Chief Inspector of Hospitals rates South London and Maudsley NHS Foundation Trust as Good

The Chief Inspector of Hospitals has rated South London and Maudsley NHS Foundation Trust as Good overall following an inspection by the Care Quality Commission (CQC).

South London and Maudsley NHS Foundation Trust provides mental health services to a local population of 1.3 million people, including adults, older people and children living within the London boroughs of Lambeth, Southwark, Lewisham and Croydon. The trust also provides more than 20 specialist services for children and adults across the UK, as well as a range of mental health services internationally.

The CQC inspection team, which included specialist advisors and experts by experience, visited the trust over a period of several days during September 2015. Inspectors rated South London and Maudsley NHS Foundation Trust as Good for providing effective, caring, responsive and well-led services, and Requires Improvement for providing safe care.

Inspectors assessed the trust’s core services. These included community mental health services for children and young people, for adults of working age, for older people and for people with learning disabilities or autism. They also assessed mental health wards for adults, children and young people and older people. These included acute wards, the psychiatric intensive care units, health based places of safety, long stay rehabilitation wards, forensic wards and some specialist wards for people with autism and children and young people. The CQC did not inspect all of the specialist services provided by the trust.

Full reports for the inspection have been published on the CQC website: www.cqc.org.uk/provider/RV5.

The inspectors noted a number of areas of good practice:

• Most of the staff were caring, professional and worked tirelessly to support their patients.
• The trust was supporting patients with their physical health. People had their health assessed in a comprehensive manner and were supported to have any healthcare needs addressed.
• Staff had access to a wide range of opportunities for learning and development, which was helping many staff to make progress with their career while also improving the care they delivered.
• The trust was aware of best practice and was using guidance and research to inform their work. As a result of this, patients were receiving high quality care across the trust. For example patients had access to a range of psychological therapies alongside their medical treatment.
• The trust provided many opportunities for patients to be involved in the running of and decision making about services. This input was leading to changes across the services. 

The community learning disability services and the ward for people with autism were rated as Outstanding. This was because the holistic services focused on meeting the specific individual needs of each person. Staff providing care were compassionate and flexible in order to ensure they supported people well.

• Inspectors identified some areas for improvement, particularly in relation to the safety of care. These were of particular concern in the wards for working age adults. The trust had a substantial problem with staff recruitment and retention. There were too few staff to consistently guarantee quality of care especially on the acute wards for working age adults. There were staffing problems in some other areas but these were not as severe.
• The trust needed to make improvements across most of its services regarding the documentation of risk for individual patients, in order to ensure that information was readily available, accurate and being followed.
• The trust must improve its practices in relation to restrictive interventions such as the use of restraint and seclusion. The trust must ensure that staff use restraint only as a last resort, that the use of restraint in the prone position is minimised, and that they accurately document and record the use of restrictive interventions. The trust had a number of areas that were not safe or where the risks were not being robustly mitigated to keep patients safe.

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

“During our inspection, we saw committed and enthusiastic staff throughout the trust working hard to deliver the best care for patients. Staff were aware of best practice and used guidance and research to inform their work. This resulted in most patients receiving high quality care.

“Strong academic and research links enable the trust to develop and trial new treatments, and continue to strive for better care for patients.

“Patient health needs are fully supported and patients are encouraged to be involved in decisions about their care and in the running of services.

“Although overall we rated the trust as Good, we have told the trust about a number of areas that require improvement, which I expect the trust to address as a priority. In particular, staff recruitment and retention problems must be addressed to ensure a consistent standard of care across the trust.

“The use of restraint and seclusion must be accurately recorded and monitored. Restraint must also only be used as a last resort. The management of risk must be robust.

“We will continue to monitor the trust's performance and we look forward to seeing the necessary improvements being in place when we return to check on their progress.”

The Care Quality Commission will be presenting 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.

Ends

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