The Care Quality Commission (CQC) has published a report for Central and North West London NHS Foundation Trust, about the quality of four services and an assessment of whether the trust is well led. The inspection took place from July to September last year.
CQC chose to inspect forensic inpatient wards, long stay or rehabilitation wards, child and adolescent mental health (CAMHS) wards and mental health crisis services due to concerns raised around serious incidents and the risk of people’s experiences being poor.
The trust has been again rated as good for being well-led. However, the trust’s rating for safety has dropped from good to requires improvement because of findings in these four services. The trust remains rated good overall, and how caring the trust is has again been rated as outstanding.
Jane Ray, CQC deputy director of operations in London, said:
“When we inspected the trust, we found that on the whole they were maintaining the same good quality of care provided at our last inspection. However, we had concerns about people’s safety at two services, which had also impacted our view on how the trust were embedding their systems and processes to deliver safe care and treatment.
“Although leaders were aware and taking action to identify and tackle trust-wide issues affecting people’s care, they weren’t always doing this in some wards across their geographically spread services.
“People’s experiences were also being affected by how long they were waiting for urgent mental health care. This is a picture that we’ve seen reflected nationally, and the trust are working towards addressing these challenges.
“Whilst we saw very committed and caring staff, leaders need to improve systems and oversight to ensure the care they are delivering is safe.
“We saw leaders involving more people using services in their improvement projects, and working well with other organisations to meet the needs of their local population.
“We’ll continue to monitor the trust to ensure they’re building on existing good care and making further improvements where they’ve been told to in order to keep people safe.”
Inspectors found:
- On one of the trust’s long stay rehabilitation wards, Westfield House, inspectors found restrictive practices. People’s independence and preferences weren’t being respected, and a closed culture was at risk of developing. Following this inspection, and initial feedback, the trust made a decision to close Westfield House.
- People’s physical health wasn’t always monitored thoroughly. On the forensic wards, one person had died after staff failed to identify a decline in their physical health. The trust were working on processes to improve the monitoring of people’s physical health, but this needed further work to make sure it was embedded. The trust needs to prioritise this as a matter of urgency.
- People weren’t always receiving appropriate observations to keep them safe, and this was a recurring theme in serious incidents where people had been able to harm themselves. The trust was taking action, including by improving training and introducing digital equipment to record observations, but these improvements needed more work to embed.
- Staff didn’t always receive appropriate supervision from leaders to make sure they could meet people’s needs. While this had improved since CQC’s last inspection, staff focus groups reported mixed experiences.
However:
- The trust had further developed their programmes to support diversity and inclusion, expanding their staff networks for marginalised groups and encouraging their input during decision-making. However, trust data showed ongoing inequality in their career progression.
- The trust was embracing digital technology to improve people’s care, such as electronic alternatives to paper prescriptions.
- Most staff knew how to raise concerns about people’s care and felt comfortable doing so.
- When things went wrong, staff reported it and leaders shared learning well to protect people in future.
See the full report on the CQC website.