Coventry and Warwickshire Partnership NHS Trust provides a range of community based mental health and community health services which mainly provide a service in a person’s home.

These services are varied and are registered with CQC at the Trust’s Headquarters address.

Due to the wide range of services provided in the community by this trust, we did not inspect all of them, instead we took a sample and looked at a smaller number more in-depth.

On this occasion we inspected community based health services and community mental health services. These services are provided across adult and children’s services, meeting mental health and physical health needs.

Adult community based services

We found that the trust did not have suitable storage, recording and monitoring systems to ensure medicines were handled safely and appropriately.

There was an effective referral system in place and people received care quickly. Where there were waiting lists, people were assessed and knew when they would be seen.

There were consistent staffing levels and people knew who their care coordinators were. People were involved in the care planning process and reviews of their care. We heard positive reports on how staff had worked with people to help improve their mental health.

We saw there was good communication between community mental health teams in each area inspected and there was good collaborative working between social workers, community psychiatric nurses and occupational therapists. The effectiveness of communications with teams working in the acute admission wards varied and did not always facilitate people being discharged smoothly.

Staff across the teams we visited spoke about their concerns regarding the trust’s reorganisation programme. Staff were unclear about how the new structure would look and were worried about the impact for staff jobs, roles and responsibilities and how this would affect people using the service. Some staff expressed concern that their views were not being listened to.

Child and adolescent mental health services

We talked to doctors, managers, nurses and other staff from the service who told us they were struggling to cope with an increasing workload with more priority cases and child protection work. They were concerned about having to deal with more young people that they felt to be at risk, and that this meant that others who had less urgent need had to wait a long time to get a service.

There were plans to reorganise the service to improve access and manage workloads, but it had not been made clear to staff how this would work and there was a lot of anxiety about how the service would cope in the future. We talked to young people and families who used the service and they felt that they got good support, but they had to wait a long time and sometimes there were too many changes in staff.

Community services for adults with long-term conditions

Across all three services, staff were well trained and training was appropriate to their role. The exception to this was the children’s nursing within the Health Visiting service. Staff told us that their mandatory training was out of date and that staff did not always have the opportunity to attend specialised training specific to their job roles. For example, some nursery nurses found working part time hours reduced their time available for training because they prioritised client contact above their own training needs.

Across all three services, most people described their care as good to excellent and said that staff were caring, despite being busy.

Care plans within the district nursing services did not always reflect people’s needs. However, most people felt that they were involved with their care and informed about their treatment.

Staff were full of praise for their immediate line managers, who supported and listened to them. However, the trust’s restructure programme made them feel unsettled. Communication between the senior management team and clinicians was good.

We looked at staffing levels and workloads across Willenhall and Tile Hill District nursing teams. Both teams organised their work in advance and several nurses told us they were able to incorporate additional calls during the day. Staffing levels were at a safe level at Willenhall and most people received care according to their needs.

However, we saw risk assessments and care plans were not always in place and updated at regular intervals. Vacancies at Tile Hill meant a high use of agency staff. District nurses told us that the agency nurses were unable to fulfill a number of the tasks undertaken by regular staff, for example referrals to other agencies or ordering equipment. Additionally they were not familiar with the workload and trust’s policies and procedures, which meant that nurse’s time was often spent explaining what the agency worker needed to do.

The Willenhall team had not implemented all the lessons learned from previous medication errors to improve standards and safety for people who used the service.

During home visits, we saw nurses responded well to people’s needs. Nurses listened to people and answered questions relating to their care and treatment. Nurses also worked effectively with external agencies, making referrals for specialist assessments and equipment to improve people’s care.

Community services for children and families

Health visitors and children’s nursery nurses who provided support to the team told us that overall they felt they had enough staff to meet appointments. However, nursery nurses said that not all staff were able to attend mandatory and specialised training to support them in their roles, especially part-time workers, who found it difficult to attend training and manage their workload.

Mothers told us that health visitors and children’s nurses provided sound advice and support during one-to-one consultations. However, contacting health visitors was problematic as they had busy workloads and clinics were often full.

School nursing services

Doctors, managers and nurses from the service told us they were struggling to cope with demands of general school nursing duties and managing additional child protection work. They provide health reports for all case conferences as well as attending these and doing the necessary work and liaison afterwards. The sharp increase in safeguarding and child protection work, which always takes priority, meant that they struggle to do other work, especially health promotion. School nurses told us they had good training programmes in place and were able to attend mandatory and specialised courses. School nurses told us they had very good appraisals and supervision systems in place.

We talked to school nurses who told us that due to increased child protection work placed upon them they were struggling to respond to the day-to-day school referrals. The increased time devoted to attending safeguarding meetings and case conferences had resulted in fewer school nurses being available to meet the students’ needs.