Chief Inspector of Hospitals finds Barnet, Enfield and Haringey Mental Health NHS Trust requires improvement

England's Chief Inspector of Hospitals has found that, although the leadership team at Barnet, Enfield and Haringey Mental Health NHS Trust has identified many of the problems facing the organisation and made a start to address them, there is still much to do. The Care Quality Commission has given the trust an overall rating of requires improvement following an inspection during November and December 2015.

CQC have rated five of the eleven core services inspected as requires improvement, five as good and the forensic services as outstanding. The services that require improvement are the acute mental health admission wards for adults, the community based mental health services (mainly the community recovery teams), the child and adolescent mental health ward the Beacon Centre, the specialist community mental health services for children and young people and crisis mental health services which include the home treatment teams. The Enfield community services had an overall rating of good.

Full reports of the inspection including ratings for all core services are available at: www.cqc.org.uk/provider/RRP.

The Deputy Chief Inspector of Hospitals (and CQC’s lead for mental health), Dr Paul Lelliott, said:

“It is clear that over the past couple of years there has been progress at Barnet, Enfield and Haringey Mental Health NHS Trust. Although the trust recognises there is still further progress to be made we expect them to address the issues we have identified on this inspection and we will continue to monitor the trust's progress."

At the start of the inspection, the chief executive of the trust gave a presentation about the areas they were proud of and the challenges faced by the trust. The inspection findings reflected most of the priorities identified by the trust. This demonstrated that the senior trust managers had identified many of the problems that they needed to address. However, CQC believe that there is still a great deal to do for services to be a consistently high standard. Inspectors found that these challenges are greater in the borough of Haringey where more improvements are needed. It was also concluded that at St Ann’s the physical environment of the three inpatient mental health wards is not fit for purpose due to its age and layout. This impacts on the trusts ability to deliver safe services within this environment”.

The main areas for improvement were as follows:

• The trust had a substantial problem with staff recruitment and there was a high use of temporary staff that was impacting on the consistency of care. There were too few regular staff to consistently guarantee safety and quality in the acute mental health wards, the child and adolescent ward and in the Enfield health visiting services. There were staffing problems in some other areas but these are not as severe.
• A significant number of new or interim managers provided important support roles or directly led teams providing care. Permanent managers with strong leadership skills were needed to improve and sustain standards of care.
• The management of risk was very variable across the mental health services. In some cases this was because staff had not considered individual risk or updated records following specific incidents. Sometimes the record keeping needed to improve. This meant that there was a possibility of staff not safely supporting patients with their individual risks.
• The trust did not operate lone working arrangements robustly in some of the community mental health services. Staff safety was potentially compromised. Patients had absconded from mental health inpatient wards whilst detained under the Mental Health Act. These incidents and the learning from them were not being addressed.
• Staff in acute mental health inpatient wards did not always recognise when a patient’s physical health was deteriorating and ensure they received timely input. The trust’s communication with primary care needed to improve, not only when patients were being discharged from inpatient services, but also throughout their ongoing care and treatment.
• The telephones and IT systems did not support effective working by staff in the community. Whilst the trust was working on this there was more to be done.

Despite these problems there was much for the trust to be proud of. The senior executive team were committed to improving services and to providing a high standard of care for patients receiving treatment from the trust. Staff working for the trust valued the leadership provided by the senior team, especially the chief executive.

The main areas which were positive were as follows:

• Most of the staff inspectors met were very caring, professional and worked tirelessly to support the patients using the services provided by the trust. The trust was continuously looking at how the patients using their services could be supported with their ‘enablement’ and new projects with other external providers were happening.
• The trust had improved the arrangements for patients to access the Enfield community health services.
• The trust was working to reduce the use of physical interventions. The use of restraint was low and on the forensic wards they made good use of relational security to minimise the use of restraint and seclusion.
• Staff had access to a wide range of opportunities for learning and development, which was helping many staff to make progress with their career whilst also improving the care they delivered to people using the services.
• Staff morale was good and most staff said how much they enjoyed working for the trust.
• Staff felt able to raise concerns and most had done so where needed.
• The trust had a robust governance process that identified areas of concern and monitored progress in addressing these matters.

The trust had recently introduced a new management structure for services based on borough lines and this was well received. There was ongoing work to improve patient, carer and staff engagement in the work of the trust. These and the many other positive developments need time to consolidate.

CQC will be working with the trust to agree an action plan to assist them in improving the standards of care and treatment.

Ends

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