South London and Maudsley NHS Foundation Trust

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

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

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff made sure patients’ care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

We reviewed 18 care and treatment records across all 7 wards. Staff completed comprehensive mental and physical health assessments and updated these as required. Physical health assessments were conducted on admission by GPs, opticians and dentists. Diabetic eye screening was conducted by trained staff. We saw evidence of physical health concerns being identified and escalated appropriately through a referral to secondary care. Staff completed patient-reported outcomes measures (PROM) and Health of Nation Outcomes Scales (HoNOS), a framework for assessing patient’s needs and changes in these over time. Staff completed drug and alcohol screening for new patients, because they knew their patient group often presented with a dual diagnosis (combination of a mental health condition and substance use disorder). Staff recorded a summary of need for each patient.

Staff developed care plans that met the needs identified during assessment and updated these when necessary. Most care plans were personalised, holistic and recovery-oriented, with evidence of patient voice. However, some care plans on Chaffinch and Waddon wards did not consistently reflect this, with more limited evidence of patient involvement in the review process.

Some patients we spoke with described different levels of involvement with their care plans, depending on their preference. Most said they felt involved with their care and treatment, could give their views in ward rounds and were listened to. Most had been offered a copy of their care plan.

Staff identified if patients had carers they wished to involve and completed carer engagement and support plans. Where their relatives had consented to this, some carers said they were involved in the care plan reviews. Staff arranged interpreters for patients and carers and provided information in accessible formats if required.

Ward round entries were consistently recorded and demonstrated a multidisciplinary approach. They captured key clinical decisions, patient progress, and forward planning in a comprehensive manner. Most patients we spoke with told us they had regular one-to-one time with their named nurses. One-to-one nursing sessions and social work involvement were clearly documented. However, on Chaffinch Ward the quality and consistency of nursing entries varied.

Staff planned and delivered patients’ care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Staff provided a range of care and treatment interventions suitable for the patient group. The interventions were those recommended by, and delivered in line with, guidance from the National Institute for Health and Care Excellence (NICE). These included medication and psychological therapies, as well as activities to improve daily living skills.

The team included, or had access to, the full range of specialists required to meet the patients’ needs. As well as doctors and nurses, there were occupational therapists (OT), clinical psychologists, social workers, pharmacists, peer support workers, speech and language therapists, dieticians. Staff regularly met as a team.

Staff followed the trust’s physical healthcare policy and ensured that patients had good access to physical healthcare. The service had access to a dedicated GP-led physical health suite and had appointed a substantive physical health nurse. Patients accessed national screening programmes, such as cervical, breast and bowel screening. Each patient received an annual physical health review. We saw evidence of patients being referred to primary and specialist care when needed.

A wide range of psychological interventions was available, including Historical Clinical Risk Management-20 (HCR-20) assessments, eye movement desensitisation and reprocessing (EMDR), trauma-informed care, schema therapy, cognitive behavioural therapy for psychosis (CBTp), dialectical behaviour therapy (DBT), and psychotherapy. Patients we spoke with gave examples of attending psychology groups, and said they could speak to a psychologist one-to-one. Patients and carers could access systemic family therapy.​ Trained staff provided autism assessments, positive behavioural support and sensory interventions.

The care records we reviewed evidenced consistent input from the OT and psychology teams, reflecting the scope of therapeutic interventions. On Norbury Ward, access to individual psychology sessions was more limited at the time of our inspection due to staff maternity leave, however a dedicated assistant psychologist and a lead psychologist provided the required psychology input for the ward. Additionally, dedicated family therapy provision was available.

Staff assessed and met patients’ needs for food and drink and for specialist nutrition and hydration. Patients could access dieticians, and staff took a balanced approach to restricting the number of takeaways patients could order each week. Patients’ views about food on offer were mixed. Some said the variety was good and they could get snacks and hot and cold drinks. However, others shared their dissatisfaction with the quality of the food, small portions, or both. The service was working to address these concerns and invited the catering provider to community meetings. Carers’ feedback on the food was also mixed, with some saying their relatives liked it, and others that it was “not always good”.

Staff participated in audit activity at ward, directorate and provider level. Audits covered a broad range of areas including clinical safety, physical health and medicines. Central nursing and quality teams carried out additional reviews.

Managers provided staff with training opportunities to develop their skills and knowledge. For example, DBT training was provided to all Band 6 nurses, and social workers could train as Approved Mental Health Professionals (AMHP). Staff on Waddon Ward (service for men with personality disorders) ran regular training on personality disorders and led research activities in this area.

Staff worked effectively across teams and services to support people. They shared assessments of patients’ needs when they moved between different services.

Staff held regular and effective handovers, daily huddles and multidisciplinary team (MDT) meetings at ward and service level. The MDT meeting minutes showed that staff shared information effectively.

