The Care Quality Commission (CQC) has published two reports following an inspection of the community forensic mental health team at the Portman Clinic and specialist community mental health services for children and young people (CAMHS) at the Tavistock and Portman NHS Foundation Trust in January and February.
The trust has gone through significant change in terms of its senior leadership team. It is also experiencing ongoing challenges with managing the gender identity services for young people during the period before it transfers to new regional services. These inspections were to ensure other services provided by the trust were continuing to deliver safe and effective care and treatment.
The inspection of the Portman Clinic was to follow up on a previous visit to the clinic which rated the service good overall and requires improvement for safe. The Portman Clinic provides individual therapy, group therapy and occasionally couples’ therapy. They also offer a treatment programme for men with a diagnosis of antisocial personality disorder.
Inspectors also visited Camden north and south child and adolescent community teams (CAMHS) and the Camden Adolescent Intensive Support Service (CAISS) team. Both teams offer assessment and treatment that include cognitive behavioural therapy, psychology, child psychotherapy, psychiatric input and family therapy.
Five months before our inspection, the trust had experienced a malware attack affecting the trust’s electronic patient record system. CQC took this into account during the inspection and assessed how the service had managed this.
Inspectors did not rate the Portman Clinic at this inspection. However, the CAMHS service was rated as requires improvement for safe a drop from the previous good. How responsive and well-led the service was also inspected but not rated.
The overall rating for the service and Tavistock and Portman NHS Foundation Trust remains as good.
Jane Ray, CQC deputy director of operations in London, said:
"We found The Portman Clinic has made progress on improving these services since our last inspection.
“People told us they felt supported and safe and that all staff treated them with kindness, compassion, and respect. It was great to hear people tell us their treatment had changed their lives and helped them understand themselves for the better. Staff were always available by phone if people needed them, and they asked people about their physical as well as mental health.
"When we last inspected, the Portman Clinic didn’t offer separate waiting rooms for children and adults. This time we found that adults and children had separate waiting areas. The under eighteen’s waiting room was decorated in a child-friendly way and was put in place shortly after our last visit.
“In both services, none of the offices and therapy rooms had panic alarms fitted and staff didn’t carry personal alarms which was concerning as therapy rooms were located away from busy areas in the centre. However, the service effectively managed any risks to staff by only seeing people using the service if another clinician and reception staff were in the building. The service also planned to introduce a software application for reception where staff could raise the alarm to call for assistance if they needed to.
“Staff in the Camden CAMHS south team told us they weren’t provided with mobile phones to communicate with young people as part of their care and were expected to use their own phones and hide their personal number. This method raised the risk of staff accidentally sharing their personal numbers which is unsafe.
“We will continue to monitor the service closely through future inspections, to ensure people are still receiving a high standard of care, and that the trust makes the improvements we’ve told them to.”
At the Portman Clinic inspectors found:
- The clinic had enough staff to care for people and keep them safe.
- Staff knew how to recognise adults and children at risk of harm and worked with other agencies to protect them.
- The service took account of people’s individual needs and made it easy for them to give feedback.
- People could access the service when they needed it and did not have to wait too long for treatment.
However, inspectors also found:
- Adult case records sometimes lacked consistency in case recording and risk documentation was not always completed.
- None of the office and therapy rooms had panic alarms fitted and staff did not carry personal alarms.
At the CAMHS service inspector found:
- Staff assessed and treated patients in crisis promptly. the CAISS team were able to support young people in the community and no young people had required an inpatient admission.
- The website for the service had sections for young people and for children. These were written in an age-appropriate voice so they were accessible to young people and children.
- There were communal toys and colouring available for younger children in the waiting areas. Each child also had their own named box of toys and games, which could be used during therapy sessions.
- The premises were accessible for people with physical disabilities.
- Staff told us that they could always access an interpreter when required and leaflets in different languages were available.
However, inspectors also found:
- The service did not provide alarms in rooms where therapies with the patients took place or for staff in case there was an incident.
- Rooms where clinicians met with young people to have confidential discussions were not well soundproofed. This could compromise the young person’s confidentiality.
- The premises where the Camden CAMHS south team was based still had issues with providing enough room for treatments.