Agenda item

Oxford Health NHS Foundation Trust has been invited to present the Trust’s Annual Quality Account for the year 2025-2026.

The Committee is RECOMMENDED to:

a) AGREE to provide feedback on the Trust’s Quality Account.

b) AGREE to finalise the wording of the feedback subsequent to and outside this meeting, and to submit the feedback to the Trust prior to the publication date for the Quality Account at the end of June 2026.

Rob Bale (Chief Operating Officer Mental Health and Learning Disability, Oxford Health NHS Foundation Trust [OH]);  Emma leaver (Chief Operating Officer Community Health Services, Dentistry & Primary Care, OH); and Angie Fletcher (Deputy Chief Nurse, OH) have been invited to present the Oxford Health NHS Foundation Trust quality account for the year 2025-2026.

The Committee examined the outcome of the most recent Care Quality Commission (CQC) inspection of Child and Adolescent Mental Health Services (CAMHS) inpatient units, conducted in November 2025. The Deputy Chief Nurse explained that the inspection had identified a number of areas for improvement, including individualised care planning, the use and documentation of restrictive practice, and aspects of medication management. Many of the issues identified related not to the care delivered itself, but to the quality and consistency of documentation, particularly the lack of recorded evidence demonstrating the extent of de‑escalation efforts undertaken by staff prior to incidents.

The Chief Operating Officer (Mental Health and Learning Disability Services) added that CAMHS inpatient provision served a much wider geography beyond Oxfordshire, including highly specialised services such as a national‑level intensive care unit for young people. He emphasised the increasing complexity and acuity of patients, noting that young people now presented with higher levels of trauma, emotional dysregulation, and neurodivergent needs than had been typical in earlier years. This complexity influenced both care delivery and the interpretation of incident data, particularly in relation to restrictive interventions.

Members examined the Trust’s progress in reducing restrictive interventions, with particular focus on seclusion and prone restraint. The Deputy Chief Nurse reported that the Trust had succeeded in improving its measurement of seclusion by introducing metrics to record duration of seclusion, rather than simply the number of incidents. This allowed the Trust to better understand the extent to which patients’ liberty was being restricted and to identify opportunities to reduce the length of seclusion episodes.

However, the Committee was advised that the Trust had not met its target for reducing prone restraint during the year. The Deputy Chief Nurse explained that this was not unexpected and reflected increasing patient complexity and risk behaviours, including incidents of self‑harm and violence, often involving a small number of highly complex patients. The Trust had established a prone restraint taskforce, with all incidents subject to rapid review at senior level to identify learning and alternative approaches. Further targeted interventions had been introduced, including enhanced training, the introduction of alternative de‑escalation equipment, and improved early identification of high‑risk patients.

The Committee examined the Trust’s priority relating to integration of physical and mental health care, particularly in light of evidence suggesting under‑recording of physical health conditions among mental health patients. The Chief Operating Officer (Mental Health and Learning Disability Services) acknowledged that data quality challenges existed and that diagnosis coding was not always complete or consistent across systems. He emphasised that people with severe mental illness experienced significantly poorer physical health outcomes and reduced life expectancy compared to the general population, and that addressing this inequality was a key priority.

He outlined planned action through the establishment of an oversight group, improved integration of physical health teams within mental health services, and stronger collaboration with primary care.

The Committee considered the Trust’s approach to learning from deaths, including the impact of national changes to the Learning from Deaths and LeDeR programmes. The Chief Operating Officer (Mental Health and Learning Disability Services) confirmed that all deaths were subject to internal review, irrespective of national programme changes, and that the Trust actively analysed trends and themes to identify areas for improvement. There had been some increase in the average age of death among people with learning disabilities, which indicated improvement in addressing physical health needs, though Members noted that significant national inequalities remained.

The Committee asked about engagement with bereaved families. Officers explained that families were actively invited to participate in investigations, including contributing to terms of reference, and were supported by family liaison officers. The Deputy Chief Nurse added that families were involved not only in investigations but also in subsequent improvement work, and that the Trust had employed patient safety partners to ensure that patient and family perspectives informed safety processes. 

The Committee raised concerns regarding the number of suspected or confirmed suicides among patients and asked what changes had been implemented as a result of partnership working on suicide prevention. The Deputy Chief Nurse explained that the Trust had moved away from traditional “low, medium, high” risk stratification and towards a more individualised and dynamic assessment of risk, reflecting the complexity of suicide risk and the variability between individuals. The Trust had revised documentation, training and assessment tools accordingly. The Chief Operating Officer (Mental Health and Learning Disability Services) added that improvements had been made to safety planning, including co‑production of safety plans with patients and, where appropriate, their families. He also described the expansion of access routes into support, including safe havens, mental health support lines, and digital services, designed to make support more accessible and less institutional. Members were advised that the Trust worked closely with public health partners to analyse suicide data and respond to emerging trends, including potential links to wider social or environmental factors.

The Committee scrutinised the Trust’s approach to co‑production and patient voice, including the role of lived experience in governance and service design. The Chief Operating Officer (Mental Health and Learning Disability Services) acknowledged that while the Trust had a strong cohort of experts by experience, there remained a challenge in ensuring representation from harder‑to‑reach groups. The Trust was seeking to address this through neighbourhood‑based approaches, improved use of population health data, and targeted engagement with specific communities. He gave examples of partnership working with voluntary sector organisations to reach groups such as traveller communities.

The Committee AGREED to:

a) Provide feedback on the Trust’s Quality Account.

b) Finalise the wording of the feedback subsequent to and outside this meeting, and to submit the feedback to the Trust prior to the publication date for the Quality Account at the end of June 2026.