West London Mental Health NHS Trust has been rated as ‘requires improvement’, following an inspection in June by the Care Quality Commission (CQC).
A team of CQC inspectors and specialist advisors spent five days inspecting the services provided by the trust. The team inspected the mental health wards for children and young people, working age adults and older people, forensic services, including the high secure service, and the community mental health services for people of all ages.
The inspectors rated the trust services overall as being good for being caring and responsive. However, they were rated as being ‘requires improvement’ for being safe, effective and well-led. Forensic services, which include the West London forensic services and the high secure services at Broadmoor were rated inadequate. Inspectors were most concerned about the West London forensic services.
Inspectors found that the trust had a substantial problem with staff recruitment and retention. There were too few staff to consistently guarantee safety and quality in the medium and low secure forensic services, high secure services and community-based mental health teams. There were less severe staffing problems in some other areas.
Although most staff were hardworking, caring and compassionate, the trust had a problem with low morale. Despite some staff engagement work, frontline staff in some services did not feel well engaged with the wider organisation. This particularly affected those in working in the forensic services.
Inspectors said the trust must improve its use of physical restraint and seclusion. The problem was most serious in the forensic, high secure, adult admission and older people’s wards. The West London forensic services did not keep consistent and accurate records regarding the use of restraint and seclusion. Some staff did not recognise that the restrictions that they had placed upon patients amounted to seclusion or restraint, and inspectors did not see convincing evidence that seclusion and restraint was only being used when absolutely necessary.
Dr Paul Lelliott, the CQC’s deputy chief inspector of hospitals and lead for mental health, said: “Staffing shortages and difficulties with recruitment at West London Mental Health NHS Trust are having a noticeable impact on the quality of some services. In the forensic services, this is compounded by low morale. As well as affecting the quality of care, there is the risk that staff might not show the openness, transparency and honesty that are essential to provide safe care.
“We were concerned at the apparent overuse of physical restraint, and the failure to keep proper records. Staff must use restraint only as a last resort, and minimise the use of restraint in the prone (face-down) position. They must record the use of all types of restrictive intervention. They must also make the necessary physical health observations to ensure the safety of patients who have been given an injection to manage disturbed or distressed behaviour.
“West London Mental Health NHS Trust is a large organisation with many parts. Despite the problems described above, our inspectors visited other services where staff were positive about the work of the trust and where care was delivered by hard working, caring and compassionate staff. This included Broadmoor hospital where staff showed a real concern for patients on an individual basis and a desire to see them progress towards recovery.
“The trust is developing a leadership team which has a good insight into the challenges they face. However, we believe that our inspection has identified that the scale and speed of change that is needed is very significant. They must address our findings as a matter of urgency. We will be working with the trust to agree a plan to assist them in improving their standards of care and treatment.”
More work to do
In response, West London Mental Health NHS Trust chief executive, Steve Shrubb, said: “The inspection was rigorous and the CQC’s assessment of the trust is very fair. They recognised our staff’s hard work and compassion, many of our services were found to be good, and all of our services were found to be caring and staff should feel rightly proud of this.
“However, we know that we have more work to do and need to deliver improvements if we are to deliver consistently high quality care to every single patient. I apologise to patients and their families if they have received poor care from us.
“We need to speed up the work the leadership team is undertaking to create the conditions for our staff to be the best they can be. This includes increasing staffing, improving staff engagement and morale and reducing the use of restrictive practices including restraint and seclusion.
“We have been working on these issues and although we have made improvements in some areas we are committed to accelerating and building on that work.”