Central and North West London NHS Foundation Trust

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Hillingdon Perinatal Service provided safe care. The service had enough nurses and doctors. Staff anticipated and managed risks to patients. The service was meeting their target for referral to treatment, which was 28 days.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Not all staff were clear on the process of incidents reporting or what incidents met the threshold for reporting. The service had logged 7 incidents in the last 12 months. We fed this back to the service at the time. Where incidents had taken place, staff had managed these appropriately within the service.

There were no serious incidents reported over the past 12 months. Staff explained that they would record incidents on an electronic incident reporting system. All incidents were reviewed and signed off by the service manager. Managers told us that they would investigate incidents thoroughly if needed.

Staff understood the duty of candour. They were open and transparent gave patients and families a full explanation if things went wrong.

The service worked with people and partners to establish and maintain safe systems of care, in which safety is managed, monitored and assured. The service ensured continuity of care, including when people moved between different services.

The service received referrals from several streams. Community Mental Health Teams, General Practitioner, Social Services, Drug and Alcohol services, Maternity, Health Visiting Services and various other services. The multi-disciplinary team based at the service then reviewed the information and the risk to determine whether a further assessment is required, how urgent this was, or if the referral is appropriate based on a variety of factors. Referrals received from Maternity that were assessed as urgent would be seen within 4 hours during working hours; outside of this, Maternity would contact Psychiatric Liaison. Referrals from other sources deemed as urgent or high risk would be redirected to the Single Point of Access or to Accident and Emergency, or supported by the Home Treatment Team.

The service was meeting their target for referral to treatment, which was 28 days.

Staff told us that they felt involved in discussions around referrals and admissions and that their views were taken on board. Senior leaders and staff worked collaboratively to support patients through their journey at the service.

Staff ensured that patients were only discharged when appropriate and crisis information was shared with patients upon discharge.

The service worked with people to understand what being safe means to them as well as partners on the best way to achieve this. The service concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect.

Staff received training in safeguarding vulnerable adults and children. This was in line with the Community Perinatal Mental Health Services standards which identified competencies required for all Perinatal staff. Staff compliance with safeguarding training was 99%.

Staff knew who to inform if they had safeguarding concerns. Staff would discuss any immediate safeguarding concerns with a senior manager and discuss them during risk meetings with the wider multidisciplinary team. Staff worked alongside the local authority in conducting any necessary safeguarding investigations.

Staff told us they knew how to recognise adults and children at risk of or suffering harm and worked with other agencies to protect them. Staff could give examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act 2010.

The service worked with people to understand and manage risks by thinking holistically so that care met their needs in a way that was safe and supportive and enabled them to do the things that matter to them.

Staff completed risk assessments for each patient and reviewed risk regularly. The provider used a risk assessment tool that prompted assessment of risks to the patient and any children. There was a checklist with 7 areas which prompts clinicians to review all risk factors that were systematically addressed in the assessment process.

Staff involved patients in care planning and risk assessment. We reviewed 8 patient records. We saw some evidence that risk assessments and care plans were co-produced with patients. Some of the patients we spoke to told us that they had a copy of their care plan. Some stated that they did not know what a care plan was. The service follows the “Please, write to me” guidance and the care plan is in a letter format; therefore, some patients may not be familiar with the term ‘care plan’, but would understand the plan of care/treatment.

Staff communicated with patients in their preferred communication method to ensure that they understood their care and treatment. Some patients told us that they were supported with their language barrier and supported with their language needs. Staff told us that they were able to offer easy read formats or provide letters in different languages. The provider could access interpreters, who could join meetings via telephone or in person.

Patients we spoke with were not aware that advocacy services were available, if they wished to use them. Advocacy services offer the support of someone not involved in your care to help you express your wishes and views.

As staff members used various locations, for example children’s centres, family hubs, other Trust sites, home visits and Maternity, risk assessments for those premises were carried out by the provider of that service.

