Community-based mental health services for working age adults at South London and Maudsley (SLaM) NHS Foundation Trust have been rated Requires Improvement overall by the Care Quality Commission.
During the inspection in July 2017 CQC inspectors rated the trust’s community based services as being Requires Improvement for being safe, effective and responsive. Caring and well-led were rated as Good.
In the six months before the latest inspection, there were 11 incidents when patients identified as in need of a Mental Health Act assessment, were not assessed promptly. This was due to a lack of hospital beds, complicated further by issues beyond the trust's control.
Thirty four of the 131 patients’ risk assessments CQC looked at did not have a current risk assessment and management plan in place. This was a particular concern in the early intervention team in Lambeth, where six of seven records examined did not have current risk assessments and risk management plans.
There were no care plans available in five of 16 patient records inspectors reviewed in the early intervention teams. In some teams, care plans were not always completed in full to ensure that patients received appropriate support.
Patients referred to the Croydon assessment and liaison (A&L) team were not being seen within trust target timescales. This left some of them waiting up to18 weeks for an assessment, thereby increasing chances of deterioration and putting them at greater risk of avoidable harm. In some teams, patients were waiting for approximately one year for individual psychological therapies.
Staff in some early intervention teams had caseload sizes in excess of the nationally recommended maximum number. This created pressure on the teams and potentially affected the quality of care that patients received.
CQC rated the core community based services as being Good for well-led, despite having rated it as Requires Improvement in three domains. This recognises that service managers were already aware of the issues found relating to risk assessments and care plans, and were working actively to address them at the time of the inspection. The trust had also taken proactive steps to address long waiting times in the Croydon A&L team, and regarding delays in Mental Health Act assessments.
At a previous inspection in September 2015, the trust did not have safe systems for transporting medicines, medical waste and sharps, and not all equipment used in teams was safe and in working order. During the current inspection, CQC found that regular checks were in place to ensure that equipment was serviced, and new bags and arrangements were provided to transport medicines, waste and sharps safely.
Staffing levels across the community teams had improved and there were a wide range of quality improvement projects in place encouraging staff to be actively involved in improving services.
The trust offered patients the opportunity to participate in innovative treatments. For example, patients who met the research criteria could participate in trials of a new digital therapy. The therapy aimed to assist patients to understand and control their thoughts.
You can read the report in full on our website.
Paul Lelliott, Deputy Chief Inspector (Mental Health),said:
“I would like to see the overall rating for community-based mental health services for working age adults at South London and Maudsley NHS Foundation Trust improve."
“However, the leadership team are aware of the areas that need work and when we return to the trust to inspect community-based mental health services for working age adults again, we expect to see improvements in this service.”
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