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Provider: Central and North West London NHS Foundation Trust Good

We are carrying out checks on locations registered by this provider. We will publish the reports when our checks are complete.

Reports


Inspection carried out on 16 Jan – 2 Apr 2019

During a routine inspection

Our rating of the trust stayed the same. We rated it as good because:

  • On this occasion, we inspected five key questions for three core services; a total of fifteen key questions. The rating improved for three key questions and worsened for one - from good to requires improvement. This meant that the overall pattern of ratings for the whole trust remained broadly the same. When these ratings were combined with the previous ratings from services not inspected this time, 15 core services are rated as good and two as outstanding.

  • We rated the trust as good for well-led. The trust had a highly experienced, skilled and respected executive leadership team. They were inspiring, committed and continuously challenged themselves to improve services to meet the needs of patients.

  • The trust had a high calibre board, with a wide range of appropriate skills and experience, who were open and determined to provide high quality care to their local communities and those in receipt of specialist services.

  • 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. The depth of knowledge held by senior leaders about each service and the people running them was phenomenal given the size of the trust.

  • The divisional structure and borough-based working for local services were fully embedded and there was evidence of strong partnership working, with good foundations to increase this much further. The trust was participating effectively in local care systems and with NHS partners to drive progress and develop new models of care, such as integrated community health services in Hillingdon.

  • The board had good oversight of operational issues across all divisions. The governance processes were robust and ensured that both achievements and concerns were escalated appropriately. Problem areas had largely been identified before we brought them up and work was, for the most part, underway to resolve matters. The trust was very responsive and took steps to increase the pace of improvement and the support available following our feedback.

  • The trust had a strong grip on its finances. It was on target to achieve its control target for 2018 -19. Its spending on agency staff had significantly reduced and it was working to drive it down further.
  • 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.

  • The trust was committed to improving the safety of staff, patients and the wider community and there were a number of initiatives and programmes in place to try to achieve this. For example, the roll out of the safer leave project for both detained and informal patients on the mental health wards. The trust was just short of its target of 95% compliance with statutory and mandatory training, averaging 93% which was high for a trust of this size.

  • The trust 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. On a smaller scale, the Campbell Centre at Milton Keynes had developed a social recovery team to focus on resolving practical issues for patients which delayed discharge.

  • The trust was making good progress with their quality improvement (QI) work, and despite this approach only being used in practice for about 18 months, it was becoming established across the trust. The trust had received an award from the South of England QI collaborative for building capability and capacity. During the inspection many of the staff we met spoke about their involvement in QI projects. At the time of the well-led review there were 276 active projects and 32 completed projects. The trust had a QI microsite which was accessible on the trusts website. This live site enabled staff to access resources, sign up for training events and record progress with their own project. This enabled services to identify similar projects and learn from each other. The trust was working with patients and carers and they were actively involved in 26% of the projects.

  • All staff we spoke with acknowledged they were provided with good learning and development opportunities and, through the trust’s recovery and wellbeing college, patients who used mental health services and their carers benefited from access to a wide range of courses. Trust mental health staff and staff working in partnership with them could also access these courses. The trust had invested in the development of leadership skills and we noted the competency and confidence of most leaders at all levels of the organisation.

  • The trust was making good progress with promoting equality diversity and human rights throughout the organisation. They had stated a commitment to becoming one of the most inclusive employers in the NHS by 2020. The trust had three well-established staff networks in place to support staff and to promote equality and diversity; the Black, Asian and minority ethnic staff network, the disability equality network and the lesbian, gay, bisexual and transgender staff network. Stonewall ranked the trust equal 28th in its list of top employers for 2019 (only five healthcare employers were in the top 100).

  • The trust had developed robust and innovative ways of managing its estate of 150 sites in ways that were just starting to benefit staff, patients and its finances. With the exception of one site, where there were ongoing negotiations with commissioners, the trust had plans in place to eliminate all its dormitory bedroom accommodation.

  • The trust transferred most of its services to a new electronic patient record system during our inspection; possibly the biggest migration of its kind in the UK. Technically, it went well, although staff were still in the process of getting used to it and some areas needed more time and support than originally envisaged. The new system will enhance joined up work with primary care services.

  • Trust staff had access to a full range of accurate and clearly displayed data relevant to their work which could be viewed at numerous levels from trust-wide to individual team or ward. Clinicians were involved in digital developments to ensure they complemented clinical work.

  • The trust’s communications strategy was working extremely well and staff commented favourably about the high quality of communications and the relative ease of finding information, when needed, on the trust’s intranet site.

  • The trust’s public website had been developed with the needs of people with communication difficulties in mind with links to a growing library of easy-read information on every page. The intranet and microsites were developed to make it as easy as possible for staff to adjust the information to their needs in terms of colour and font.

However:

  • Our inspection did identify wards and teams where improvements were needed. The trust was already aware of where services were facing challenges and was providing additional leadership and support.

