- SERVICE PROVIDER
North London NHS Foundation Trust
This is an organisation that runs the health and social care services we inspect
Report from 24 July 2025 assessment
Contents
Ratings - Acute wards for adults of working age and psychiatric intensive care units
Our view of the service
We carried out a comprehensive assessment of all mental health wards for adults of working age and psychiatric intensive care units (PICU) delivered by North London NHS Foundation Trust. We inspected 20 wards across 4 sites between 10 February and 4 March 2025.
The wards we visited were:
Four wards at Chase Farm Hospital
- Devon Ward (PICU)
- Dorset Ward
- Suffolk Ward
- Sussex Ward
Three wards at Blossom Court, based at St Ann’s Hospital
- Daisy Ward
- Sunflower Ward
- Tulip Ward
Three wards at the Dennis Scott Unit, based at Edgware Community Hospital
- Shannon Ward
- Thames Ward
- Trent Ward
Ten wards at Highgate West Mental Health Centre
- Coral Ward (PICU)
- Ruby Ward (PICU)
- Amber Ward
- Amethyst Ward
- Diamond Ward
- Jade Ward
- Opal ward
- Rose Quartz Ward
- Sapphire Ward
- Topaz Ward
We rated the service as requires improvement.
North London NHS Foundation Trust was formed in November 2024 following the merger of 2 former trusts: Barnet, Enfield and Haringey Mental Health NHS Trust and Camden and Islington NHS Foundation Trust. Prior to the official merger, they operated under a joint leadership team called the North London Mental Health Partnership.At the time of the inspection the organisation was implementing its three year plan for the new trust, in collaboration with the Institute for Healthcare Improvement, to promote quality improvement throughout the organisation.
Barnet, Enfield and Haringey Mental Health NHS Trust was last inspected between October and December 2021. At this inspection we issued 3 requirement notices for breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to the mental health wards for adults of working age and psychiatric intensive care units (PICU). They were, that the trust must ensure action is taken to protect the privacy and dignity of patients using the seclusion room on Trent Ward. The trust must ensure that staff working on acute wards and PICUs that need immediate life support training complete it. The trust must continue to take action to address the high rates of unfilled staff shifts on acute and PICU wards, particularly on Devon, Trent and Daisy wards.
Camden and Islington NHS Foundation Trust was last inspected in November 2022. At this inspection we issued 1 requirement notice for a breach of the Health and Social Care Act (Regulated Activities) Regulations 2014 relating to the mental health wards for adults of working age and psychiatric intensive care units (PICU). That was, the trust must ensure that there are sufficient staff assigned to all wards to ensure the safety of patients and quality of care.
We carried out this comprehensive assessment due to the number of serious incidents and a number of deaths noted within the trust’s inpatient wards. The assessment followed up the themes from these deaths. Between April 2022 and March 2024, there had been 8 deaths in Barnet, Enfield and Haringey Mental Health NHS Trust and there had been 5 deaths in Camden and Islington NHS Foundation Trust.
In the 6 months between September 2024 and February 2025, there had been 4 deaths within the acute and PICU wards.
At this assessment we found areas that needed to be improved. Seclusion reviews did not always happen at the scheduled frequencies. Patient observations across the wards were not always being carried out in line with trust policy. Fire drills and fire risk assessments were not in place across all sites. There were low compliance rates for key training, such as life support and prevention and management of violence and aggression. Staff did not always receive regular supervision and appraisals. Team meetings were not always happening each month. Patients and staff told us there were not enough staff working on the wards. Wards did not use outcome measures to track patient outcomes.
We did find several areas of good practice, including, the majority of staff were positive about working for the trust, and the support they received from their managers. There was good career development for staff and access to further training. Most patients and carers said staff were kind and caring. There were quality improvement projects across the trust, which staff were passionate about. Managers were receptive to feedback from the inspection team and worked to create action plans and solutions.
During this assessment, the inspection team:
- visited 20 wards, including 1 unannounced visit in the evening
- reviewed the environment on each ward and observed staff supporting patients
- spoke with 58 staff including registered nurses, healthcare assistants, activity co-ordinators, psychologists and occupational therapists.
- spoke with 29 ward managers, senior managers, matrons, associate directors of nursing, and a Mental Health Act administrator.
- spoke with 7 pharmacists
- spoke with 12 doctors
- spoke with 56 patients
- spoke with 32 carers
- reviewed the care and treatment records for 52 patients
- reviewed 76 prescription and administration records and associated care records
- attended handover meetings, safety huddles, multidisciplinary team meetings, a formulation meeting, an activity group and community meetings
- reviewed other documents, performance data and policies relating to the running of the service
Action we have taken
We found 13 breaches of the regulations in relation to safe care and treatment, person centred care, staffing and governance.
We have asked the provider for an action plan in response to the concerns found at this assessment.
Mental Health Act and Mental Capacity Act Compliance
Mental Health Act
Most staff were trained in and had a good understanding of the Mental Health Act 1983, the Mental Health Act Code of Practice and the guiding principles. Overall, 83% of staff had received training in the Mental Health Act. However, compliance in this training varied across wards. For example, 100% of staff on Rose Quartz Ward had completed this training, compared to 67% of staff on Devon Ward.
Staff had easy access to administrative support and legal advice on implementation of the Mental Health Act and its Code of Practice. Staff knew who their Mental Health Act administrators were and how to contact them.
Staff explained to patients their rights under the Mental Health Act in a way that they could understand and repeated this as necessary. Most records showed staff recorded when and how they shared the information with patients, and this was done regularly. We reviewed 52 care records across the trust, and we found 6 examples where patient’s rights were not being read regularly.
We saw examples across the trust where patients had been administered medicines that had not been in line with the Mental Health Act consent to treatment authorisations. This was found on Trent Ward, Thames Ward, Sussex Ward and Sapphire Ward.
Staff supported patients to take Section 17 leave (permission for patients to leave hospital) when this had been granted. However, patients and staff told us there were often delays in using escorted leave due to staffing pressures.
Staff requested an opinion from a second opinion appointed doctor when necessary.
Staff stored copies of patients' detention papers and associated records correctly and they were available to all staff that needed access to them.
Patients had access to information about independent mental health advocacy, such as posters on notice boards. However, 12 out of the 56 patients we spoke with said they were not aware of what an advocate was or how to contact them.
Mental Capacity Act
Most staff had completed training in the Mental Capacity Act. Overall, 81% of staff had completed this training. However, some wards had a lower compliance, for example, 56% of staff on Tulip Ward and 60% of staff on Topaz Ward and Devon Ward had completed this training.
For patients who may have had impaired mental capacity, staff assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis with regard to significant decisions. We saw evidence of these assessments in patient’s care records.
People's experience of this service
We spoke with 56 patients across the trust. Most patients told us staff were kind and approachable. However, 11 patients were unhappy with the way staff treated them.
Eighteen patients felt there were not enough staff, particularly at the weekend. Patients told us this impacted on their needs being met. Patients said their escorted leave was often delayed, and they had to wait a long time for their requests to be met, such as a drink or the laundry room to be opened.
We spoke with 32 carers across the trust. Most carers spoke positively about their interactions with staff. However, 3 carers told us their relative’s discharges were not managed well, with little communication from the ward. Six carers told us the ward did not keep them informed of their relative’s progress or involve them in their care planning.
Whilst on the wards, we saw examples of staff supporting patients in a kind and caring manner.
The trust collected feedback from patients about their care through surveys and community meetings. However, community meetings did not always happen weekly and often did not follow up on the concerns raised.