South London and Maudsley NHS Foundation Trust

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This means we looked for evidence that the service met people’s needs.

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

This meant people’s needs were met through good organisation and delivery.

This service scored 79 (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 people were at the centre of their care and treatment choices and decided, in partnership with them, how to respond to any relevant changes in their needs.

We reviewed 18 care and treatment records. Staff developed care plans to address the needs identified during assessment. Most care plans were personalised, holistic and recovery-oriented, with evidence of patient voice.

Staff we spoke with told us how they based patient care around individual needs and preferences. For example, for one patient this involved support with their personal care and physical health concerns, and for another, supporting them to engage with more activities. Staff knew which activities individual patients enjoyed.

Staff empowered patients to make their own decisions about their care and treatment. For example, staff told us that some patients did not wish to participate in physical exercise. Staff discussed alternative ways to achieve a healthier lifestyle, such as a referral to a dietician or reducing takeaway orders. Staff on Thames Ward told us that one patient recently reduced his takeaways from 2 to 1 a week.

Staff enabled patients to discuss their offences in ways that were safe for them. One-to-one psychological support and a dedicated course on safe disclosures was available.

Most patients and carers told us they felt involved with their care, could give their views and were listened to.

Staff understood the diverse health and care needs of patients and their local communities, so care was joined-up, flexible and supported choice and continuity.

Staff enabled patients to access education and work opportunities. There was an employment lead and a dedicated teacher within the service. Patients and carers we spoke with shared various examples depending on personal interests, including vocational work, education sessions, training as a peer mentor, working as an activity coordinator or at the service’s non-profit café co-run by patients and staff. Patients could access education ranging from basic skills to formal qualifications and further education. There was a range of sessions available, some led by peers or community providers, for example creative arts with the local gallery, barista training, digital suite, hairdresser and barber sessions. Staff and patients regularly engaged in joint activities such as visits to the theatre, zoo, cinema, and seaside trips. Patients and carers could contribute to quality improvement projects, research and policy, and the work of the Service User and Carer Advisory Group in this area was recently recognised by a Royal College of Psychiatry award. However, due to shortages of occupational therapy and activity practitioner staff, some patients on Norbury, Thames and Effra wards reported limited ward-based activities and feeling bored.

Staff actively supported patients to maintain contact with their families and carers. Staff identified if patients had carers they wished to involve on admission and completed carer engagement and support plans. One carer told us about their relative: “He was allowed to visit his dad in hospital and to go to his funeral. That meant a lot, we are truly grateful.” There were dedicated visiting facilities at the hospital, which had been re-designed with patient involvement.

Staff supported patients to access their chosen places of worship. Patients who could not attend those in person could access live feeds from the local mosque and online church meetings.

To help patients integrate back into the community, Recovery College had developed an 8-week course, ‘Gateway into the Community’. Staff told us about supporting patients with gradually increasing leave and introductory visits prior to discharge.

The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Staff made appropriate notifications to external bodies as required. With consent in place, staff updated carers and other relevant professionals about the patients’ progress.

Information governance systems ensured confidentiality of patient records. Staff completed training in this area, with 96% up-to-date with Information Governance training. The provider’s electronic record system provided staff and managers with accurate oversight of information relevant to their roles. However, we found that the physical health information was not always completed consistently across patient records. On Norbury Ward, food, fluid, and stool charts were not consistently completed electronically, with continued use of paper-based records. For other patients, the paper records were limited, however the electronic record showed that appropriate physical health monitoring had been carried out.

Staff arranged interpreters for patients and carers and provided information in accessible formats if required. Staff were aware of individual communication needs and for example, told us about using a poster with words and images to communicate with an autistic patient on Spring Ward.

Staff ensured that patients could obtain information on a variety of topics such as treatments, local services, helplines, their rights, advocacy and how to complain. However, on Chaffinch Ward, not all information was available in easy-read formats. On Norbury Ward, the information was displayed in a corridor off the ward. Following our feedback, staff ensured it was moved to the main ward area.

The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

Staff followed the trust complaints policy and knew how to handle complaints. During the 6 months prior to our inspection, the service received 14 complaints, 3 of which were still in progress. Of the closed complaints, most were not upheld or partially upheld, and 1 was upheld. Most complaints were about care and treatment. Leaders monitored the numbers of complaints and compliments received, themes, outcomes and lessons learnt. Complaints were a standing agenda item at ward, community and clinical governance meetings.

