28 Feb 2018
The Care Quality Commission (CQC) has published a re-inspection report on our acute wards and psychiatric intensive care unit today (Wednesday 28 February 2018).
As this was a focused inspection, the service was not re-rated. As well as areas for improvement and learning, the report highlights good practice and notes that “good progress had been made in some key areas”.
The CQC visited 10 wards over three locations, spoke with 38 patients, one carer and 43 members of staff from 9-11 January 2018. This was an unannounced, focused inspection to check our progress since the last full inspection in November 2016. The inspection team looked at whether specific parts of the service are safe, effective, responsive and well-led. The team did not inspect the ‘caring’ aspect of our work as it was previously rated ‘good’.
The good practice the CQC highlighted includes:
- Most risk assessments were comprehensive and updated with recent risk information. Staff had a good understanding of the level of risk and this was discussed in handovers.
- Seclusion rooms are being reconfigured to reduce movements between wards.
- Staff felt supported and able to raise concerns. They said they found the reflective practice groups helpful. There were some gaps in bank staff supervision, which we know we need to address.
- Most staff had appraisals.
- Patient involvement in care planning had improved.
- Screening, follow up and recording of physical health needs had improved.
Responsive to people’s needs
- Significant improvements with bed management and patient flow across all the wards. The inpatient wards worked collaboratively with the community teams to ensure timely patient discharges.
- Ward managers had access to a lot of useful information to support them to manage their service.
- Service managers had oversight of their areas of responsibility through clear governance processes. This meant most key areas of risk were identified.
The areas still requiring improvement include:
- Some minor works and repairs were not carried out in a timely way.
- High levels of registered nurse vacancies, particularly at St Bernard’s.
- The safeguarding policy on recording patient assaults was not being followed consistently.
- Further steps to improve patient involvement in care planning.
- Clinical psychologist input could be increased.
- Some data was not available at ward manager level; this related particularly to seclusion data.
- There was no assurance that some information on seclusion was accurate.
Responding to the CQC’s re-inspection report, Carolyn Regan, Chief Executive at West London Mental Health NHS Trust said:
“This re-inspection report highlights a range of improvements which our staff have worked tirelessly to put in place.
“We have made good progress on creating additional bed capacity so that we can provide inpatient care to those who most need it.
“We have also strengthened our physical health screening and made sure our risk assessments are comprehensive and up to date.
“We have focused on supporting our staff with regular supervision and reflective practice groups. Our staff told the inspectors that they find this helpful and that they feel confident about raising concerns.
“All these changes have made a big difference to our patients, service users and carers.
“The CQC also highlighted areas where we need to make further improvements. We know there is more to do and we have a quality improvement programme under way to tackle this.
“Like many other trusts, recruiting and retaining registered nurses continues to be a challenge and we have put in place a wide range of measures to increase the number of registered nurses in post and reduce our reliance on agency staff. These include a relocation allowance and the Capital Nurses foundation development programme.
“We have made it our priority to invest in the development of our staff. We have a preceptor programme already in place for newly qualified nurses and are successfully developing a career pathway for non-qualified staff. We are active participants in the Capital Nurse programme and have an innovative partnership with The University of Buckingham on the new nurse degree apprenticeships.
“Thank you to our staff for everything they have done and continue to do to ensure the best possible care for people who use our services.”