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SLAM wards are improving says CQC
Acute wards and psychiatric intensive care units (PICUs) at a south London NHS trust have improved since September 2015 but have still been rated Requires Improvement by the Care Quality Commission.
The acute wards for adults of working age and PICUs at South London and Maudsley (SLAM) NHS Foundation Trust were rated as Requires Improvement for being safe, effective and well-led. They were rated as Good for being caring and responsive, following the focused inspection in January and February 2017.
The trust had addressed the most serious issues that had caused CQC to rate the safe category as Inadequate after an inspection in September 2015.
At the most recent inspection CQC found that, despite significant efforts by the trust to improve staff recruitment, there was a high number of nursing vacancies on some wards. This led to cancelled escorted patient leave and patient activities.
Staff on PICUs had not recognised and addressed a number of ligature risks on the ward.
On some PICUs information available to staff about fire safety procedures was not up to date. This put patients and staff at potential risk in the event of a fire.
More than 360 patient restraints in the last seven months involved patients being held in a face-down (prone) position. There was no detailed plan in place to reduce the use of prone restraint.
Ward environments at the Ladywell Unit were either too hot or too cold making it unpleasant for patients and staff. Pest control at the Maudsley Hospital was not completely effective.
Inspectors said the trust must now:
- Continue to address the high number of nursing vacancies on some wards.
- Ensure that all staff recognise potential abuse and report safeguarding concerns appropriately.
- Ensure that all ligature anchor point risks on the psychiatric intensive care wards are recorded on the ward ligature risk assessment and that staff are aware of the risks and how they are mitigated.
- Develop clear plans to reduce the number of patients being restrained in the prone position and monitor the impact of actions taken.
- Ensure that information about fire safety procedures and evacuation is up to date on all wards. Fire drills must take place regularly.
- Ensure that governance processes are sufficiently robust so that they identify where improvements need to be made.
Inspectors also said the trust should take a number of other measures including: take all necessary steps to ensure effective pest control on the wards at Maudsley Hospital; ensure that staff continue to increase their completion of mandatory training; the trust should ensure that confidential patient information is not visible to other patients and visitors to the wards; it should ensure that ward temperatures at the Ladywell Unit are comfortable for patients and staff.
Dr Paul Lelliott, CQC's Deputy Chief Inspector of Hospitals (and lead for mental health), said:
“It is good to see some improvement at South London and Maudsley NHS Foundation Trust, but there is still much to do."
“Although we continue to have concerns about the safety and effectiveness of care, the majority of patients spoke positively about the care and treatment they received and their relationship with staff. Many patients told us that they were treated with kindness and respect and that staff were hard working and caring. Patients on the Croydon psychiatric intensive care unit, in particular, said the care they received was excellent."
“The trust was piloting a new electronic system for recording patients’ physical observations. This system automatically prompted staff on the frequency of required observations and when an observation should prompt a response or escalation. They hoped to develop the system to cover all ward observations.”
You can read the report in full on our website.
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- Last updated:
- 5 May 2017
Notes to editors
The South London and Maudsley NHS Foundation Trust provides acute mental health services in four London boroughs: Southwark, Lambeth, Lewisham and Croydon. The trust serves a local population of 1.3 million people. The acute care pathway consists of 17 in-patient acute wards and four psychiatric intensive care units (PICUs) based at four hospitals. Staff in the acute referral centre review all referrals for admission to an acute ward or PICU in the trust. The trust employs more than 4,700 staff overall and had more than one million patient contacts in the last 12 months.
- Are they safe?
- Are they effective?
- Are they caring?
- Are they responsive to people’s needs?
- Are they well-led?