Chief Inspector of Hospitals rates services at West London Mental Health NHS Trust as Requires Improvement

England’s Chief Inspector of Hospitals has rated West London Mental Health NHS Trust as Requires Improvement following an inspection in June 2015 by the Care Quality Commission.

A team of CQC inspectors and specialist advisors spent five days inspecting the services provided by the trust. The team inspected the mental health wards for children and young people, working age adults and older people, forensic services, including the high secure service, and the community mental health services for people of all ages.

The inspectors rated the trust services overall as being Good for being caring and responsive. However, they were rated as being Requires improvement for being safe, effective and well-led.  Forensic services, which include the West London forensic services and the high secure services at Broadmoor, were rated Inadequate. Inspectors were most concerned about the West London forensic services.

Full reports including ratings for all of the provider’s core services are available at: http://www.cqc.org.uk/provider/RKL.

Inspectors found that the trust had a substantial problem with staff recruitment and retention. There were too few staff to consistently guarantee safety and quality in the medium and low secure forensic services, high secure services and community based mental health teams. There were less severe staffing problems in some other areas.

Although most staff were hardworking, caring and compassionate, the trust had a problem with low morale. Despite some staff engagement work, front-line staff in some of the services did not feel well engaged with the wider organisation. This particularly affected those in working in the forensic services.

Inspectors said the trust must improve its use of physical restraint and seclusion. The problem was most serious in the forensic, high secure, adult admission and older people’s wards. The West London forensic services did not keep consistent and accurate records regarding the use of restraint and seclusion. Some staff did not recognise that the restrictions that they had placed upon patients amounted to seclusion or restraint, and inspectors did not see convincing evidence that seclusion and restraint was only being used when absolutely necessary.

Dr Paul Lelliott, the Deputy Chief Inspector of Hospitals and Lead for Mental Health, said:

“Staffing shortages and difficulties with recruitment at West London Mental Health NHS Trust are having a noticeable impact on the quality of some services. In the forensic services, this is compounded by low morale. As well as affecting the quality of care, there is the risk that staff might not show the openness, transparency and honesty that are essential to provide safe care.

“We were concerned at the apparent overuse of physical restraint, and the failure to keep proper records. Staff must use restraint only as a last resort, and minimise the use of restraint in the prone (face-down) position. They must record the use of all types of restrictive intervention. They must also make the necessary physical health observations to ensure the safety of patients who have been given an injection to manage disturbed or distressed behaviour.

“West London Mental Health NHS Trust is a large organisation with many parts. Despite the problems described above, our inspectors visited other services where staff were positive about the work of the trust and where care was delivered by hard working, caring and compassionate staff. This included Broadmoor hospital where staff showed a real concern for patients on an individual basis and a desire to see them progress towards recovery.

“The trust is developing a leadership team which has a good insight into the challenges they face. However, we believe that our inspection has identified that the scale and speed of change that is needed is very significant. They must address our findings as a matter of urgency. We will be working with the trust to agree a plan to assist them in improving their standards of care and treatment.

The inspection identified a number of areas where the trust must improve including:

• The trust must work to reduce the variation in the use of restraint and the high numbers of prone restraint used across the trust.
• The trust must ensure that all seclusion facilities are in a state of adequate repair and consideration is given to the maintenance of patient dignity when using the facility.
• The use of rapid tranquilisation medication must be clearly stated on patients’ medication charts. The necessary physical health checks must take place and be recorded after this medication has been administered.
• In the high secure and forensic services, the trust must ensure that staffing levels are sufficient to ensure safety of staff and patients, and also to promote the quality of life of patients in terms of ensuring they can access therapeutic and leisure activities, or escorted leave, as agreed in their care plans.
• In community based mental health services, there must be enough doctors to meet the needs of patients. Recovery team patients must have a named clinician responsible for their care and treatment.
• The trust must ensure that staff are more engaged in the running of the high secure and forensic hospitals and that communication with staff at all levels improves. Staff must feel that the environment and culture of the hospitals and trust is one that values their input and engagement.

The report identifies a number of areas of good practice including:

• The trust actively encouraged the personal development of its staff. It supported them in this and enabled them to access training and other development opportunities. The trust was making real strides with user and carer engagement. An example of this was the support it offered to the West London Collaborative.
• The trust worked closely with statutory and voluntary sector partners to improve mental healthcare in the wider community. For example it had worked with the police to better support people in a crisis. This had resulted in the police not having to take a single person detained under section 136 to a police cell for over a year.
• The Care Quality Commission has already presented its findings to a local quality summit, including NHS commissioners, providers, regulators and other public bodies. The purpose of the quality summit is to develop a plan of action and recommendations based on the inspection team's findings.

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For further information please contact Yetunde Akintewe, CQC Regional Engagement Manager, on 07471 020 659. For media enquiries, call the press office on 020 7448 9401 during office hours. Journalists wishing to speak to the press office outside of office hours can find out how to contact the team here. (Please note: the press office is unable to advise members of the public on health or social care matters. For general enquiries, please call 03000 61 61 61.)