Mental health crisis services and health-based places of safety at Camden and Islington NHS Foundation Trust have been rated as inadequate following an inspection by the Care Quality Commission (CQC).
The trust has been rated as requires improvement overall by the CQC. It provides mental health services to two London boroughs, as well as substance misuse services in Westminster, and a substance misuse and psychological therapies service to people living in Kingston, serving a population of about 431,000.
A team of inspectors visited all of the wards across the trust, looked at the health-based place of safety under section 136 of the Mental Health Act, inspected the crisis teams, community services for people with learning disability and for older people and visited a sample of adult community and substance misuse services.
The inspectors rated mental health crisis services and health-based places of safety as inadequate. Wards for older people with mental health problems, community-based mental health services for older people, and community mental health services for people with a learning disability or autism were rated as good overall.
Inspectors found that facilities at 2 of the 3 health-based places of safety, at other NHS hospitals, did not promote dignity, recovery, comfort or confidentiality for people using the service. Premises at the Royal Free Hospital were unsuitable: the trust had not ensured the environment was clean and well-maintained and the toilet had ligature points which could be used by a patient to self-harm.
There was limited assurance about safety. In some wards staff could not observe all parts of the ward. Inspectors identified ligature points in wards that had not been removed or where measures had not been put in place to mitigate risks. Some wards were not equipped with ligature cutters, or staff did not know where they were kept.
Waiting times in some services were long – up to a year for people needing psychological support with the complex depression, anxiety and trauma service.
People waited for routine referrals for five weeks for an initial assessment. People needing the personality disorder service had to wait 16 weeks to be allocated to a care coordinator and 12 months for therapy.
Paul Lelliott, deputy chief inspector hospitals (mental health) at the CQC, said: “While some services managed risks to patients well we also found examples of wards which were not safe for people who may be at risk of suicide.
“Some wards were safe, clean and well maintained – but we found room for improvement in acute wards for adults of working age. The trust had not completed urgent repairs on three wards at St Pancras Hospital, in a timely manner.
“On a positive note we found that staff interactions with people using services and their families in a variety of settings was responsive and respectful and staff provided practical and emotional support. Staff supported families and carers to be involved in people’s care and offered families access to psychological therapies. Staff said they felt supported to raise concerns without fear of victimisation and told us that morale and job satisfaction was good.
“Overall, we have made it clear that the trust needs to take steps to improve the quality of its services. We will be working with the trust to agree an action plan that will identify how the trust will improve the standards of care and treatment and we will return in the future to check if the required improvements have been made to ensure the trust provides safe and good quality services to patients in the future.”