Mental health trust rated Good by CQC

Camden and Islington NHS Foundation Trust has been rated Good overall by the Care Quality Commission.

Following an inspection in December 2017 the trust was rated Outstanding for being effective, Good for being caring, responsive and well-led and Requires Improvement for being safe.

Inspectors found evidence of some outstanding practice which really went the extra mile to meet the needs of some patients and carers:

• The community rehabilitation team in Islington provided a consistent care coordinator and consultant psychiatrist who supported patients through the rehabilitation services, including periods as inpatients and when they accessed community rehabilitation services.
• The integrated health team supporting people with a learning disability in Islington had developed a health hub and a joint low vision clinic with the Royal National Institute for the Blind. These clinics were always full and were supporting people to access health care and reduce health inequalities.

The trust promoted the use of research to improve the care and treatment of patients. The carers of patients using the memory clinics were being offered access to a programme of psychological therapies which improved their ability to cope with the challenges of supporting a relative with dementia.

The trust had made good progress in ensuring that patients also had their physical health care needs met. For adults being supported by the community recovery and rehabilitation teams, weekly physical health clinics were being developed. These had a particular focus on supporting patients who were hard to engage or not registered with a GP to ensure their physical health needs were addressed.

There were many examples of person-centred care, where staff had been thoughtful about working with patients and carers to meet their individual needs.

However, the trust still faced many challenges with the recruitment and retention of staff. Whilst the recruitment of qualified nurses is a national and regional challenge, the trust had an unusually high level of vacancies for unqualified care staff.

At the time of the inspection, 63% of staff had completed their mandatory training. There were some significant shortfalls in staff needing to complete life support and break away training.

Further work was needed in terms of maintaining the safety of patients when physical interventions are used. On the acute wards records of restraint did not always include details of the type of restraint used, the names of the staff involved and the length of time that staff restrained the patient.

There were significant pressures in accessing an acute bed. This was impacting on the amount of time patients were waiting at home, in acute hospital emergency departments and in health based places of safety for a bed. At the time of the inspection, 15 patients were placed in beds in the independent sector.

Areas where the trust must make improvements include:

• Ensuring that the completion of mandatory training relating to patient safety reaches the trust target as a priority.
• On acute wards for adults of a working age and psychiatric intensive care units it must employ sufficient staff to ensure that the shifts are covered. The service must ensure that staff consistently complete comprehensive records after all incidents that involve staff restraining patients.
• On long-stay wards the trust must ensure that patients on inpatient rehabilitation wards have access to sufficient occupational therapy input.
• The trust must take action to address high caseloads, and individual workloads for staff in the Islington Crisis Resolution and Home Treatment Team (CRHT), and the high turnover of staff across the CRHTs.

Dr Paul Lelliott, Deputy Chief Inspector (and lead for mental health) said:

“Camden and Islington Mental Health Trust is generally providing a good service to the people it cares for. I congratulate all who work for the trust for making substantial improvements since our first comprehensive inspection in 2016.

“The trust had an excellent clinical strategy that provided clear future direction for the services it delivered. This strategy drew on a good understanding of the mental health needs of the population that the trust serves. Managers also had a clear view about the importance of a healthy culture within the staff group.

“In the future though, I would like to see improvement in the safe category, that we have again rated as Requires Improvement.”

You can see the latest ratings tables on pages 22 and 23 of the attached inspection report.

Read the inspection report in full.

Ends

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