A mental and community health services trust in London and south east England has again been rated Good overall by the Care Quality Commission.
Central and North West London (CNWL) NHS Foundation Trust was rated Outstanding for being caring and Good for being safe, effective, responsive and well-led, following the inspection that took place between January and April 2019.
CNWL provides mental health and community health services to a population of three million people, employing around 7000 staff who work across 150 locations in the south-east of England, particularly in central and north-west London and Milton Keynes. CQC inspected three services on this occasion. They were: wards for older people mental health problems; community-based mental health services for adults of working age; acute wards for adults of working age and psychiatric intensive care units (PICU). These services were chosen as all three were previously found to be Requires Improvement.
Inspectors found some Outstanding care at the trust. The trust was fully committed to working in partnership with patients and, increasingly, carers. There were many excellent examples of patient and carer involvement at many levels within the organisation, including well established peer support workers. People with severe and enduring mental illness were supported back into work or to maintain their employment through a specialist employment scheme. Staff on inpatient mental health wards were working to reduce restrictive interventions and had achieved considerable success at reducing restraint on one ward which was an early implementer of the new model. In offender care the trust had recruited 13 patient experience leads to enhance patient involvement with a group that can be hard to engage with. Carers had been involved in organising a carers’ conference with the trust. Inspectors saw many examples of kindness, compassion and respect.
The trust had a strong, cohesive senior leadership team which had instilled a positive ‘can-do’ culture within the organisation. Senior leaders expected high standards of themselves and their colleagues, but most staff regarded them as kind and supportive when teams and individuals were facing challenges.
CNWL had worked creatively to meet emerging needs. A large-scale example was their response to the Grenfell tragedy where they, alongside many partners, were seeking to try to meet mental health needs that had been triggered, or exacerbated, by the trauma. The Grenfell Health and Wellbeing Service is now the largest trauma service in Europe with 50 trauma-trained therapists, child and adolescent mental health services and a school nursing team.
However, there were some wards and teams where the trust must improve. Of greatest concern were the acute mental health wards at the Gordon Hospital where the physical environment was out of date and limited patients access to space. Also, staff morale was poor following recent safeguarding concerns. The trust was working to address both these areas.
On the wards for older people with mental health problems, some patients did not have access to the full range of specialists to meet their needs, dietetics, speech and language therapists and physiotherapists. Not all staff were not appropriately trained in dementia care, so they are equipped with the skills to support this patient group.
In the community-based mental health services for adults of working age some assessments and reviews were not carried out in a timely manner. Particularly in the Milton Keynes urgent access team.
Dr Paul Lelliott, Deputy Chief Inspector (and lead for mental health) said: “I am pleased that Central and North West London NHS Foundation Trust has retained its Good overall rating. It is a testament to all who work at the trust that we have rated caring as Outstanding overall. The trust has undertaken some innovative work to engage people who use services in developing the trust’s services.
“CNWL has a strong leadership team which appears very knowledgeable about its services. The executive leadership team continuously challenged themselves to improve servicers and meet the needs of patients. The depth of knowledge held by senior leaders about each service was described as ‘phenomenal’ given the size of the trust.
“However, despite this positive report there are still some areas where CNWL can improve and I’d like to see those addressed as soon as possible.”
You can read the inspection report in full when it is published on CQC’s website at: www.cqc.org.uk/provider/RV3
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