  • The inspection did find that some of the improvements recommended at the previous inspection had not taken place. This included ensuring patients on the wards for older people had access to specialist staff such as a dietician when needed, or that information was put into accessible formats for patients with dementia or other cognitive impairments.

  • Recruitment and retention of staff remained challenging for the trust; and they were working creatively to address this within the context of national shortages. Despite the use of temporary staff where needed, some teams were struggling to deliver consistently high-quality care.

  • Some staff were not receiving supervision at the frequency required by the trust’s own policy and neither this, nor the quality, was monitored in a systematic way by managers, unless individuals had set up their own systems. This had also been identified as an area for improvement at the previous inspection. During the inspection the trust was piloting an online system to address this, but this would need to be embedded.

 


CQC inspections of services

Service reports published 4 June 2019
Inspection carried out on 16 Jan – 2 Apr 2019 During an inspection of Community-based mental health services for adults of working age Download report PDF | 512.75 KB (opens in a new tab)Download report PDF | 1.16 MB (opens in a new tab)
Inspection carried out on 16 Jan – 2 Apr 2019 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 512.75 KB (opens in a new tab)Download report PDF | 1.16 MB (opens in a new tab)
Inspection carried out on 16 Jan – 2 Apr 2019 During an inspection of Wards for older people with mental health problems Download report PDF | 512.75 KB (opens in a new tab)Download report PDF | 1.16 MB (opens in a new tab)
See more service reports published 4 June 2019
Service reports published 18 August 2017
Inspection carried out on 8,9,10,11,12 and 15 May 2017 During an inspection of Community-based mental health services for adults of working age Download report PDF | 396.66 KB (opens in a new tab)
Service reports published 14 June 2017
Inspection carried out on 27 and 28 Mach 2017 During an inspection of Wards for people with a learning disability or autism Download report PDF | 402.86 KB (opens in a new tab)
Service reports published 25 April 2017
Inspection carried out on 30,31 January and 3 February 2017 During an inspection of Wards for older people with mental health problems Download report PDF | 395.25 KB (opens in a new tab)
Service reports published 6 January 2017
Inspection carried out on 1,3,4,5 and 6 October 2016 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 509.14 KB (opens in a new tab)
Service reports published 19 June 2015
Inspection carried out on 23 – 27 February 2015 During an inspection of Community dental services Download report PDF | 323.71 KB (opens in a new tab)
Inspection carried out on 23rd – 27th February 2015 During an inspection of End of life care Download report PDF | 269.09 KB (opens in a new tab)
Inspection carried out on 23 – 27 February 2015 During an inspection of Community health services for adults Download report PDF | 346.09 KB (opens in a new tab)
Inspection carried out on 23 – 27 February 2015 During an inspection of Specialist community mental health services for children and young people Download report PDF | 320.46 KB (opens in a new tab)
Inspection carried out on 23 - 27 February 2015 During an inspection of Community health sexual health services Download report PDF | 234.31 KB (opens in a new tab)
Inspection carried out on 26-27 January 2015 (Horton) 23 – 27 February 2015 (London) During an inspection of Long stay or rehabilitation mental health wards for working age adults Download report PDF | 333.37 KB (opens in a new tab)
Inspection carried out on 26 February 2015 and 9 March 2015 During an inspection of Community mental health services with learning disabilities or autism Download report PDF | 271.3 KB (opens in a new tab)
Inspection carried out on 23 – 27 February 2015 During an inspection of Child and adolescent mental health wards Download report PDF | 274.02 KB (opens in a new tab)
Inspection carried out on 23 – 27 February 2015 During an inspection of Wards for older people with mental health problems Download report PDF | 341.16 KB (opens in a new tab)
Inspection carried out on 23 – 27 February 2015 During an inspection of Community-based mental health services for older people Download report PDF | 285.87 KB (opens in a new tab)
Inspection carried out on 23 – 27 February 2015 During an inspection of Mental health crisis services and health-based places of safety Download report PDF | 365.1 KB (opens in a new tab)
Inspection carried out on 23 – 27 February 2015 During an inspection of Substance misuse services Download report PDF | 306.52 KB (opens in a new tab)
Inspection carried out on 23-27 February 2015 During an inspection of Wards for people with a learning disability or autism Download report PDF | 294.14 KB (opens in a new tab)
Inspection carried out on 27-29 February 2015 During an inspection of Community health inpatient services Download report PDF | 312.84 KB (opens in a new tab)
Inspection carried out on 23-27 February 2015 During an inspection of Forensic inpatient or secure wards Download report PDF | 295.83 KB (opens in a new tab)
Inspection carried out on 23 - 27 February 2015 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 480.96 KB (opens in a new tab)
Inspection carried out on 23 – 27 February 2015 During an inspection of Community health services for children, young people and families Download report PDF | 260.52 KB (opens in a new tab)
Inspection carried out on 13 February 2015, 24-27 February 2015, 4-5 March 2015, 9 March 2015 During an inspection of Community-based mental health services for adults of working age Download report PDF | 312.71 KB (opens in a new tab)
See more service reports published 19 June 2015
Inspection carried out on October 2016 to May 2017

During a routine inspection

When aggregating ratings, our inspection teams follow a set of principles to ensure consistent decisions. The principles will normally apply but will be balanced by inspection teams using their discretion and professional judgement in the light of all of the available evidence.

