Central and North West London NHS Foundation Trust

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

This means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect.

Patient feedback about staff was mixed, with some being very positive and some saying they did not always feel they had been treated well and with dignity. The trust had been working to improve culture around patient interaction and on some wards we saw positive, frequent patient staff engagement. Most patients, and where appropriate, families, were involved in discussions about care and were asked for feedback. Patients had access to independent advocates.

The trust recognised the importance of staff wellbeing and made efforts to support this at a local and organisational level through different initiatives. However, some sites did not have sufficient spaces for staff to take their breaks off the ward.

At our last assessment, published in June 2019, we rated this key question Good. At this assessment the rating has changed to Requires Improvement.

This service scored 60 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Patient feedback about staff was mixed, but patients reported the majority of staff were kind, thoughtful and supportive. Some patients described staff as amazing, helpful, hands on and polite.

Across all wards, patients described a lot of staff as kind and helpful. On some wards patients said some staff were dismissive and rude. At the Campbell Centre and St Charles, some patients said they did not feel like they'd been treated with respect or dignity by all staff.

Feedback from carers and relatives was generally very positive. Carers said staff were friendly, cared about patients and did their best for them.

The trust had been working to improve culture around patient interaction and some patients and relatives across the sites noted a positive change over time. The trust had asked Healthwatch to support patient engagement and feedback on Willow Ward and 83 patients had attended sessions with the patient engagement coordinator and peer support worker.

The trust collected feedback from patients about their care. Ten of 18 wards had 80% positive responses or higher. Four wards, across 4 sites, had between 45% and 56% positive responses.

At St Charles, some clinic rooms were too small for physical health observations so staff did these in communal areas. The Trust was taking steps to resolve this by building new clinic rooms. In the interim, patients were offered the choice to have their physical health observations in their individual bedrooms or communal areas.

During the inspection we saw patient engagement and interaction varied across sites. We saw more frequent engagement at Riverside and Northwick Park and several patients here told us that staff made efforts to engage with them with conversations, do activities and answer questions and medicines. Engagement we did see was positive, friendly and supportive. Staff talked about patients in a respectful, caring and compassionate way during meetings.

Staff considered relevant protected equality characteristics and individual needs.

Services were accessible for disabled patients.

Staff ensured that patients could obtain information on treatments, local services, patients’ rights, how to complain and so on, in an accessible form.

Staff ensured that patients had access to appropriate spiritual and religious support, which they asked about on admission. Most sites had a pastoral care team who could come to the wards and had leaders from different faiths. This was not available to patients at the St Charles site at the time of inspection.

Patients had a choice of food to meet the dietary requirements of religious and ethnic groups and to account for allergies and intolerances. Services planned for religious events and mealtimes and medicines could be adjusted to accommodate periods of fasting.

We saw some wards had created information boards to share how lesbian, gay, bisexual and transgender (LGBT+) patients would be welcomed and supported on the ward. These were bright, engaging and informative. We saw on Danube Ward that staff took care over updating and making patient information boards engaging. At Riverside, one staff member told us how they intervened in an incident of discrimination and what action was taken to support those involved.

Although staff could provide information to patients in other languages, it was not clear how the service supported people whose first language was not English to engage in one-to-one sessions with staff and have a full understanding of their care documentation. Staff recognised that it could be challenging to get hold of an in-person interpreter, and they sometimes used technology to support conversations with patients in meetings. For one patient, we saw challenges in having an interpreter available meant ward round discussions were delayed. Two relatives said engaging patients whose first language was not English could have been managed better.

Staff involved patients in discussions about their care. Patients had access to independent advocates. Staff informed and involved families and carers.

Staff involved patients in discussions about their care and all patients we spoke with were aware of ward rounds and most said doctors were supportive and helpful in these meetings. We saw some records included patient views and feedback, but not all. At St Charles, patients told us they could fill in questionnaires before ward rounds if they wished, although they would have liked support from staff to complete this. Advocates told us they observed patients were involved in their care.

Not all patients were aware of their care plan or had a copy. Some patients were aware of a care plan being in place but did not want a copy.

The trust employed lived experience peer support workers. They were available to engage with and support patients, observe patient care and give feedback to staff and be involved in staff training. Feedback from staff and patients was very positive about these roles and the activities they supported.

The trust employed a patient and carer engagement coordinator who had developed initiatives to gather more feedback from carers in order to improve services.

Families and cares told us most staff were very good and looked after their relative well. Several relatives said doctors were very good, approachable, caring and informative during meetings. Relatives said that staff cared for their patients, got to know them, and created a good, friendly atmosphere on the ward. Other people said staff were very dedicated to patient care and were really brilliant.

Relatives said visits to the ward were supported and facilitated well. Some relatives said a dedicated visiting space would mean more relaxed experience. One relative at Park Royal said staff were sometimes unclear around the visiting process, which could cause delays.

There was a variation in how much patient voice was included in individual care plans. We observed during handover and other clinical meetings that staff were generally aware of individual patient needs.

Feedback from some patients, relatives and staff was that more access to the garden spaces would be helpful. Patients said they could not access fresh air in the garden as freely as they would like, as it depended on staff availability. We observed that some wards were not well ventilated and communal areas could become hot.

The trust had policies and procedures in place for searching patients or their bedrooms. At an inspection of the Campbell Centre in April 2023, we asked the trust to ensure patients were searched in a place that upheld their privacy and dignity. During this inspection, we saw staff used a private area and searches were done by a nurse and healthcare assistant. At Park Royal we saw some patients were still searched in a public area. The trust should ensure practice is consistent across sites.

We saw there were several areas across wards that needed attention, and there was a trust wide maintenance team and programme of work in place to support this.

On Frays Ward, there was graffiti for a discriminatory nature on the wall in a patient bedroom, that staff had not identified. On Pond Ward, the TV in the patient lounge had been broken for two weeks. Across all sites, we noted garden areas were not well kept, with some overgrown plants.

The provider recognised the importance of staff wellbeing and made efforts to support this at a local and organisational level through different initiatives. There were some areas where more focus was needed. Not all wards had a staff room or suitable space away from the nursing office where staff could take their breaks. Staff said this had an impact on wellbeing and also created a challenge when patients wanted the attention of staff visible in the nursing office, but who were attempting to be on their break. At the Campbell Centre, a small number of staff said the day-to-day experiences of ward staff were not always clearly understood by senior staff and that they could have had a more supportive approach.

Staff told us they felt respected, supported and valued by their line manager and their colleagues. They described working in good teams with an understanding manager who discussed decisions relevant to the wards. One staff member described her colleagues as dedicated, passionate and compassionate.

Staff said there were processes and policies to challenge and deal with racial discrimination from patients and received support from managers and the trust around this. Staff had the option to report incidents to the police and explore working on other wards

Staff across the sites told us there had been a lot of work and a positive change in culture to improve patient engagement and staff and patient experience.

The provider recognised staff success within the service – for example, through staff awards.

Staff appraisals included conversations about career development and how it could be supported.

Staff had access to support for their own physical and emotional health needs through an occupational health service.