The care watchdog has raised its rating for South London and Maudsley NHS Trust’s psychiatric intensive care unit to ‘good’ from ‘requires improvement’ after its most recent inspection.
Today (Friday, August 20) the Care Quality Commission (CQC) published its latest report into the trust’s working-age adult acute wards, psychiatric intensive care and adult community services, praising improvements made since a previous inspection in 2019.
Inspectors did, however, highlight improvements needed in the trust’s community services, which are struggling with high caseloads and long waiting lists no doubt worsened by the impact of the pandemic.
For these reasons, the community service remained rated ‘requires improvement’.
Overall, the three services inspected are currently rated as ‘good’ for being effective, caring, responsive, and well-led and ‘requires improvement’ for being safe while the trust as a whole is continues to be rated as ‘good’.
CQC’s head of hospital inspection, London, Helen Rawlings, said: “When inspectors visited the three areas at South London and Maudsley NHS Foundation Trust, they were pleased to see that the level of care had remained consistent despite the significant pressures caused by the pandemic which is good news for people using these services.
“Since our last inspection in 2019 there has been significant changes to leadership with a substantive team of executive directors now in position who have settled into their roles and are working together effectively.
“The trust had responded positively to the previous inspection and worked to make the necessary improvements.
“For example, we saw progress with physical health monitoring for patients in the community with staff supporting patients to live healthier lives by encouraging them to take part in programmes or giving advice.
“There was a continued focus on improving patient safety by reducing violence and aggression and the use of restrictive practices.
“A redesign was ongoing to improve this area which focused on providing a safer, therapeutic service for patients.
“Staff were proud to work for the trust and felt supported, valued and respected by their managers. They spoke about improvements in culture and said leaders were much more visible.
“There are, however, areas where improvements must be made and maintained.
“For example, within community services, some teams reported high caseloads that exceeded safe levels and long waiting lists for psychological therapies and non-urgent referrals.
“These long waiting times can have a very negative impact on people’s wellbeing whilst they’re trying to access these services.
“The service was implementing a change programme to improve these areas in order to speed up patient access and flow.
“Action was also being taken to address nursing staff vacancies and the low rates of staff training in some mandatory areas.
“We have reported our findings to the trust and are pleased that the strong commitment from all staff to deliver good services has resulted in higher standards of care for people. The provider must now ensure these positive changes are sustained and the necessary improvements are made.”
The CQC has also praised its ‘ability to adapt at a fast-changing pace during the COVID-19 pandemic’.
The community-based mental health team now needs to ensure that patients who require a Mental Health Act assessment must be assessed without delay to ensure their safety.
Other issues also identified include some gaps in mandatory staff training, and how emergency medicines and equipment were being managed in teams specific to Croydon.
At the acute wards for adults of working age and psychiatric intensive care units the CQC has told the hospital to ensure sufficient numbers of staff on each ward must receive training in the use of physical restraint and disengagement, immediate life support and basic life support.
Examples of ‘outstanding care’ highlighted by inspectors include how community based patients could now, as part of a new service, receive a one-to-one session with a specialist mental health pharmacist.
A clinical psychologist had also obtained funding for an innovative project to help patients work on their known anxiety scenarios using virtual reality headsets, due to begin in June 2021.
And community-based mental health services also had access to testing facilities which meant patients could have physical health monitoring completed and medicines supplied within just a 20-minute appointment.
Responding to the findings, David Bradley, chief executive officer, at South London and Maudsley NHS Foundation Trust said: “I am delighted that the CQC has highlighted so many areas of excellent practice and that we have built on our good rating.
“We have made significant improvements across our acute wards and psychiatric intensive care units which is testament to the hard work of our front-line staff and service managers.
“Thank you to all our staff who have worked hard over the last eighteen months, while adapting to the significant challenges posed by the COVID-19 pandemic.
“During this time we have improved the length of stay for patients, delivered step down housing to support people back into the community, made improvements in our staff survey results and continued our £140 million building and modernisation programme to improve our mental health services and facilities for local people.
“We are also proud that the report highlighted our programme of mental ill health prevention and recovery to ensure we are able to support people to stay well in our communities, which we are delivering together with our partners across south London following the pandemic.
“We are committed to working together with the people who use our services, and their carers, who remain crucial in our ambition to improve the quality of our care and the design of our services. We recognise there is still much for us to do to improve services and we are publishing our new strategy in September that will set our vision for the Trust.”
Vanessa Smith, chief nurse, at the trust said the findings reflected the ‘compassion, hard work and commitment of our staff’.
“When inspectors visited the trust, they were pleased to see that the level of care had remained consistent despite the significant pressures caused by the pandemic, which is good news for people using our services,” she said.
“The CQC found that we had taken positive steps to make the necessary improvements from our previous inspection in 2019.
“For example, they saw progress with physical health monitoring for patients in the community with staff supporting patients to live healthier lives by encouraging them to take part in programmes or giving advice.
“The CQC report also highlights areas we can improve, and I look forward to working with our staff, patients and partners to address these together.”
Next month the trust will publish a new strategy which will outline how it intends to move from ‘good’ to CQC rated ‘outstanding’ in the next five years.