THE Care Quality Commission (CQC) has rated Essex Partnership University NHS Foundation Trust, which is responsible for mental health care across the region, as requires improvement for how well-led it is, following an inspection in March.

The trust provides community health, mental health and learning disability services to more than 3.2 million people across Luton and Bedfordshire, Essex and Suffolk. It employs more than 5,000 permanent staff working across 200 sites, including care delivered in people's homes.

It is currently subject to a major, ongoing inquiry, led by Baroness Kate Lampard, and in July this year the failinging in management were highlighted.

And now that has been followed by a series of critical reports. Ahead of the well-led assessment, CQC inspected three services at the trust, long stay or rehabilitation mental health wards for working-age adults, child and adolescent mental health wards, and community health inpatient services.

CQC also visited one acute ward for working-age adults, Ardleigh ward, following concerns about the quality and safety of care there. Following concerns about the quality and safety of care, CQC took enforcement action and required improvements to be made.

The trust acted to address some concerns immediately, while a warning notice was issued for long stay or rehabilitation mental health wards. CQC will revisit to check on progress.

Earlier this year the Chief Executive of the Trust, Paul Scott, announced he was leaving the Trust for another post - sparking condemnation and accusations of 'cowardice' from some critics on the Trust.

CQC gives NHS trusts a single trust-level rating focusing on leadership and culture that replaces all other ratings at that level. CQC consulted on this approach and used feedback gathered to ensure this well-led key question at NHS trust level is appropriate for the new innovative, complex and integrated models of care being created.

Victoria Green, CQC deputy director of mental health in East of England, said: "During our inspection of leadership at Essex Partnership University NHS Foundation Trust, we found a board that had matured its management arrangements since our last inspection. However, this hadn't yet been translated into a consistently positive experience for staff or sufficient monitoring of frontline care.

"It was concerning that staff told us about a disconnect between senior leaders and front-line services, and that some were worried about speaking up for fear of reprisal. When staff don't feel safe to raise concerns, it creates a real risk to people's safety, as there is limited learning to prevent poor care from happening again. Staff also described inconsistent experiences of leadership, from visible and supportive managers in some services to a lack of presence and engagement in others.

"We were also concerned that monitoring of frontline care and the assurance received by the board needs improving. Leaders were not consistently reporting overdue safety incidents to the board, including cases classified as severe harm or death, some of which had been waiting for review for more than two years. This, along with a lack of clear leadership on equality, diversity and inclusion, and rising use of restraint in some inpatient services for children and for autistic people and people with a learning disability, meant the trust could not be assured it was learning from all the risks it faced.

"However, there were areas of strength. Governors, non-executive directors and system partners spoke of an improving open and transparent organisation, willing to learn from mistakes and share that learning. The trust had also strengthened its management arrangements through its accountability framework and demonstrated strong financial management with a track record of delivering its financial plans.

"We have told leaders at Essex Partnership University NHS Foundation Trust where improvements are needed, and we will continue to monitor the trust closely to ensure this happens."

Inspectors found:

• Staff raised concerns about ineffective leadership and its impact on wellbeing, with some describing senior leaders as disengaged and decision-making focused on financial pressures rather than people's outcomes.
• There was not a clearly defined strategic approach to equality, diversity and inclusion, and improvement work was needed to improve the experience of people with a disability and people from ethnic minority groups.

However:

• The trust had strengthened clinical leadership within its care units and demonstrated strong financial management, with clear ambitions for the coming financial year.
• Medicines optimisation was identified as an area of strength, with staff describing clear management, open communication and strong support for professional development.

A statement from the health Trust says: "EPUT welcomes the CQC's feedback as an opportunity to recognise areas for ongoing improvement and positive changes already made, as the Trust continues to focus on the transformation of its services to provide the best patient care. "

Trevor Smith, Interim Joint Chief Executive Officer at EPUT, added: "It's really important to work with the CQC and other partners so that together we can improve healthcare for all our communities.

"I'm proud of the work all of our staff do for our patients each and every day, continually enhancing the quality of patient care across our services. Whilst we have made improvements, there is more to do to ensure that everyone experiences the best possible care and we are firmly committed to that."

The statement says a number of improvements have already been made at the Trust including the re-design of care on wards co-designed with patients, the investment in mental health urgent care centres (with two more in development) and a current review of community mental health services to provide the best possible care at home.

The Trust says it is also working with partners to deliver a first of type Electronic Patient Record system across community, mental health and acute services.

The report will be published on CQC's website in the coming days.