South London and Maudsley 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.

At our last inspection we rated this key question good. At this inspection the rating has remained good.

This meant people were supported and treated with dignity and respect; and involved as partners in their care.

This service scored 80 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff consistently treated people with kindness, empathy and compassion and respected their privacy and dignity. Staff treated colleagues from other organisations with kindness and respect.

We spoke with 27 patients and 16 relatives/carers of patients across all 7 wards.

Most patients described staff very positively. They said they treated them with kindness and respect, were polite, understanding, caring, friendly and remained professional even when handling high intensity situations. They described staff as supportive and non-judgmental. One patient said: “They give a 10/10 service to patients”. However, 2 patients said staff sometimes ignored them.

Carers’ feedback about staff was also positive. Carers described staff as kind, welcoming, attentive, friendly and respectful in their interactions with them and their relatives.

We observed positive, calm and relaxed interactions between staff and patients on the wards. Staff attitudes and behaviours when interacting with patients showed that they were discreet, respectful and responsive, providing patients with help, emotional support and advice at the time they needed it. In the meetings we attended, discussions were conducted in a respectful and appropriate manner, reflecting a positive and collaborative atmosphere.

Staff we spoke with discussed patients with kindness, compassion and empathy and were aware of their individual needs. For example, staff spoke kindly and respectfully about a transgender patient and used their preferred pronouns. Staff supported patients to maintain activities they had an interest in.

Staff supported patients to understand and manage their care and treatment. This was through informal support, ward rounds, meetings with medical staff, psychologists and occupational therapists. Most patients said they had regular one-to-one sessions with their named nurses.

Staff directed patients to other services when appropriate and, if required, supported them to access those. For example, staff told us about supporting patients to explore their health concerns with external services and putting them in touch with solicitors.

Staff maintained the confidentiality of information about patients. However, the patient bedroom windows on Chaffinch Ward were overlooked by public areas and compromised privacy. On the same ward, the patient search room lacked internal blinds, allowing visibility during searches. Although external windows were fitted with blinds, these were raised during a search we observed, further compromising privacy. We raised these concerns with the leaders, who responded promptly by fitting a blind to the search room and started a consultation with the patients about improving privacy in the bedrooms.

Staff treated people as individuals and were exceptional in how they made sure patients’ care, support and treatment met their needs and preferences. Staff took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

Staff made individual adjustments for patients, taking into account their needs and preferences. Staff described which activities individual patients liked and demonstrated they knew the patients well. Patients and carers we spoke with said the staff understood and supported their individual needs.

The premises were fully accessible for people with mobility needs. Patients with additional needs had personal emergency evacuation plans (PEEPs). Staff arranged interpreters for patients and carers and provided information in accessible formats if required. They knew about communication needs of people with protected characteristics under the Equality Act 2010 and 100% of staff had completed the Oliver McGowan Tier 1 Mandatory Training on Learning Disability and Autism. Although there were issues outside of the provider’s control with availability of Tier 2 of this training, staff could access a range of training resources on learning disability and autism through the trust and external organisations. Trained staff provided autism assessments, positive behavioural support and sensory interventions.

There was a wide range of information displayed on the ward notice boards, including independent advocacy, interpreter services, chaplaincy, trauma, risks of substance use, safeguarding, LGBTQ+ support, and least restrictive practice.

Staff recorded patients’ demographic and ethnicity data and knew the unique characteristics of the patient groups they supported. These were characterised by high levels of deprivation, history of trauma and substance misuse. Black British people were overrepresented among the patient group. Patients could be involved in the Patient and Carer Race Equality Framework (PCREF) work aimed at reducing inequalities in NHS services. A joint Black Lives Matter forum for patients and staff was held monthly. A wide range of therapeutic and psychological interventions was available, including trauma-informed care and support with substance use.

Patients had a choice of food to meet their dietary requirements in line with their religious and cultural needs, as well as allergies and intolerances. Feedback from patients around this was mostly positive. One patient told us that staff supported him with fasting. Carers’ feedback was positive overall and some told us about their relatives’ dietary needs and preferences being met.

Staff ensured that patients had access to spiritual support and there were multi-faith and prayer rooms available. Patients told us about regular pastoral visits. A carer told us their relative could access Christian meetings online. Muslim patients could access a live feed from the local mosque. We heard that previously there were some challenges in organising faith leaders’ visits, and staff had worked to improve this. The service recognised that spiritual support was an area for further improvement and had started collaborating with a local Islamic centre to strengthen this provision.

