Improvement required at South London and Maudsley NHS Foundation Trust

BY TOBY PORTER
toby@slpmedia.co.uk

Managers of the world famous Maudsley hospital’s trust have been told they need to improve care for mental health patients in the community.

Community support for working age adults at South London and Maudsley (SLaM) NHS Foundation Trust have been downgraded from being “good” in a previous report by the Care Quality Commission (CQC).

SLaM’s outreach care was rated as “requiring improvement” for its safety, effectiveness and responsiveness following the inspection in July 2017.
An action plan is now being implemented by management to ensure patients are assessed and treated as soon as possible.

The Maudsley’s caring and leadership were rated as “good” in the inspection report.

There were 11 incidents when patients were not assessed promptly in the six months before the inspection. This was due to a lack of hospital beds, complicated further by issues beyond the trust’s control, the report said:

Thirty four of the 131 patients’ risk assessments CQC looked at did not have a current risk assessment and management plan in place. This was a particular concern in the early intervention team in Lambeth, where six of seven records examined did not have current risk assessments and risk management plans.

There were no care plans available in five of 16 patient records inspectors reviewed in the early intervention teams. In some teams, care plans were not always completed in full to ensure that patients received appropriate support.

Patients referred to the Croydon assessment and liaison (A&L) team were not being seen within trust target timescales. This left some of them waiting up to18 weeks for an assessment, which increased their chances of deterioration and put them at greater risk of avoidable harm. In some teams, patients were waiting for about one year for individual psychological therapies.

Staff in some early intervention teams had more cases than the nationally recommended maximum number. This created pressure on the teams and potentially affected the quality of care patients received.

CQC rated the core community-based services as being “good” for its leadership, despite its shortfall in the other areas. This was because managers were already aware of the issues on risk assessments and care plans, and were working to address them. The trust had also taken steps to address long waiting times in the Croydon A&L team and Mental Health Act assessments.

At a previous inspection in September 2015, the trust did not have safe systems for transporting medicines, medical waste and sharps, and not all equipment used in teams was safe and in working order. During the current inspection, CQC found these issues had been rectified.

Staffing levels across the community teams were better and teams of staff were involved in improvement projects.

The trust offered patients the opportunity to participate in innovative treatments, for example, a digital therapy which enabled them to understand and control their thoughts.

Paul Lelliott, Deputy Chief Inspector (Mental Health) for the CQC, said: “I would like to see the overall rating for community-based mental health services for working age adults at South London and Maudsley NHS Foundation Trust improve.

“However, the leadership team are aware of the areas that need work and when we return to the trust to inspect community-based mental health services for working age adults again, we expect to see improvements.”

Tom White of Southwark Pensioners Action Group said: “We want to work with professionals, local groups and users of all ages to improve the quality of mental health provision for Southwark residents.

“We continue to believe front line staff at Maudsley and Kings do great work whilst under enormous pressures because of lack of funding and staff.”

A spokeswoman for South London and Maudsley NHS Trust said: “Safe and compassionate care is a priority for everyone at our Trust which is why following the CQC inspection in July 2017 and the published report in October 2017, we have been addressing the areas we must improve.

“The Trust remains rated overall ‘good’, an achievement we are proud of.

“The report provided us with an action plan which we are using to improve our community services for adults of a working age. This includes making sure risk assessments are always completed and reviewed after changes in patients’ circumstances, improving the quality of care plans and making sure patients who require a Mental Health Act assessments are seen without delay. The Trust is also working to ensure that all patients referred to services receive a timely assessment.

“The CQC’s report highlights many areas of good practice in our community services, including giving us a ‘good’ rating in the area of being caring. We are grateful to our staff who work constantly to improve the care we provide.”