This report provides the Health, Care and Wellbeing Scrutiny Committee with the background and findings of the Care Quality Commission’s (CQC) inspection of Herefordshire and Worcestershire Health and Care NHS Trust (the Trust).  It also outlines the actions taken following the “Well Led” inspection.

The Chairperson invited representatives from the Herefordshire and Worcestershire Health and Care NHS Trust (the trust) to update the committee on the outcomes of the Care Quality Commission (CQC) inspection report of the trust.

The committee received the presentation ‘Herefordshire and Worcestershire Health and Care NHS Trust Improvement Plan’ (link to the presentation).  The Director of Strategy and Partnerships presented the slides: Background; Trust services in Herefordshire; Our communities and patients.  The Director of Nursing presented the slides:- Overview of our Improvement Plan; CQC inspection; Rating for mental health services; Overall rating; Areas for improvement; Current actions; and Six key elements of the Improvement Plan.

The principal points of the discussion included:

1.           The Chairperson noted that aspects of the inspection report on mental health services were relevant to Herefordshire and welcomed the Improvement Plan; the report also covered a broader range of services which were delivered by the Trust in Worcestershire.

2.           In response to a comment from a committee member about the ratio of ‘leaders’ to other staff, the Director of Nursing explained that leaders included anyone with line management responsibility.

3.           The Director of Strategy and Partnerships commented on the interdependencies within mental health and on the regulated activity delivered by the trust.

4.           The Vice-Chairperson questioned the level of awareness about the issues inherited through the transfer of the mental health and learning disability service to the trust in 2018. 

The Director of Strategy and Partnerships commented that due diligence had not identified any performance ‘red flags’ and outlined subsequent challenges which had arisen from the community mental health transformation process and from the COVID-19 pandemic.  It was noted that recruitment and retention was a significant issue for the trust, and for the NHS generally.

The Associate Director, Primary Care and Community Mental Health Services commented that there had been high vacancy rates in some community teams but this was now returning to typical levels, in the context of the characteristics of the health service nationally; the vacancy rate for adult mental health community services was around 12%.

5.           Attention was drawn to the slide Rating for mental health services which showed the position for ‘Acute wards for adults of working age and psychiatric intensive care units’ as ‘Inadequate’ for Safe, and there was decline to ‘Requires Improvement’ for Effective, Caring, and Responsive.

The Director of Nursing confirmed that the trust was looking at all areas.  An overview was provided of the challenges, exacerbated by the pandemic and workforce difficulties, in adult inpatient mental health services.

6.           In response to a question about the effects of the pandemic, the Director of Nursing explained that demand went down initially, as people avoided health settings, but many individuals’ mental health had deteriorated during that period which had resulted in increased demand for mental health services subsequently. 

The Director of Strategy and Partnerships added that this was particularly apparent for children and young people.  The Vice-Chairperson commented on the consequential challenges for learning providers.

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