Urgent action is required to address a series of concerns over services run by the only NHS trust in England that provides care exclusively for people with learning disabilities, the Care Quality Commission has found.
An inspection report on Calderstones partnership trust raised concerns over the frequent use of face-down restraint by staff and regular breaches of the Mental Health Act at the trust’s services. Ward environments were also dirty, some rooms used to seclude patients in were not safe and recruitment problems and high staff turnover had left teams too reliant on agency staff, the CQC found.
The inspection took place in July and the findings have been published this week.
The trust acknowledged that the inspection had flagged “inadequate” care and said it had taken immediate steps to improve services.
The CQC report pointed to the unique nature of the trust’s services. Calderstones only handles highly complex cases involving learning disabilities. All of its patients are cared for on inpatient units and almost all are detained under the Mental Health Act.
Over 40% of the trust’s patients are subject to restriction orders that mean key decisions about their care, including discharge, must be authorised by the Ministry of Justice. Restriction orders are usually put in place when people have committed offences linked to their mental illness or learning disability and a court has deemed hospital care is more appropriate than prison.
Long hospital stays at the trust’s services are also common. At the time of the CQC inspection, 43% of patients had been at the trust’s services for more than five years. The CQC found that the trust had done too little to support people out of hospital but acknowledged that factors outside of the trust’s control, such as Ministry of Justice approval for discharge being required for many patients, had contributed to this.
Dr Paul Lelliot, the CQC’s deputy chief inspector of hospitals, said Calderstones faced major challenges.
“The conditions that we found on some of the wards were unacceptable. It should go without saying that a hospital ward should be clean. It is even more troubling when these wards, are in effect, people’s homes,” he said.
Lelliot said that inspectors were surprised at the number of times staff had resorted to physical restraint. Recently published national guidance states that people should not be restrained in the face-down position. Yet, CQC inspectors found that Calderstones staff had “frequently” used the technique as a planned intervention. At one of the trust’s services, staff had restrained one person in the face-down position 10 times during June 2014.
Mark Hindle, chief executive of Calderstone’s partnership trust, said: “The inspection was an important snapshot at that time and disappointingly it highlighted a number of unacceptable and inadequate areas of process and service delivery, which we acknowledge and have taken immediate steps to improve.”
He added: “There are challenges in supporting people with extremes of behaviour, where because of their learning disabilities, many have committed crimes that put themselves and other people in danger.
“Although the CQC specifically recognise that we are unique and consequently it is difficult to compare us to other services, we are committed to improving quality in this organisation for our service users. We have agreed with them that further inspections, focussed on the specific areas that required improvement, will take place.”