A report written for the NHS South of England strategic health authority has made some serious criticisms of the Avon and Wiltshire Mental Health Partnership Trust (AWP) which provides adult mental health services for over one and a half million people in Wiltshire, Bristol, Swindon, North Somerset and Gloucestershire. The report (published on Thursday, July 26) looked specifically at AWP’s management and governance arrangements.
This report follows an investigation published last year which said that three murders in Swindon in 2007 by two mental health patients could have been prevented. Amongst its findings the new report says: “We have observed the Swindon services five years later to still be in a seriously deficient state and this is unacceptable.”
In April this year AWP’s Chairman resigned and its chief executive went on extended leave and has since left. Earlier this week a new Chairman, Tony Gallagher, was appointed. He had been interim chairman since April and a non-executive director of AWP for four years.
Dissatisfaction with AWP’s services has led to Bristol taking steps to find an alternative provider. Doubts have been expressed by Swindon GPs and NHS Wiltshire is taking precautionary measures in case it too has to look elsewhere for mental health services.
The report says bluntly: “We observed the Trust culture to be centralist, top down, and target driven, bureaucratic and controlling.” And while ‘significant progress’ had been made to put things right, after six years of change, “in its present guise the Trust is still beset with ongoing challenges relating to embedding high quality service delivery across all services.”
“The focus of the Board and executive team is on process and demonstrating compliance both internally and externally at, we believe, the expense of integrating quality into clinical practice…There is a weak clinical voice in decision making, inadequate medical (and wider clinical) engagement, with doctors broadly distanced from management, and with little evidence of engagement with clinical commissioning.”
AWP are in the process of applying for Foundation Trust status, but the report concludes ‘regrettably’ that it does not currently meet the necessary requirements.
The report was led by Susan Sutherland, a former Chief Executive of a Foundation Trust, with two consultant psychiatrists and a nurse consultant for clinical risk who is deputy director of clinical governance at the University of Manchester.
Among its fifteen recommendations, the twenty-two page report says “The Board should revisit the Homicide Inquiry reports and consider whether actions need to be taken to remedy the issues identified there are still resonant today and consider how those changes should be effectively implemented.”
You can read the full report here.
In a statement, NHS South of England added:
The report says the Trust should put on hold its application to become an NHS Foundation Trust “until such time as it has achieved a culture where the quality of patient care is the primary concern of all staff; the Board accurately understands the quality of care that the Trust provides, and there is evidence of effective clinical engagement throughout all the Trust’s decision making processes.”
The findings have been fully accepted by the Board of Avon and Wiltshire Mental Health Partnership Trust which has responded with a comprehensive action plan to address the concerns raised.
Liz Redfern, CBE, Director of Nursing at NHS South of England, said: “We are grateful to the authors of this report for setting out so clearly what needs to be done.
“Since its completion we have worked closely with the Trust to ensure that its action plan is robust and deliverable.
“We are satisfied that it addresses the serious concerns and issues highlighted, but we will continue to monitor progress so that all who rely on these vital mental health services can have confidence in the quality of care provided.”