Staff were aware of the unique needs of women within the service and were planning further work on improving female-only space provision and supporting autistic women on the wards. There were dedicated care packages and groups for carers. Carers were positive about this offer. One said: “They give you space to talk and offload.”

Staff promoted patients’ independence, so they knew their rights and had choice and control over their own care, treatment and wellbeing.

Staff involved patients in planning and reviewing their care and treatment. Patients could request to work with male or female staff. Most patients we spoke with told us they were involved in their care and treatment and were offered a copy of their care plan. Most patients and carers said staff had provided enough information about theirs or their relatives’ medicines. A project to involve patients in chairing their own care programme approach (CPA) meetings and medication reviews was ongoing, with the aim of promoting autonomy and engagement.

Staff supported patients to maintain relationships and networks that were important to them. Patients could involve family and friends in their care, or decline this if they preferred.On the medium secure wards, patients had access to telephones and supervised access to the internet. On Chaffinch (low secure pre-discharge ward), patients could have independent access to smartphones and internet, to promote their independence and digital inclusion in preparation for discharge.

Most restrictions in place were proportionate to maintain a healthy and safe environment.

Staff spoke about involving patients in decisions about their care, based on their individual needs and preferences. Staff supported patients to complete Advance Choice Documents (preferences in receiving care when acutely unwell) to promote their autonomy.

There were activities, training and work opportunities on offer aimed at improving daily living skills. Chaffinch Ward provided flats for patients nearing discharge to prepare them for independent living. Patients received a weekly shopping allowance and could prepare their own meals.

Staff explained to patients their rights under the Mental Health Act (MHA) and documented this in a timely manner. However, Section 132 rights for 3 patients on Norbury Ward were not consistently documented as reviewed at the required intervals.

Comprehensive information on support for patients and carers was available. Staff ensured that patients could access independent advocacy easily. Patients we spoke with knew about the advocacy service and who the advocate was.

Staff listened to and understood patients’ needs, views and wishes. Staff responded to patients’ needs in the moment and acted to minimise any discomfort, concern or distress.

Staff were aware of patient-specific risk issues and planned for these accordingly. For example, staff told us about adapting their approach for an autistic patient who found bright lighting and noises challenging.

Staff identified and responded to changing risks to, or posed by, patients. The use of restraint on the wards was rare. Staff used de-escalation techniques effectively to reduce the need for physical interventions when patients’ behaviours became heightened. A carer said: “Staff are so good, they recognise when my relative is getting stressed”. Most patients we spoke with told us they had not been restrained. One patient shared an example of being restrained, but said that staff “did it properly and normally they calm down the situation by speaking with the person”.

When patients reported physical health concerns, staff responded promptly and arranged appropriate follow-up. For example, staff told us about taking a patient to hospital recently for a tooth extraction.

We saw staff always present in the communal areas and engaging with patients. We observed staff responding to patients’ requests promptly. Most carers’ feedback indicated that staff were responsive to them and their relatives. One told us: “Twice I have been worried and told the ward, and both times the doctor called me back.”

The provider cared about and promoted the wellbeing of their staff, and supported and enabled staff to always deliver person-centred care.

Staff we spoke with told us they felt respected, supported and valued. Staff said they felt positive and proud about working for the provider and their teams. They spoke with compassion about the patient group they supported.

Staff had access to support for their own physical and emotional health needs through the employer’s wellbeing offer. This included post-incident support, reflective practice, counselling, occupational health and themed wellbeing events. There were dedicated support groups for staff from minoritised backgrounds. Teams had nominated wellbeing advocates. The forensic service staff had access to the hospital gym when not in use by patients, yoga, badminton, walks and regular social events on the wards. Staff wellbeing folders on the wards included information about topics such as eating and sleeping well, menopause and stress management.

Staff could participate in staff forums and give feedback through surveys. The provider recognised staff success within the service, for example through ward and staff awards and long service awards. There were joint events for staff and patients, such as annual achievement awards, sports competition and a barbecue.

Staff appraisal and supervision records included conversations about health and wellbeing and personal development. Staff said they found this process helpful.