Review prompts tough new action plan by AWP

A review of governance and management arrangements at Avon and Wiltshire Mental Health Partnership NHS Trust is published today.  The report was commissioned by NHS South of England following concerns raised by reports into two mental health homicides.

While noting some positive innovations at the Trust the report also contains some serious criticisms including:

• A lack of clinical engagement
• Top down decision making
• Slow incident reporting to the National Patient Safety Agency
• Performance management style
• Little evidence of constructive internal dialogue
• Concerns over some aspects of safety

Overall the report notes a Trust culture that was "centralist, top down, and target driven, bureaucratic and controlling".  It says, "There is an urgent need to change the culture and leadership from one of central control to one in which all staff are positively engaged in determining and delivering safe, high quality care."

The report was completed earlier this year and it is a matter of public record that since its completion the Trust's former chairman has resigned and the Trust's former chief executive has retired.  The Trust now has a new chairman, Mr Tony Gallagher, and has begun the process of recruiting a new chief executive.

The Trust has acted swiftly to address the issues raised in the report by developing a comprehensive action plan (Fit for the Future) which is also published today.  The action plan sets out how the Trust will improve to better meet the needs of patients.  It includes a commitment to strengthening the involvement of clinicians in management decision making and as a first step in doing this the Trust's professional council is being strengthened to help provide a stronger clinical voice.

The action plan also sets out actions to:

• Decentralise management and increase local service accountability
• Establish a clinical engagement strategy which covers quality and safety
• Improve service user and carer involvement in strategic business units
• Improve staff engagement and morale
• Improve care planning through sharing of best practice
• Increase Board scrutiny, including recruitment of a clinician as a non-executive director
• Restructure executive functions to ensure effectiveness

The new chairman, Mr Tony Gallagher said, "I welcome the publication of this report and I would like to make it clear that the Trust board accepts the report and its recommendations.  There are some very important lessons here and I am determined that we will learn them.

"I am determined too that we should create a new, less centralised leadership model that is strongly informed by the needs of our local communities and our service commissioners.  We will put service users and carers at the heart of everything we do.

"I want the Trust to be more responsive in dealings with all our stakeholders and thoroughly committed to openness and transparency.  Our overarching objective will be to radically improve outcomes for service users and to improve our staff's ability to make a real difference."

• Full report available at NHS South of England publications and reports
• Fit for the Future

Monthly updates to Fit for the Future will be found in the Trust Board Publications area from August 2012.