The teams had developed effective working relationships with other relevant teams within the organisation (for example, security, estates) and externally, such as local authorities, partner organisations within the South London Partnership (SLP), police, prisons, community teams and voluntary organisations. We heard how the strong working relationships within the SLP helped to ensure patients received care near their home areas, facilitating regular contact with family and friends. The service also worked in partnership with the Ministry of Justice (MoJ) and held joint learning sessions with MoJ case workers to improve their understanding of secure services.

Staff referred patients to other teams, such as dieticians and speech and language therapy, through an online referral system which they said worked well. Staff facilitated patient participation in national screening programmes through direct contact with the relevant teams. Screenings were conducted both on- and off-site, with both arrangements working effectively.

The provider’s electronic care record (ECR) system enabled the MDT to access patients’ up-to-date information. There were some limitations in this, for example the GP could not access the London-wide care record, which meant that online referrals could not be completed and had to be made via a letter instead. Additionally, there was no integration between the ECR and the physical health hub, leading to potential gaps in information.

Staff supported patients to manage their health and wellbeing to maximise their independence, choice and control. Staff supported patients to live healthier lives and where possible, reduce their future needs for care and support.

Staff supported patients to live healthier lives. The service had a dedicated smoking cessation lead. Nicotine replacement therapy was available to patients. Smoking Cessation training was mandatory for all staff and 97% had completed it.

Substance misuse was a challenging issue on the wards and both staff and patients shared their concerns about this. There was support on offer for patients, including weekly cannabis clinics, mutual aid groups and education on the legal implications of drug use. Occupational therapy supported with motivation, relapse prevention and sensory strategies. Patients could also access the local community substance misuse service.

The service had a substantive nurse who had developed and improved the physical health pathway. Staff facilitated patients’ access to national screening programmes, such as cervical, breast and bowel screening. Each patient received an annual physical health review. GP, dentist, optician and podiatrist visited the wards regularly, and access to dieticians and speech and language therapy was via a referral system.

Ward activities helped promote a healthy lifestyle for patients, depending on their individual needs and preferences. Patients could access indoor and outdoor gym facilities, yoga, badminton, football, cycling proficiency course, walking group, litter picking on the hospital grounds, and could cook healthy food. However, one patient told us that their gym referral had not been approved after 2 weeks, and we asked the managers to follow this up. Due to staffing shortages described in other sections of this report, patients on some wards reported there were not enough activities and their access to fresh air was limited.

Staff did not always routinely monitor patients’ care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of patients themselves.

Staff used recognised rating scales and outcome measures. These included Health of Nation Outcomes Scales (HoNOS), AUDIT-C (alcohol use screening), and Historical Clinical Risk Management-20 (HCR-20) assessments. We saw patient reported outcomes measures (PROM) in the care records we reviewed.

Staff used technology to support patient care, for example utilising online referral and appointment systems effectively.

However, we found that NEWS2 observations on Norbury and Chaffinch wards were not always completed in line with the prescribed frequency. In some cases, elevated scores were recorded without a corresponding narrative or follow-up action. We also identified some inconsistencies across different systems. For example, on Norbury Ward electronic food, fluid and stool charts were not consistently completed and staff told us they still used paper-based sheets. For other patients, the paper records were limited, however the electronic record showed that appropriate physical health monitoring had been carried out.

Staff told people about their rights around consent and respected these when delivering person-centred care and treatment.

The service provided care to patients detained under the Mental Health Act 1983 (MHA) and 96% of staff had completed training in the MHA.

Staff explained to patients their rights under the 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.

Staff stored copies of patients' detention papers and associated records. Staff ensured that patients were able to take Section 17 leave when this had been granted. However, some patients reported that their outdoor access was limited due to staff availability.

Patients had easy access to information about independent mental health advocacy (IMHA). The service was implementing an opt out system for advocacy, meaning that every patient would receive advocate’s support automatically, but could opt out if they did not want it. Advocates’ contact details were clearly displayed on the wards. Patients we spoke with knew about the advocacy service and who the advocate was.

The provider had a policy on the Mental Capacity Act (MCA) and deprivation of liberty safeguards (DoLS). Over 96% of staff had completed training in the MCA and 97% in DoLS. The service had arrangements to monitor adherence to the MCA and audited its application. There was a designated MCA and DoLS lead, and the trust’s MCA team offered training and drop-in consultations to staff.

Staff took all practical steps to enable patients to make their own decisions. For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis regarding significant decisions. For example, staff told us about supporting a patient at risk of financial exploitation who had the capacity to make unwise decisions.

Staff recorded patients’ consent to involve other people in their care, or whether they wished to decline this. However, one carer told us that staff had shared some information with their relative without their permission. The carer said this had caused problems between them and their relative.