run a service providing high-quality sustainable care.
• The service had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community.
• Managers across the service promoted a positive culture that supported and valued staff. The service was committed to improving services by learning from when things went well and when they went wrong, promoting training, research and innovation.
• The service engaged well with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.
• Staff cared for patients with compassion and took account of their individual needs. Feedback from patients confirmed that staff treated them well and with kindness.
• The service had a process for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff.
• There was a new meal break policy and staff now received 30-minute meal breaks during their shifts. This was an improvement since our last inspection.

However:

• The service strived to improve the quality of its services. However, we found issues regarding the governance and oversight of medicines management and some concerns regarding security of paper patient records.
• Systems to analyse, and use the information were now available to the service to support service development were under development. New reporting and governance system were in the early stages of being embedded into the service, Therefore, it was too early to fully establish whether new strategies and quality improvement programmes were effective or working well.
• The long-term plans for divisional and reporting structure under which the ambulance service would be managed were not yet clear.