A Pre-admission Suite (PAS) at a south London mental and community health trust has now closed, following a Care Quality Commission focused inspection in August 2019.
CQC undertook the inspection following concerns received about the length of
time patients stayed in Oxleas NHS Foundation Trust’s PAS and complaints from patients and relatives.
The PAS was a waiting area for patients who had been assessed as requiring an inpatient admission but were not subject to the Mental Health Act. Patients stayed in a waiting area whilst staff try to find a bed on a ward for them. The PAS was in Oxleas House, Woolwich.
Patients mainly came to the PAS from the emergency department in the acute hospital in the building next door. The aim was that patients waited in the PAS no longer than 12 hours.
Following this inspection CQC sent a letter of intent to the trust informing it that CQC proposed to impose conditions on the provider’s registration because of the serious concerns about the length of time patients were staying in the PAS, the inadequate facilities provided to patients for lengths of stay beyond 12 hours, and the overly restrictive environment.
Oxleas responded quickly describing the actions it was taking to minimise risks to patients in the service. The trust informed CQC it had decided to close the PAS as it failed to meet essential standards of quality and safety in respect of length of stay; patient privacy, dignity and comfort; and access to and from the unit for informal patients. The PAS closed on 27 August 2019.
Following the closure of the PAS, CQC told the trust it would take no further action in response to the serious concerns identified at the time of the inspection. These concerns included:
- Patients were staying in the PAS for too long. The unit was intended for short stays of under 12 hours, but patients routinely stayed for longer. Between 1 January 2019 – 15 July 2019 151 patients had stayed in the PAS for longer than 12 hours. Sixty-four of these patients had stayed for over 24 hours. Of these, 11 patients had stayed between 2-3 days and 12 patients had waited for 3-8 days. This placed patients at risk of psychological harm. The physical environment and facilities did not meet the needs of people waiting for long periods.
- Patients privacy, dignity and comfort was compromised. The room only contained upright, non-reclining and armless chairs that were not suitable for spending long periods of time on. There were difficulties in accessing meals, snacks and drinks. No bedding was provided, there was a lack of private space and limited access to shower facilities outside the unit. There was no separation of male and female patients and no safe places to store possessions. This compromised patients’ dignity, privacy, comfort and recovery.
- The PAS was a potentially overly restrictive environment for patients. The PAS waiting area had restricted access via an entrance door with a key code. Patients could not leave the PAS without permission and when they did leave, staff accompanied them.
Dr Kevin Cleary, CQC’s Deputy Chief Inspector Hospitals Mental Health and Community Services, said: “While I was pleased with the speed at which Oxleas NHS Foundation Trust moved to close the Pre-admission Suite at Oxleas House, I recognise that this could lead to additional pressures at the local acute hospital, Queen Elizabeth Hospital, which is located next to Oxleas House. This will require a whole system response that protects patients.”
“Patients should never have been allowed to stay in a unit that did not have the necessary staff or facilities to support them adequately.”
You can read the inspection report when it is published on CQC’s website at: www.cqc.org.uk/provider/RPG
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