North East London NHS Foundation Trust

Ratings - Acute wards for adults of working age and psychiatric intensive care units

• Overall

  Requires improvement

• Safe

  Requires improvement

• Effective

  Good

• Caring

  Requires improvement

• Responsive

  Good

• Well-led

  Good

Our view of the service

We carried out this short notice announced inspection of acute wards for adults of working age and psychiatric intensive care units as part of our continual checks on the safety and quality of healthcare services. We visited the acute wards for adults of working age and psychiatric intensive care units at Sunflowers Court over three days on the 15, 16 21 October 2024. We gave verbal feedback which we confirmed in a letter to the trust shortly after our inspection.

As part of the inspection, we spoke with 24 patients. We also spoke with 63 staff members including doctors, ward managers, clinical leads, registered and non-registered nurses, student nurses, occupational therapists and assistants, psychologists, social workers, pharmacists, and administrators. We looked at 42 patient care and treatment records, and 28 medicines administration records, including 8 rapid tranquilisation records. We examined the environment on each ward, and attended 8 ward meetings including community meetings, safety huddles, and moderate harm meetings. During and following the inspection we spoke with 30 carers/relatives of patients using the service. Following the inspection we also spoke with the Integrated Care Director, Associate Director of Nursing and Quality and Deputy Director of Nursing.

We had previously inspected acute wards for adults of working age and psychiatric intensive care units in August 2022. As a result of that inspection, we had rated the safe, effective, caring, responsive and well led domains as good. Our overall rating was good.

As a result of this inspection our ratings changed. We rated safe and caring as requires improvement. Our ratings for effective, responsive and well-led were good. Overall, our rating for acute wards for adults of working age and psychiatric intensive care units went down from good to requires improvement.

During this inspection we had concerns how the trust ensured dignity and respect for all patients which was a breach of Regulation 10 Dignity and respect. We also had concerns in relation to patient safety and found the trust to be in breach of Regulation 12 Safe care and treatment. Improvements were also needed in relation to governance and we additionally found the trust to be in breach of Regulation 17 Good governance under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

• We found that some patients did not have risk assessments and care plans in place for physical health conditions. Many of the patients had complex physical health conditions and nursing staff did not always feel confident in the management of these conditions.

• There were some safety concerns in relation to the environments on Ogura, Picasso and Kahlo wards. Following the inspection the trust advised that they had taken action to address the environmental concerns on Ogura and Picasso wards but further environmental improvements were needed.

• Improvements were needed in the way that restraint and subsequent debriefs were recorded so that the use of restraint could be appropriately monitored.

• Some staff were undertaking intermittent observations at regular intervals, making them predictable. Following the inspection, the trust updated their policy on observations to reflect the need to vary times of observations. Changes in staff practice would need to be embedded.

• We found some issues with medicines administration including medicines prescribed as needed. We also found instances when controlled drugs were administered with only one signature.

• Patients on all the wards said that they did not have direct access to hot drinks and snacks. We observed, and patients reported having to wait a long time for staff to provide these. Following the inspection, senior managers in the trust said that they were taking steps to address this.

• There were limited rooms available on the wards to facilitate private meeting between carers and their family members if several visitors arrived at the same time. Some carers were unhappy with the facilities for visiting patients and said they could not meet patients in private each time. Most carers reported problems getting through to the wards by telephone especially at night.

• Some patients were not receiving their halal and vegetarian meals as these were being taken by other patients. The service reported that since this was reported, staff were being more vigilant in the allocation of meals to patients.

• Whilst governance systems were in place, these needed some further refining and embedding to ensure services were delivered consistently appropriately and safely.

However, we also saw improvements:

• Staff learnt from incidents. Staff on each ward were able to tell us about how they had taken steps to incorporate learning from incidents and there were action plans in place for all serious incidents.

• Appropriate environmental checks were in place and works to roll out patient call bells was underway. The wards were visibly clean, with regular hand washing and infection control audits in place.

• Staff were clear about how the trust’s safeguarding procedures to protect patients from abuse.

• There had been significant recruitment to the wards although all wards had vacancies for permanent consultant psychiatrists, with locum consultants covering. The trust was working hard to address this.
• Mandatory training rates were quite high across the wards and staff described good opportunities for professional development within the trust.

• Staff provided a range of care and treatment suitable for the patients in the service consistent with national guidance.

• Staff ensured that patients had access to physical healthcare input and supported them to live healthier lives. For example, physical health and substance misuse specialists visited the wards and provided professional advice as needed.

• Supervision for clinical staff was mostly provided monthly, although there were inconsistencies in provision between the wards. Levels of appraisals still needed to improve for some wards.

• Staff were involved in several quality improvement projects and working towards accreditation with the Royal College of Psychiatrists.

• Multidisciplinary staff met with patients weekly to discuss their support and treatment. Patients could give feedback on the service. Staff carefully planned patients’ discharge and worked with care managers and coordinators to make sure this went well.

• Most staff felt respected, supported and valued, and said that the trust promoted equality and diversity in daily work and provided opportunities for development and career progression. Following the most recent staff survey from 2023 the trust had an action plan including introducing long service awards and opening a café in the hospital building.