The Care Quality Commission (CQC) has told North East London NHS Foundation Trust that it must make immediate improvements following its latest inspection.
Inspectors visited the trust during May and June 2019 to check the quality of eight core services:
- Acute wards for adults of working age and psychiatric intensive care units.
- Community-based mental health services for adults of working age.
- Forensic inpatient/secure wards (low secure).
- Wards for people with a learning disability or autism.
- Mental health crisis and health-based places of safety.
- Community-based mental health services for people with a learning disability or autism.
- Specialist community mental health services for children and young people.
- Urgent Care.
CQC also looked specifically at management and leadership to answer the key question: Is the trust well-led?
As a result of this inspection the trust has now been rated Requires Improvement overall. For caring effective and responsive the trust was rated as Good. For safety and well led it was rated as Requires Improvement. Previously it had been Good overall.
Jane Ray, CQC’s Head of Hospital Inspection (and lead for mental health), said:
“The inspection of North East London NHS Foundation Trust was one of great contrast. On the one hand we inspected some outstanding services that were going the extra mile to meet the needs of every patient. On the other hand, we saw services where the care was unsafe. The services for adults who needed acute inpatient mental health treatment were under extreme pressure. This impacted on the safety and quality of patient care.
“The trust had made some progress with many of the areas identified at the last inspection. This included an extensive consultation and the launch of the trust strategy which was now embedded into the ongoing work of the organisation. It was also good to note the progress with visits to services by non-executive directors with arrangements for them to share their feedback. Governors were offered more opportunities to be included in aspects of the trusts work which supported them to undertake their role.
“However, a combination of new concerns and previous issues still needing to be fully addressed meant the trust’s overall rating has moved from Good to Requires Improvement.
“We have made it clear to the trust where it must take action to improve and we will return in due course to ensure that these changes have been made.”
The inspection found some unsafe practice for patients coming at night to Sunflowers Court, the main mental health inpatient base on the Goodmayes Hospital site. They were waiting for variable lengths of time, either for an assessment or admission by the acute crisis assessment team (ACAT) without clinical staff available to provide support and in an unsafe environment. The arrangements for the acute crisis assessment team to work with other professionals and teams in the trust was adversely affecting the responsiveness of the service to meet the needs of patients. Staff told inspectors of many occasions when they had encountered difficulties working with ACAT. Staff described the impact of this process on their morale, often feeling professionally undermined.
Staff engagement was mixed. The trust had achieved positive staff survey results, most staff were very enthusiastic about working for the trust. There were still however, some pockets of unhappy staff who did not feel adequately engaged. Some junior doctors and consultants working in the mental health services explained how they had tried to escalate concerns but, they had not received a timely or adequate response. They thought their professional views were not adequately respected and when things went wrong there was a culture of blame rather than learning.
The senior executive leadership team was not working in a cohesive manner and this was found to have an impact on the safe delivery of services. Some members of the leadership team recognised the difficulties in working together and expressed a sense of frustration that this was hampering their ability to do their jobs well.
The trust continued to have significant workforce challenges and did not have enough medical or other professional staff in some services to provide consistently safe and high-quality care. Whilst the trust was aware of these short-falls and were working to address them this had not yet resulted in the necessary improvements. In Kent CAMHS the number of staff available including bank and agency, was below the agreed establishment levels. The vacancy rate for medical staff in Kent was 50% impacting on the trusts ability to deliver the service. In acute and PICU services, further work was needed to reduce the use of locum consultant psychiatrists and have more permanent staff in post to improve clinical leadership and the provision of high-quality care and treatment. In some community mental health teams for adults, there was a high turnover and staff reported feeling ‘burnt out’.
The inspection also found some very positive and innovative practice. The trust continued to progress work on equalities, diversity and human rights. This included the development of staff networks and work to improve the trust’s performance in relation to the Workforce Race Equality Standard.
The trust was using technology to support mobile working. This also included innovative use of digital technology to meet the needs of patients and staff.
The trust was also involved in work promoting partnership working to achieve greater integration to meet the needs of populations especially across North-East London. There was also innovative partnership working across specific services with other health and third sector providers to meet patient needs.
You can read the report in full when it is published on the CQC website at: www.cqc.org.uk/provider/RAT
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