A south east London NHS trust that specialises in mental health care has been rated Good overall for its forensic inpatient/secure wards by the Care Quality Commission. It had previously been rated Requires Improvement.
Oxleas NHS Foundation Trust, which provides community and mental health services to the London boroughs of Bromley, Bexley and Greenwich, was rated Outstanding for being responsive to patients and Good for being safe, effective caring and well-led.
During the Care Quality Commissions previous inspection in 2016 a number of concerns were identified. These included assessments of potential ligature anchor points in the wards not being thoroughly completed, the results of audits not being acted upon and one ward where there was only one staff member on occasions. The trust had addressed all these concerns. They had also taken swift action following incidents and had significantly improved the safety of the service.
At this inspection, the trust demonstrated how they had piloted a new tool on one ward, which was a checklist, to predict increasing levels of patients’ aggression. Part of this pilot involved an audit, which found a 37% decrease in patient incidents after using the new tool. Following the audit all forensic admission wards in the trust began using the tool.
The inspection also found other improvement. For example occupational therapy staff worked every day of the week and activities took place every day, including bank holidays. There was an exceptional range of individual and group activities during the day and evening.
The trust also introduced a project to provide a smoking cessation education session. Patients’ carbon monoxide readings were also taken. As a result of this, in seven months, 63% of patients had lower carbon monoxide readings. This meant these patients were healthier.
However, there were some areas where the trust could make some improvements.
- A number of blanket restrictions and practices were in place across all wards. These included room searches and patients’ use of mobile phones. These restrictions and practices were not specific to the groups of patients on individual wards or the level of security.
- Patients’ care plans varied in quality across the forensic services. While some patients’ care plans were detailed and person centred others were not. Some did not address all the patients’ needs.
- The patients' telephone on each ward had a privacy hood, but these were not effective and did not enable patients to make private phone calls.
Jane Ray, CQC’s Head of Hospital Inspection (Mental Health), said:
“It is encouraging to see that Oxleas NHS Foundation Trust has improved its rating for forensic inpatient/secure wards from Requires Improvement to Good overall."
“We were particularly impressed with the range of activities for patients, which focused on patient’s strengths and provided patients with a variety of choices. This, and other work being undertaken in the forensic services, meant we rated the service Outstanding for being responsive to people in its care."
“However, there are some areas where the trust can make further improvements and I expect that the senior management team will ensure this happens in the future.”
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