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

This was a focused inspection of the practice around use of force at The Campbell Centre. The overall scoring for Safe is taken from the comprehensive inspection of Acute and PICU wards, which took place between August and October 2024, across 18 wards.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

During an inspection of the Campbell Centre in September 2024, we identified examples of excessive use of force used during restraint and took enforcement action with the trust around this. During this focused inspection, we found the trust had introduced processes to identify and end this practice.

During this inspection we found that staff were using an appropriate and proportionate amount of force during a physical restraint, in line with trust policy. We found that staff were up-to-date with Therapeutic Management of Violence and Aggression (TMVA) training. Staff reported incidents accurately with sufficient detail, within appropriate timescales.

Managers had a clear commitment in minimising excessive use of force in the service and learning was being embedded on the appropriate use of force used during physical interventions and managing incidents. The service had considered and made changes to the leadership structure with an aim for it to be clearer and more accessible, to support this change. Since our last inspection, we saw that staff were more proactive in de-escalating situations before they led further escalation, using de-escalation techniques more frequently and developing this practice with the support of the safety team. Staff were able to describe examples of where they used verbal de-escalation more regularly than they had before. Patients told us they felt safe on the ward and there were enough staff on the wards. We were assured that processes to address excessive force were effective and at the time of inspection, patients were not subject to excessive use of force in the service.

Managers had introduced a process to evaluate each physical restraint that had taken place, whether it was done appropriately and proportionately and identify any learning. The review included looking at CCTV footage of every reported incident of restraint and holding a post incident Swarm huddle. A Swarm huddle is where staff, immediately after an incident, get together to analyse what happened, how it happened and how to reduce ongoing risks. The incident was then reviewed by the divisional quality governance team to ensure all appropriate paperwork in relation to the CCTV review and Swarm were completed before being signed off. We reviewed 9 patient care and treatment records and found that all incidents, including physical restraint, were reported accurately and appropriately. Patient debriefs were recorded in patient notes in detail after an incident. Staff had escalated appropriate safeguarding concerns, citing the reference number where a referral to the local authority had been made. All incidents from the last 24 hours were reviewed at a morning safety huddle meeting and discussed in the monthly staff meeting. We also reviewed CCTV footage of incidents of physical restraint. The trust had recognised the strengths of the methodology used to identify and address the issue, and was sharing this internally and externally to improve practice in other services.

The service had received support and input from the trust’s physical intervention team, who visited the site regularly to deliver training and support. This included live training simulation training on managing violence and aggression in patients, support for staff and weekly teaching sessions to upskill staff in de-escalation techniques. The service had introduced a quality improvement project to improve the physical intervention process and quality of de-escalations within the service. This promoted ideas to increase engagement and reduce the number of physical interventions, such as offering more 1:1 activities with patients, obtaining structured feedback from patients after a physical restraint and ensuring that the MDT doctors were based on the ward. Another change idea had been permanently embedded, ensuring that staff had daily safety huddles to discuss patients with the highest risks. Staff had recorded positive outcomes from the quality improvement project so far, noticing a decline in the number of restraints over the last 6 months.

As this was a focused inspection, we did not inspect the areas of improvement identified in the comprehensive inspection of Acute and Psychiatric Intensive Care Units that took place in August to October 2024. The findings from that inspection were published on 14 July 2025.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe and effective staffing during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.