The service had policies to follow fire safety practices on site. There were fire escape plans and fire action notices on wards which showed the assembly point.

Most staff told us that estates were a challenge. The service had three offices to work from, which did not provide the necessary space for all staff to work from. Staff told us that the senior leadership team was aware of the issues, and this has been put forward in several multidisciplinary meetings. Managers told us that this was something that they were currently looking at and recognise the impact this had on staff.

The service made sure there were enough qualified, skilled and experienced people, who receive effective support, supervision and development and worked together effectively to provide safe care that met people’s individual needs.

The service had enough staff to keep patients safe. The service monitored data on referrals and caseloads. Most staff told us caseloads were manageable. The service had two vacancies:1 Psychology post and 1 Occupational Therapist to cover maternity leave. The service used bank staff two days per week and had some locum medical cover for a period of 7 months last year.

The service had a low turnover rate. For the last 12 months, staff turnover for the service was (5.3%). The service had low levels of staff sickness. The sickness rate for the last 12 months was (6.7%).

The service operated on a 9-5 basis, however the service provided service users with an out-of-hours contact number for local services and a duty rota was in place.

Mandatory training

Staff had received and were up to date with appropriate mandatory training. Overall staff compliance with mandatory training was (96%). However, we found that there were gaps and outstanding training for some Type 1 and most of Type 2 perinatal specific training as per the Perinatal Quality Standards. Senior leaders told us that there was a plan in place to ensure staff receive all training required.

Skilled staff to deliver care

The service had access to a range of specialist to meet the needs of the patients at the service. The service employed a team manager, medical staff (consultant and specialist doctor), nurses, occupational therapists, nursery nurse, social worker, cognitive behaviour therapist, psychotherapist and peer support workers.

Managers gave each new member of staff an induction to the service before they started work. All staff attend a new onboarding trust induction and then location induction when they join the service.

Managers supported permanent staff to develop through yearly, constructive appraisals of their work and 97% of staff had received an appraisal in the year before the inspection. Appraisal meetings involved reviewing objectives, a review of knowledge and skills, training, professional registration, a summary of performance and setting objectives for the following year.

Managers supported staff through regular supervision of their work. The hospital’s policy stated that staff should receive managerial and clinical supervision every eight weeks. The service was completing both clinical and line management supervision every eight weeks. During supervision sessions, staff typically discussed their health and wellbeing, follow up from appraisals, workload, clinical care, training and development needs. 100% of staff had received clinical supervision and 98% of staff had received managerial supervision.

Managers made sure staff attended regular team meetings or gave them information from those they could not attend. The service held senior leadership meetings each month. During these meetings staff discussed risk management, workforce and HR updates, training and finance. The service also held weekly multidisciplinary meetings, monthly business meetings and safeguarding reflective practice.

Managers identified any training needs their staff had and gave them the time and opportunity to develop their skills and knowledge. Managers recognised poor performance, could identify the reasons and dealt with these.

The service assessed and managed the risk of infection, detect and control the risk of it spreading and share any concerns with appropriate agencies promptly.

The service had two offices at the location, no clinical work took place within the building. Staff arranged rooms elsewhere or within the service user’s home. The two officers were visibly clean, tidy and had good furnishings.

The service ensured that medicines and treatments were safe and met people’s needs, capacities and preferences by enabling them to be involved in planning, including when changes happened.

Staff followed good practice in medicines management (which included prescribing).

The service reviewed each patient’s prescribed medicines regularly and provided advice to patients and carers about their medicines. Patients’ medicines were reviewed as part of an overall review of their progress during sessions. Staff provided information about possible side-effects. Patients were involved in discussions about medicines and care planning.

Pharmacy support was available for the service. They attended two days a week for perinatal services across the five boroughs. Pharmacy colleagues provided support for clinical team in prescribing. There was no clinic on site, no medicines were kept on site. The FP20 (prescription pad) was kept safely on site in a locked safe. Only those who prescribed medication had access to this safe.