Roller Mill

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This was the first assessment for this service. This key question was rated Good.

People received safe care and treatment. Staff understood how to report incidents, manage risks and safeguard vulnerable people. The service only treated people with low-to-moderate risks that are appropriate for short-term, remote assessment and care. When incidents occurred, leaders reviewed them and implemented changes to stop them being repeated. Safe systems were in place for patient verification, initial risk assessment and information sharing with GPs. However, not all safeguarding actions were recorded within the patient care records.

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

The service had a positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learned to continually identify and embed good practice.

Managers reviewed mistakes and took corrective action to prevent future occurrences. For example, when a patient's information was added to another person's care record, managers reviewed the incident, apologised to the people concerned and updated procedures to prevent it happening again.

Leaders also responded to operational challenges. When patients reported difficulties with the online booking portal, the service adapted by contacting people via telephone. As a result, phone contact is now made within 2 working days of receiving a referral. Incident reviews and actions are discussed at regular meetings with senior leaders.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They advised GPs about people’s care when they moved on from Roller Mill.

The service enforces a strict inclusion and exclusion policy to ensure treatments are limited to what Roller Mill is set up to safely deliver: caring for people with low or moderate mental health risks.

Most referrals are from a private medical insurance company and often contain very brief information. Staff manage the risks from only having brief referral information by remaining vigilant for new information that may increase risks during the initial assessment appointments. Clinicians will decline or return cases if they are unable to care for people safely.

Most initial assessment appointments occur within 5 days of referral. Safety protocols are robust; clinicians verify patient identities over video using photo ID and summary care letters are automatically sent to patients after appointments. Staff share information with GPs appropriately based on patient consent and clinical necessity.

The lead doctor has experience managing high-risk mental health care. This means the service is aware how to respond to emergencies if a person unexpectedly needs urgent help.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Staff were trained to recognise abuse and make safeguarding alerts, supported by a safeguarding lead and online advice service. Senior leaders discussed cases to ensure safety and look for any emerging trends.

Clinicians provided clear examples of appropriate multi-agency working including safeguarding referrals to local authorities, for example notifying the DVLA regarding driving safety or completing safeguarding alerts for coercive and controlling domestic abuse. The service utilised its large administration framework to manage the challenge of processing fast, prompt referrals across multiple UK local authorities. An electronic tagging system within the care records also assisted clinicians.

However, we found that not all safeguarding actions taken and completed by staff had been fully recorded within some patient care records.

Mental Capacity Act

Staff always correctly work under the assumption that people using the service have the mental capacity to make and communicate their own decisions. The provider had established clear boundaries for its remote, short-term care model. If a clinician doubted a person's mental capacity or determined that a comprehensive mental capacity assessment may be required, then the person would meet the service's exclusion criteria. Staff would then end or decline care and safely signpost the individual to other help.

The service worked with people to understand and manage risks. Staff assessed and managed risks to patients well. People had access to their regular care summaries.

The service supported people to manage their own safety by sending an electronic information pack during portal creation, which detailed the assessment process and how to access urgent support if they need it.

We reviewed 10 patient records and confirmed that individuals were actively involved in creating their own risk assessments and care plans. Patients can also have a family member or friend present to support them during their remote appointments. Doctors created and uploaded a summary letter to the portal quickly after every appointment. People could gain further support by showing the letters to employers or their GP.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The online portal and video systems were secure and normally restricted to UK access only, though telephone calls cannot be restricted in the same way. The remote systems improved accessibility by eliminating travel time and allowed people to access care from a choice of location.

Clinicians understood the limitations of only using video or phone appointment, such as the reduced ability to assess physical wellbeing or observe subtle body language. If a person wanted face-to-face appointments, the service would decline the referral under its exclusion criteria, as it was not set up to deliver that.

The provider managed technological risks through an information technology contract that ensured system resilience. For example, when a delay occurred within the electronic prescribing system software, the contractor resolved it quickly. Clinicians used telephones as a fallback measure if internet or software issues occurred, though this was rarely required.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Two consultant psychiatrists provided appointments during weekday daytime hours. Evening and weekend appointments were previously offered but discontinued due to low demand. Records showed that 79% of booked appointments occurred on time, with most of any delays caused by patient cancellations.

Psychiatrists received support from an administrative team and could access advice from physical healthcare colleagues within the wider organisation.

Training records confirmed that clinicians were up to date with all mandatory and additional training. Clinicians maintained their own professional revalidation and actively sought relevant development opportunities within Roller Mill.

The service is delivered entirely remotely, meaning patients do not attend any physical premises. Administrative offices in East Sussex were clean and safe.

The service did not always make sure that medicines and treatments were monitored for side effects. However, staff involved patients in decisions about their medicines.

Psychiatrists prescribed medicines electronically in line with national guidance, for short-term periods typically lasting a few weeks until treatment ends. When care concluded, the service stopped prescribing and contacted the person's GP to recommend ongoing care.

Clinicians sought to review the effects of medication on physical health in line with National Institute for Health and Care Excellence guidance. Because the service was remote, staff must ask patients to visit their GP for physical monitoring if it was needed, such as blood tests, blood pressure, height and weight. However, this relied entirely on patient and GP cooperation and capability. We found that one person had been prescribed medicine that needed physical monitoring and that there was no record of this having been monitored for side effects by their GP or another healthcare professional. This meant that potential adverse physical health deterioration caused by prescribed medicines may have gone undetected.