South London and Maudsley NHS Foundation Trust

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• 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 comprehensive assessment, we rated this key question good. At this assessment, the rating remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

People who used services were supported by multi-disciplinary teams and we saw skilled staff working well together. The trust had done well to increase the quality and consistency in care planning.

Improvements were needed in one area. This related to staff not consistently completing and recording physical health observations as they should. This meant there was a risk they might not identify patients who were deteriorating.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff assessed the physical and mental health of all patients on admission, but evidence shows some shortfalls in the recording physical health observations.

We looked at 44 care and treatment records across the trust.

Staff assessed the physical and mental health of all patients on admission. They developed individual care plans with patients, which were reviewed regularly through multidisciplinary discussion and updated as needed. We found that 1 example where a patient did not have care plans in place for substance misuse concerns, which they should have done. The trust had done well to increase the quality and consistency in care planning and should continue with this work.

We found inconsistencies in how physical healthcare was reviewed and managed. Whilst we saw that staff routinely supported access to interventions such as blood tests and electrocardiograms, we found inconsistency across wards in how staff completed national early warning score (NEWS) charts. On 3 of the 11 wards, 12 of 35 NEWS charts had not been completed. This meant there was a risk that staff were not following up any physical health needs as quickly as possible when concerns were identified. This is a breach of regulation 12 Safe care and treatment.
 

Evidence shows a good standard of care. The service planned and delivered people’s care and treatment with them, including what is important and matters to them and in line with legislation and current evidence-based good practice and standards. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.

Staff provided a range of care and treatment suitable for the patients in the service, consistent with national guidance on best practice from the National Institute for Health and Care Excellence. Doctors prescribed medicines appropriately with input from clinical pharmacists to ensure that national guidance was followed.

The ward teams had access to a range of specialists required to meet the needs of patients, including doctors, nurses, psychologists, and occupational therapists. Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group.

Psychologists provided assessments and therapy for patients and psychological approaches included a trauma-informed approach, dialectical behaviour therapy (DBT), and eye movement desensitisation reprocessing (EMDR). All wards had a 0.5 whole-time equivalent psychologist post, other than Lucas Ward, which was part of a pilot of increased psychology input. Lucas Ward had 4 psychologists. They spoke about the positive impact of having the opportunity to work with patients individually.

Occupational therapists provided a timetable of activities and support with activities of daily living.

Staff ensured that patients had access to specialist input when required. We saw examples of referrals being made to podiatry, diabetes nurses, and speech and language therapists. The trust had implemented physical health nurse specialists to work as part of the multidisciplinary team, providing physical health advice. The aim was to improved patient outcomes and reduce pressure on emergency services.

We observed effective staff handover and safety huddle meetings. There was a visible presence of staff from the multidisciplinary team on the wards and in multidisciplinary team meetings. A range of staff contributed to risk assessments and care plans and psychologists facilitated reflective practice sessions for staff.

Each ward had a timetable of activities available to patients. Some patients said they would like more activities. Activities available to patients included music groups, art groups, relaxation and film nights. On Eileen Skellern Ward 1, patients could access gym equipment, have massages and participate in a smoothie group, Zumba and karaoke. Lucas Ward did have an activities coordinator and provided a more varied timetable of activities for patients. Amongst other groups, they provided a ‘tree of life’ group co-facilitated by a person with lived experience of mental health difficulties.

Staff took part in clinical audits across the service to check the quality of record keeping, including care plans, risk assessment and physical health. The results were shared with the ward managers and matrons, who shared the findings and necessary action with staff in team meetings or individual supervision. Other audits included clinical safety, environment, infection control, physical health monitoring and restrictive practices.

Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge. Managers provided new staff with appropriate induction. This induction included time to shadow staff on the ward.
 

Staff held regular and effective multidisciplinary meetings, safety huddles, and handovers. Managers made sure staff attended regular team meetings or gave information to those who could not attend.

Staff shared key information to keep patients safe when handing over their care to others, internally or externally.

The wards had effective working relationships with teams outside of the organisation. We saw communication with GPs, emergency departments and community teams. Community teams were invited to ward rounds. We also saw ward staff communicating with housing and care homes to support patient discharges.

The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and, where possible, reduce their future needs for care and support.

Staff supported patients to engage with activities for supporting healthier living. For example, accessing nicotine replacement therapy and support with smoking cessation. Staff discussed healthy foods and activities. Patients were able to always access the garden and were provided with sunscreen on hot sunny days as appropriate.

There were dual diagnosis practitioners who worked across the trust to support patients with substance misuse and recovery. These staff supported people on the wards, through discharge and maintained links with acute alcohol and dependency services and community networks. Patients were referred to the dual diagnosis team as soon as their needs were identified. The practitioner also facilitated group activities with patients, including educational sessions and access to online support groups. This ensured early intervention, continuity of care, and wider recovery support for patients with complex needs.

We saw evidence of staff using recognised rating scales to assess and record severity and outcomes. We saw evidence of the use of Health of the Nation Outcome Scales (HoNOS) in patients’ care records to monitor patient outcomes. On occasion, occupational therapy staff used the Model of Human Occupation Screening Tool (MOHOST).

The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff supported patients to make decisions on their care for themselves. They understood the trust policy on the Mental Capacity Act (MCA) 2005 and assessed and recorded capacity clearly for patients who might have impaired mental capacity to make specific decisions. When staff assessed patients as not having capacity, they made decisions in the best interest of patients.

Staff were trained in the Mental Health Act (MHA) and its Code of Practice and knew how to contact the MHA administrators for support. Patients had access to information about independent mental health advocacy.

Section 17 leave (permission to leave the hospital) was agreed with the Responsible Clinician as appropriate.