The Care Quality Commission (CQC) has published a report following an inspection at South London and Maudsley NHS Foundation Trust.
The inspection was carried out at the trust’s acute wards for adults of working age, psychiatric intensive care unit (PICU) and community services for adults of working age as part of CQC’s continual checks on the safety and quality of healthcare services. An inspection of the well-led domain was also carried out.
Inspectors found good care was being provided to people using services, but some improvements were needed, particularly at the community mental health services.
Following the inspection, the acute wards for adults of working age and the PICU were rated as good. The PICU was previously rated requires improvement. Community services for adults of working age remained as requires improvement. Overall, the services were rated as good for being effective, caring, responsive, and well-led and requires improvement for being safe.
The trust’s overall rating remains unchanged as good.
CQC’s head of hospital inspection, London, Helen Rawlings, said:
“When inspectors visited the three areas at South London and Maudsley NHS Foundation Trust, they were pleased to see that the level of care had remained consistent despite the significant pressures caused by the pandemic which is good news for people using these services.
“Since our last inspection in 2019 there has been significant changes to leadership with a substantive team of executive directors now in position who have settled into their roles and are working together effectively.
“The trust had responded positively to the previous inspection and worked to make the necessary improvements. For example, we saw progress with physical health monitoring for patients in the community with staff supporting patients to live healthier lives by encouraging them to take part in programmes or giving advice.
“There was a continued focus on improving patient safety by reducing violence and aggression and the use of restrictive practices. A redesign was ongoing to improve this area which focused on providing a safer, therapeutic service for patients.
“Staff were proud to work for the trust and felt supported, valued and respected by their managers. They spoke about improvements in culture and said leaders were much more visible.
“There are, however, areas where improvements must be made and maintained. For example, within community services, some teams reported high caseloads that exceeded safe levels and long waiting lists for psychological therapies and non-urgent referrals. These long waiting times can have a very negative impact on people’s wellbeing whilst they’re trying to access these services.
“The service was implementing a change programme to improve these areas in order to speed up patient access and flow. Action was also being taken to address nursing staff vacancies and the low rates of staff training in some mandatory areas.
“We have reported our findings to the trust and are pleased that the strong commitment from all staff to deliver good services has resulted in higher standards of care for people. The provider must now ensure these positive changes are sustained and the necessary improvements are made.”
Opportunities for research were explored and supported throughout the trust. Staff were heavily involved in innovative research and were regularly published in clinical journals that had a national and international reach. The trust leadership demonstrated a high level of awareness of the priorities and challenges facing the trust and how these were being addressed.
The trust leadership had demonstrated an ability to adapt at a fast-changing pace during the COVID-19 pandemic.
Following the inspection, the trust must ensure the following improvements are made.
At the community-based mental health services for adults of working age:
- Patients who require a Mental Health Act assessment must be assessed without delay to ensure their safety and that of others
- Emergency equipment and medicines must be managed in line with trust policy at the Croydon Central Assessment and Liaison team, the MAP Croydon East Treatment team and the Promoting Recovery East Croydon team
- Staff must meet targets for compliance with mandatory training, including basic life support, immediate life support and promoting safe and therapeutic services training.
At the acute wards for adults of working age and psychiatric intensive care units:
- Sufficient numbers of staff on each ward must receive training in the use of physical restraint and disengagement, immediate life support and basic life support.
Inspectors found examples of outstanding care across services, including:
- The trust had developed a Listening into Action scheme where staff worked to find solutions to any issues which led to improvements for patients and the organisation
- In the community based mental health services, patients and carers could access a one-to-one session with a specialist mental health pharmacist. Staff were proud of the positive feedback they had received in relation to this service
- The clinical psychologist on Claire Ward had obtained funding for virtual reality headsets to work with patients on their known anxiety scenarios. This was due to begin in June 2021
- In the community based mental health services, staff had access to testing facilities which meant patients could have physical health monitoring completed and medicines supplied within a 20-minute appointment
- On John Dickson Ward in the PICU, staff were piloting testing to measure clozapine levels at patient’s bedsides with results taking just seven minutes.
Full details of the inspection are given in the report published on our website.
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