After this most recent inspection we have changed the overall rating to good because:

  • Following the last inspection In February 2015, the trust had implemented a comprehensive improvement plan.

  • In February 2015, we rated one of the sixteen core service as inadequate and a further two of the sixteen core service as requires improvement. At this inspection we found the trust had worked to make improvements and the trust had taken action to meet the requirement notices issued following the February 2015 inspection.

  • In February 2015, we recommended the trust should take a number of actions to improve services. At this inspection we found that the majority of recommendations had been met and improvements had been made.

  • Following the this inspection, we have changed ratings of the following key questions from inadequate to requires improvement:

  • the safe key question for wards for adults of working age and PICU

  • Following the this inspection, we have changed ratings of the following key questions from inadequate to good:

  • the responsive key question for adults of working age and PICU

  • Following this inspection, we have changed ratings of the following key questions from requires improvement to good:

  • the well led key question for wards for adults of working age and PICU
  • the effective key question for wards for older people with mental health problems
  • the caring key question for wards for older people with mental health problems
  • the responsive key question for wards for older people with mental health problems

  • Following this inspection we have changed the ratings for the following key questions from good to outstanding:

  • the effective key question for wards for people with learning disabilities or autism
  • the caring key question for wards for people with learning disabilities or autism
  • the responsive key question for wards for people with learning disabilities or autism

  • Following this inspection we have changed the rating of one core service from inadequate to good. This is the core service for wards for adults of working age and PICU.

  • Following this inspection we have changed the rating of one core service from requires improvement to good. This is the wards for older people with mental health problems.

  • Following this inspection, we have changed the rating for one core service from good to outstanding. This is the core service for wards for people with learning disabilities and autism.

  • Following this inspection the rating for one core service remains as requires improvement. This is the core service for community services for adults of working age.

  • We have not yet re-inspected the rehabilitation mental health wards and crisis services and health based places of safety. The requirement notices for these services will be checked at future inspections.

  • We also carried out a ‘well led’ review and found that the trust had continued to strengthen its senior leadership team and refine the trust governance processes.

Inspection carried out on 23 - 27 February 2015

During a routine inspection

We found that Central North West London NHS Foundation Trust was performing at a level which led to a judgement of requires improvement.

When aggregating ratings, our inspection teams follow a set of principles to ensure consistent decisions. The principles will normally apply but will be balanced by inspection teams using their discretion and professional judgement in the light of all of the available evidence.

The inspection of the trust was one of great contrast. The community health services were rated as good with the sexual health services rated as outstanding. The overall rating for caring was outstanding reflecting the individualised care provided in the community dental and sexual health services. The mental health services had three core services that required improvement. These were the acute wards for adults of working age, wards for older people with mental health problems and the community based mental health services for adults of working age.

The area of greatest concern related to safety and responsiveness on the acute wards for adults of working age which were rated as inadequate. There were however significant challenges being faced by the trust at the time of the inspection with pressures across the mental health acute care pathway.

We also found geographical differences, especially in London between the inner and outer London boroughs. The inner London boroughs were facing the greatest bed pressures for people needing acute mental health services. The outer London boroughs were facing challenges of demands for community services and difficulties in staff recruitment resulting in waiting lists. This was particularly notable in the London Borough of Hillingdon for mental health and community services.

There was much for the trust to be proud of. Most notably we found staff were very positive about the work of the trust and in most places care was delivered by hard working, caring and compassionate staff.

Two areas stood out as being very positive. The first were the opportunities given to staff for their personal development through strong support and access to training. We heard of many examples where staff had been able to extend their skills and develop their career within the trust and as a result provide better care to patients. Secondly we heard many examples of where the trust embraced innovation and change. Staff told us how new ideas were welcomed and we saw many examples of service improvements taking place.

We found the trust was well led. There was a strong leadership team who had developed an open culture where the vision and values were known and were being put into practice. At the time of the inspection the trust was implementing a new divisional structure with a greater focus on local contact. Running through this will be a new accountability structure to ensure effective communication and learning. This will hopefully lead to more robust governance processes and to staff working at ward and team level receiving the information they need to know.

We will be working with the trust to agree an action plan to assist them in improving the standards of care and treatment.

Intelligent Monitoring

We use our system of intelligent monitoring of indicators to direct our resources to where they are most needed. Our analysts have developed this monitoring to give our inspectors a clear picture of the areas of care that need to be followed up.

Together with local information from partners and the public, this monitoring helps us to decide when, where and what to inspect.


Joint inspection reports with Ofsted

We carry out joint inspections with Ofsted. As part of each inspection, we look at the way health services provide care and treatment to people.


Mental Health Act Commissioner reports

Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff.

Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We are looking at different ways to indicate the outcomes of our monitoring in the future.