The 3 community meetings we attended and minutes we reviewed showed that patients raised a range of issues openly and constructively. ‘You said, we did’ feedback was displayed on the ward information boards. For example, some recent changes in response to feedback included catering, cooking and new activities.

Most patients and carers told us they knew how to complain or raise concerns, including to external bodies, although most had not needed to. Some patients said they would speak to staff or advocates in the first instance. One patient told us they had complained about not being able to customise their mattress and received feedback from staff explaining the reasons for this.

During our site visit, patients on Effra Ward shared with us a copy of their recent group complaint about the shortages of occupational therapy (OT) and activity practitioner staff (AP), discussed in other sections of this report. Leaders updated us that managers attended community meetings to agree interim resolutions with the patients. Following the complaint, the OT and AP shortages were added to the service risk register and leaders told us they were working to address these concerns.Since our inspection, we heard that full staffing had been achieved across the affected wards.

Staff made sure that people could access the care, support and treatment they needed when they needed it.

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. Staff knew how to communicate with people with protected characteristics under the Equality Act 2010, with 100% of staff having completed the Oliver McGowan Tier 1 Mandatory Training on Learning Disability and Autism.

There was adequate medical cover in place and a duty doctor could attend quickly in an emergency. Each ward had a procedure for medical emergency response and staff followed the trust’s resuscitation policy. 92% of staff were trained in Basic Life Support and 88% in Immediate Life Support.

Staff monitored and reported patient discharge data. Staff ensured patients had access to appropriate support prior to and after discharge, and involved relevant care coordinators in ward rounds. Upon discharge, patients received 3 follow-up sessions jointly with the receiving team. Staff supported patients to prepare for discharge, once clinically suitable. Most patients we spoke with said staff kept them up-to-date on their discharge plans. Carers told us they knew about their relatives’ discharge plans, where applicable, and that staff kept them informed. We heard that patients and carers participated in a quality improvement project to improve care pathways, reduce length of stay, and prevent readmissions. Although some challenges remained outside of the provider’s control, the average length of stay within the service had reduced and all patients had an estimated discharge date.

Staff and leaders were innovative in how they listened to information about people who were most likely to experience inequality in experience or outcomes. Staff and leaders actively used this information to provide exceptionally tailored care, support and treatment in response to this.

The trust had undertaken equality impact assessments of their policies and procedures to ensure they did not place people with protected characteristics under the Equality Act 2010 at a disadvantage.

Staff received training in Equality, Diversity and Human Rights and 99% were up-to-date with it. Staff we spoke with thought the service was open and inclusive for diverse groups of people. We observed inclusive practice on the wards, for example LGBTQ+ support information was clearly displayed. The trust had a protocol for supporting transgender and non-binary people, and monitored the outcomes and experiences of this patient group. Staff on Spring Ward supported a transgender patient safely, kindly and respectfully.

Staff within the service and the wider organisation promoted a culture in which the people using the service were empowered to give their views. Staff sought to improve and develop services by engaging views of people with lived experience and partner agencies. Recovery College peer trainers co-produced and co-delivered training focused on integrating back into the community. The peer trainers were recently shortlisted as finalists in the outstanding leadership category at the National Lived Experience Awards.

The Service User and Carer Advisory Group (SUCAG) was a structured group who advised on internal and external service improvements aimed at reducing inequalities. The innovative work of the Group was recently recognised by a Royal College of Psychiatry award for patient and carer outstanding contribution to psychiatry. Patients participated in police partnership work, Black Lives Matter Forum and Patient Carer Race Equality Framework (PCREF) to reduce inequalities in services. The role of SUCAG was embedded in the PCREF work. PCREF items were co-produced with SUCAG and added to patient rated experience and outcomes measures (PREOM), so that equity in experiences and outcomes could be routinely monitored.

Patient involvement had enabled the launch of the White Ribbon within the service, an initiative to end male violence against women, contributing to the trust’s accreditation as a White Ribbon organisation.

Staff supported people to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Staff supported patients to make decisions about their care and treatment and their future. Staff and peer support workers promoted Advanced Choice Documents and supported patients to complete and share these. Advance Choice Documents record the person’s preferences in receiving care when acutely unwell.

Staff ensured all relevant healthcare professionals and other relevant services were involved in planning the care and treatment of people with complex needs.

Staff created personalised care plans to account for the patient’s needs, wishes and feelings. Most care plans were personalised and holistic, with evidence of patient voice.

Most patients and carers we spoke with said staff kept them up-to-date on the discharge plans. One patient told us: “Staff talk to me about my future at a supported living home”.