The Care Quality Commission has rated Camden and Islington NHS Foundation Trust as Good overall, the same as at its last inspection.
The trust was rated Outstanding for being effective, Good for being caring, responsive and well-led and Requires Improvement for being safe, following the inspection in October and November 2019.
CQC carried out comprehensive inspections on three core services: Acute wards for adults of working age and psychiatric intensive care units; Long stay/rehabilitation mental health wards for working age adults; and Mental health crisis services and health-based places of safety. In addition to the comprehensive inspections of core services, the CQC carried out a focused inspection of the trust’s Community-based mental health services for adults of working age, in which the Safe key question was reviewed.
The trust had a capable and experienced leadership team. The previous year had been very challenging due to unexpected changes in both the executive and non-executive members of the board. However, the chair, chief executive and other senior leaders across the trust had worked together to provide continuity. Members of the leadership team were open about the challenges and believed they were now through this difficult period.
The trust provided strong leadership following a serious incident of an alleged homicide on Coral ward. Managers took immediate actions to keep patients and staff safe, and longer-term work to investigate and learn from the incident had taken place. During the inspection, we found that nursing leadership had been increased at night. Leaders had been very mindful about the psychological well-being of patients, carers and staff.
The trust worked effectively in partnership with other stakeholders across north London. It had entered a formal alliance with Barnet, Enfield and Haringey NHS Mental Health Trust, which was progressing well. Suitable arrangements were in place to oversee this work.
CQC inspectors found further evidence of some outstanding care at the trust. Staff had been engaged in various ways to learn, improve and innovate and were given time to do this in their day-to-day roles. The trust was committed to delivering a Quality Improvement (QI) programme and had invested in this across the organisation. The QI programme had flourished since CQC’s last inspection and was well embedded.
Across all services, staff treated patients with compassion and kindness. They respected patients’ privacy and dignity. They understood the individual needs of patients and supported them to understand and manage their care, treatment or condition.
The trust engaged positively with patients, carers and staff. This included a wide range of co-production work. The trust was also extending the number of peer support workers. Plans were in place to develop a trust strategy for user involvement and to ensure this was embedded throughout the organisation. The trust was working to improve staff health and well-being, for which it had produced a strategy. This included understanding what would make a difference for staff and delivering a programme of activities.
However, there were areas where improvements were needed. The trust was experiencing high demand for its acute wards for adults of working age and psychiatric intensive care units. When beds were not available, some patients were placed in beds in the private sector - sometimes out of the area.
Some community-based mental health services for adults of working age teams, and individual members of staff in these teams, had caseloads that were too high to allow the staff to give each patient the time they needed and to ensure that care was safe and of a high quality.
Patients identified as in need of a Mental Health Act (MHA) assessment were not always assessed promptly.
The trust was completing serious incident investigations appropriately, but it was continuing to miss the timescales.
The trust had started work to meet the needs of staff and patients with protected characteristics, but more work was needed. For example, staff networks required strengthening. This work needed further promotion so that the trust could become a beacon of good practice.
Kevin Cleary, CQC’s Deputy Chief Inspector Hospitals Mental Health and Community Services, said: “There is much to be admired about the Good overall service that Camden and Islington NHS Trust provides for those in its care.
“I was impressed by the establishment of the Primary Care Mental Health Networks, which help provide joined up support to people in primary care.
“There are areas where the trust must improve. I am concerned that there has been no improvement in the category of safe. The trust needs to ensure that staff are in a position to provide consistent safe care across all services and we require the senior leadership to ensure this is improving continually.”
You can read the report in full when it is published on CQC’s website at: www.cqc.org.uk/provider/TAF
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