The South London and Maudsley (SLaM) NHS Foundation Trust has been rated Good overall by the Care Quality Commission.
SLaM was rated Good for being effective, caring, responsive and well-led. It was rated Requires Improvement for being safe, following the inspection in July and August 2018.
The trust provides mental health services in south London. This includes care provided at four hospital sites with a range of local and national inpatient and community mental health services for adults, older people, children and young people, and people with learning disabilities and autism.
CQC inspected six services. These were: acute wards for adults of working age and psychiatric intensive care units; forensic inpatient/secure wards; mental health crisis services and health based place of safety; community-based mental health services for older people; specialist eating disorder services and specialist neuropsychiatric services.
Inspectors found areas of good and outstanding practice, including:
In Mental health crisis services and health based place of safety the trust introduced the crisis assessment team in October 2017. The team operated in a car with a mental health nurse and a police officer and went out to assess people in crisis in the community.
In Specialist eating disorder services staff had developed an early intervention service for young people aged 16-25 years experiencing a first episode eating disorder.
The trust’s active participation in the South London Partnership was delivering new models of care for patients receiving national and specialist services and patients were receiving care closer to home.
The trust had a high calibre board, with a wide range of appropriate skills and experience, who were open and determined to make the necessary changes to provide high quality care to their local communities.
The trust alongside the BME staff network is addressing concerns of BME staff to ensure equality of opportunity.
The governors were performing their role well and holding non-executive directors to account. This had significantly improved since the last inspection and reflected the desire of the board to be open and transparent.
The trust was actively engaged in pioneering and developing digital innovations. This included the piloting of electronic observations and a personal health record to engage patients digitally in their care.
SLaM had made significant improvements to care environments since CQC’s comprehensive inspection in September 2015. This was particularly noticeable in the introduction of a single, centralised, purpose-built health based place of safety at the Maudsley Hospital. The facility had a dedicated space for children and young people and provision for their parents to stay overnight.
However, the trust must improve some of the services it provides to the local community. At the time of the inspection, adult patients from the local communities being supported on the acute care pathway, either as an inpatient or by adult community mental health teams, could not be assured of receiving consistently high standards of care. These unwarranted variations in standards of care had a negative impact on the largest group of patients receiving care and treatment from the trust. We have taken enforcement action to ensure services improve.
The quality of leadership at a ward and team level varied and was a key factor in whether the service was operating well. The trust was aware of these variations and that some leaders needed more support to enable them to deliver a high-quality service. The trust had not ensured that the necessary support had been put in place.
There had been breaches of fundamental standards of care on the acute inpatient wards, which had not been appropriately recognised and addressed by senior leaders in the trust.
Staff did not always identify and report patient safety incidents appropriately, which prevented them from being investigated in promptly and prevented staff from learning from them. Communication with wards and teams did not always happen effectively.
The trust had not been able to ensure that all acute patients had a bed to sleep in. We found some patients had slept on couches because there was no available bed in the trust. The senior leadership had been unaware of the extent of this practice.
Dr Paul Lelliott, Deputy Chief Inspector (and lead for mental health) said: “I am pleased that South London and Maudsley Hospital NHS Foundation trust has retained its rating of Good overall. There are some examples of outstanding care at the trust. However, whilst there is much to be proud of, the trust must work to address the serious concerns found across their acute and psychiatric intensive care services.” We will revisit these services to make sure this happens.”
You can read the latest detailed ratings tables on pages 25 and 26 of the report. Please note you can read the report in full when it is published on CQC’s website at www.cqc.org.uk/provider/RV5
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