Birmingham and Solihull Mental Health 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

Some people told us they did not feel safe however other people said they did and staff supported them. Two people said they did not think if they raised concerns they would be listened to. Staff understood safeguarding and how to safeguard people from abuse. We observed staff supporting people and keeping them safe from harm. People were involved in their risk assessments. People and staff told us that restraint was rarely used. Staff completed people’s therapeutic observations to ensure their safety and wellbeing. Staff and people told us there were not always enough staff which affected their leave and activities. We identified a breach of the legal regulations. Staff were not all trained in immediate and emergency life support although this was being arranged. We identified a breach of the legal regulations. The provider's systems and processes had failed to identify, manage and mitigate some areas of risk in the environment. The environment was not well maintained. In several bathrooms and toilets, we saw mould on the ceilings and there was plaster peeling off the walls. Staff and people told us repairs were not always completed in a timely way.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Three people told us they did not feel safe at Reaside and one person told us they sometimes felt scared on the ward because of other people there. 6 people told us they did feel safe, and staff supported them to feel safe. Most people told us they knew how to raise concerns if they did not feel safe. However, 2 people said these concerns were not investigated and 1 person thought it was a waste of time to raise concerns.

Staff demonstrated a good understanding of safeguarding and how to take appropriate action if they witnessed or suspected abuse. Staff gave examples of when they had witnessed abuse and how they had reported this to safeguard people from harm. Staff said they completed safeguarding training during their induction. They spent time with people to build their trust and explain safeguarding processes. Staff understood the risks of bullying between people on the wards and the hospital. Staff understood the need to restrict contact between people on the acute and rehabilitation wards due to some people’s vulnerability. Staff told us that recently there had been a ‘lockdown’ of the wards although official visits were not cancelled, people had fresh air breaks and their authorised leave where safe to do so still took place. The lockdown was in response to people telling staff that they did not feel safe as searches were not thorough and too predictable. They told staff that when people gathered on corridors, they had witnessed trading of contraband items which put some people at risk of exploitation and at risk of harm. In response to these concerns, managers had split people up accessing the courtyard and main dining room and security staff were patrolling the corridor areas. In the searches staff had found vapes were being traded which raised concerns about the effects of these on people’s physical health.

We observed staff responding to people when they said they had concerns or did not feel safe. Staff spoke with them and assured they were listening. They showed them how to raise their concerns so they could be dealt with appropriately. We observed a manager supporting a person to raise concerns about not feeling safe.

Most people told us they were involved in discussions about their risk assessments and understood what these were. One person said they did not know about their risk assessment. People told us restraint was only used as a last resort when the person was a risk to themselves or others. Some people said they had never seen people restrained at Reaside.

Staff said that each person’s records included a condensed profile that identified their risks. Staff said they tried to read people’s risk assessments but did not always have the time to do this. They said people’s risk assessments were developed with the person and staff. Staff said they attended people’s clinical risk meetings, and their input was valued in these. Staff said that restraint was rarely used and only as a last resort if de-escalation and talking with the person had not been successful. If it was used, then there was a debrief for staff and a one to one debrief for the person with support offered. There was also a post incident review to discuss what happened and if anything could be done to support the person in the future. Staff were aware of the therapeutic observations policy and completed people’s observations on an electronic device. Staff were trained in this and said that this system had helped them to complete observations in a timely way. Some staff said that there could be better training for staff in recognising risks associated with illicit drugs and action to take when this is identified. They said this could then be discussed fully with the person’s clinical team to inform the person’s risk management plan. Staff said they had not received training in completing room searches but this was not provided until after the recent ‘lockdown’ incidents. They had received training on searching a person during their induction. Staff said they now completed random room searches of 2 rooms a fortnight on the acute wards and 1 room on the rehabilitation wards. Staff said they also completed audits of sharps to ensure that where people were at risk or posed a risk, they did not have access to these.

We reviewed 8 people’s care records. These included risk assessments of which 6 were recently reviewed and updated. However, on Kennet ward, 1 person’s risk management plan and another person’s risk formulation were not fully completed. We reviewed the records of 1 person who had been in seclusion. This included a comprehensive seclusion care plan and showed that reviews by registered nurses and doctors had been completed to ensure their risks were reduced. Therapeutic observation records were completed by staff on an electronic device. This detailed the observation levels each person required with details of their risks. All observations were completed for each person when they should have been, and each person had an observation care plan. The provider trained staff in using the system and staff were assessed and signed off as competent to do.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Some people told us that most staff appeared well trained, competent and knowledgeable. However, some people told us not all staff were adequately trained, but they knew which staff to talk to and get support from. People said there were enough staff at weekends and at nights as staff were paid more at these times, however during the day Monday to Friday there were less staff available. People said the lack of staffing affected their authorised leave which meant their rehabilitation was slower as they were not getting the opportunities to go out on unescorted leave into the community. People said sometimes the activity staff were used in the nursing numbers which reduced activities and left them feeling bored. People said staffing levels affected escorted leave to see their family and made them feel stressed. People had discussed in their community meetings that staffing levels had meant their leave was cancelled. Community meeting minutes on Swift ward on 1 July 2024 stated, “leave cancelled due to staff shortages”. Residents Council meeting minutes 12 July 2024 on Kennet ward stated: “patients not having leave due to short staffing.” People said that staffing levels could also affect their vape breaks which were 4 times a day. They said sometimes staff would bring the vapes and get ready to go out in the courtyard, but they then had to wait due to staffing levels available.

Staff said there were not always appropriate staffing levels and skill mix to ensure people received good quality care that met their needs. They said activity workers were sometimes used in the nursing staff numbers which meant they could not do the activities planned with people. Staff also said there were more staff at weekends and nights as they were paid more then. Bank staff were used regularly although most knew people using the service and agency staff were not used. Staff said they were regularly asked to move to other wards to support and ward managers were part of the numbers. This affected their role in managing the ward and people’s activities and leave. Managers had recruited another 26 healthcare assistants and were awaiting start dates. Managers had a weekly rota meeting to review staffing needed across the hospital. This included how many people had court visits or hospital appointments in 1 day so transport and escorts needed could be arranged. There was only 1 vehicle to transport people, managers contacted the courts to request alternative arrangements, to see if people could attend via video link. Staff received support to deliver safe care which included training, debriefs, supervisions, appraisals, team meetings and reflective practice. Bank staff also received training. Minutes of Kennet ward staff meetings showed staffing was an issue and training in emergency life support (ELS) and immediate life support (ILS) was not compliant. Data provided by Trust managers showed training in ELS was between 27% on Swift ward and 80% on Trent ward. Training in ILS was as low as 21% on Blythe ward and 91% on Severn ward. Managers said by 20/9/2024, all staff were to be booked to do this. Managers provided training in the deteriorating patient during June and July to support staff confidence and understanding whilst awaiting ILS/ELS training. The Trust provided an update that these figures had improved and all staff were now booked to attend.

We observed staff were moved around wards to ensure skill mix and safe staffing levels on each ward. On some wards this affected the activities patients were doing that day although we saw staff trying to rearrange these. The staffing boards on Swift, Avon and Blythe wards were not up to date so it was not clear what the staffing levels were, and people did not know who was on duty.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.