The region’s NHS mental health trust has been downgraded to ‘requires improvement’ following a damning inspection
14:26, 30 May 2025Updated 14:29, 30 May 2025
The Avon and Wiltshire Mental Health Partnership hopes to relocate to Callington Road Hospital in Brislington. Google Maps. Permission for use by all partners.(Image: Google Maps)
The NHS organisation running mental health services across Bristol and much of the West Country has been downgraded from ‘good’ to ‘requires improvement’ after a watchdog inspection found failings in its leadership.
Avon and Wiltshire Mental Health Partnership runs mental health care from Bristol and Weston-super-Mare to Bath, Swindon and Salisbury, covering a population of around 1.8 million people.
But the Care Quality Commission now said it inspected the trust and found two breaches of regulation – one relating to safeguarding, and the other relating to how the trust was being managed.
The CQC inspectors said they undertook the inspection because of the number of concerns raised about the quality of care in various parts of its service. The inspectors found that specific parts of the mental health services in Avon and Wiltshire – the acute and psychiatric intensive care units and the community mental health services for working-age adults were actually both rated good.
But the inspectors returned to carry out a ‘Well-Led’ inspection, looking at the way the trust itself was managed and led – and the issues they found have now prompted the CQC to downgrade the entire trust to ‘requires improvement’.
Perhaps the most concerning discovery by the inspectors was a culture of fear of speaking out among staff about issues and problems in the trust.
“Staff felt a disconnect between senior leadership and middle management,” a CQC spokesperson said. “While staff had confidence in senior leaders, they didn’t feel issues escalated to middle management were passed up to senior management to secure the appropriate actions.
“Inspectors found issues with the trust’s Freedom to Speak up process. Data showed that concerns raised openly had decreased while anonymous concerns had increased between April 2023 and March 2024. Staff told us that this was because they felt there would be a fear of retribution if they spoke up using their real names,” they added.
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Avon and Wiltshire Mental Health Partnership Trust suffered swingeing cuts to its budgets since 2010, and has had particular issues over many years with mental health services for children and young people. In 2017, AWP was the first NHS trust in the country to be named in an inquest verdict as causing the death of a patient due to NHS neglect.
Avon Coroner Marie Voisin decided the death of 15-year-old Becky Romero, from South Bristol, was an accident contributed to by NHS neglect, because the AWP service that was supposed to be helping her did not have enough resources.
CQC deputy director of operations in the south,Catherine Campbell said in the July 2024 inspection, there were ‘closed cultures’ in parts of the trust. “Our inspection found a decline in some aspects of leadership which the trust needed to address,” she said.
“CQC identified closed cultures in parts of the trust, especially secure services. Senior leaders had started improvement work and introduced mechanisms to identify poor culture early, however at the time of the inspection it was too soon to measure the effectiveness of this improvement.
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“Some stakeholders said the trust’s culture felt defensive. They didn’t feel consulted on key issues like commissioning, risks and quality. Partners told us information from the trust lacked timeliness and details, causing delays in Integrated Care System decision-making that impacted people. However, lately they noted things have started to improve.
“Leaders had started to tackle governance issues by reviewing how responsibilities were shared, to make sure senior staff were clearly accountable for different areas of work. They also set up new sub-committees, made up of senior staff, to focus on important topics like quality, safety, staff wellbeing, workplace culture, and leadership. These changes were positive steps forward, but they were still too new at the time of the inspection for the trust or the CQC to say how well they were working.
“We told the trust at the time of the inspection where they needed to make improvements, we will continue to monitor their progress to make sure people are safe while this happens,” she added.
GV of Avon & Wiltshire Mental Health Partnership NHS Trust – Bath NHS House, Newbridge Hill, Bath
AWP’s leadership said that, while specific parts of the service it provides were rated ‘good’ it was ‘disappointing’ to have an overall ‘requires improvement’ rating. They pointed out the inspection was almost a year ago now, and they have put measures in place to improve the way the trust is run.
“Whilst disappointed with the outcome of the Well-Led inspection, we are pleased to have been rated ‘good’ in our adult community services and adult wards, which is a tribute to the hard work of our staff,” said AWP chief executive Dominic Hardisty.
“This demonstrates a commitment to, and track record of progress, and over the last year we implemented a range of additional improvements in those areas identified by CQC to further enhance the experience for our patients, staff and stakeholders,” he added.
AWP is part of the integrated care board covering Bristol, North Somerset and South Gloucestershire. Its chief executive, Shane Devlin, said he was reassured that things were starting to get better.
“We acknowledge the findings of the CQC’s Well-Led inspection and recognise that further improvement is needed,” he said.
“We are assured by the progress AWP has already started to make and are committed, as system partners, to supporting its leadership team in driving continued improvements. Through close collaboration and a shared focus on quality and accountability, we will work together to ensure the Trust is Well-Led and delivering safe, high-quality care for all,” he added.
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