- SERVICE PROVIDER
South London and Maudsley NHS Foundation Trust
This is an organisation that runs the health and social care services we inspect
Assessment report published 8 July 2025
Contents
Ratings - Forensic inpatient or secure wards
Our view of the service
The Ward in the Community is part of the forensic service provided by South London and Maudsley NHS Foundation Trust. It is a low secure ward on the Lambeth Hospital site, providing rehabilitation for up to 13 male patients. There were 11 patients on the ward at the time of the inspection.
We visited the service with 30 minutes notice on 26 November 2024. During the visit we spoke with 2 patients, 6 staff members including registered nurses, an activity practitioner, a social worker and a clinical psychologist. We reviewed 3 patient records, looked at the ward environment and medicines storage and administration, and attended a staff handover meeting. Following the inspection we spoke with 2 carers/relatives of patients on the ward, the ward manager and responsible clinician.
Staff had completed individual structured patient risk assessments and kept these updated. The ward environment was clean and appropriately maintained. Staff were generally up to date with their mandatory training. They had received training in safeguarding and knew how to make appropriate referrals to the local authority safeguarding team. We saw appropriate examples of learning from incidents, and actions being put in place to prevent recurrence. All staff we spoke with, were aware of incidents that had taken place in the last year. Incidents were discussed at handover meetings, in team meetings and supervision sessions and regular bulletins were distributed to highlight recent incidents and learning.
Although there were processes in place, oversight by managers of staffing numbers on the ward at weekends, was not sufficient prior to the inspection, to ensure the safety of patients and staff. There was insufficient monitoring of compliance with the trust policy on patients absent without leave, including recording around decisions made when a patient subject to restrictions did not return from leave on time. This was a breach of regulation 17(2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following the inspection, the provider indicated that the clinical application of this policy had been reiterated to the clinical team.
The service engaged and involved patients in the care they received. For risks identified, patients had care plans in place to address these. However, in 2 cases of patients with physical health conditions, the medicines specified in the care plans were not up to date. Staff ordered, stored, dispensed and disposed of medicines safely. There had been no incidents of restraint or rapid tranquilisations in recent months.
The service provided evidence-based care and treatment and measured outcomes for patients to determine the effectiveness of treatment. Treatment included medication, psychological therapies and occupational therapy support. Staff used the national early warning score (NEWS) tool to monitor and manage patients’ physical health and identify any deterioration. Care plans were personalised, holistic and recovery oriented.
Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They supported patients to make decisions about their care and encouraged patients to live healthier lives. Managers made sure staff had the necessary skills to carry out their role safely and effectively. Where clinical audits identified areas for improvement, action plans were put in place.
Staff worked together effectively to review each patient and manage their progress as well as their discharge or transfer. Staff liaised with patients’ community care coordinators, social services, patients’ GPs and other organisations that provided support. Where relevant staff worked with patients’ offender managers, and specialist teams responsible for managing Registered Sex Offenders and ensuring public protection.
Patients reported that staff treated them well and described staff as caring and supportive. Carer feedback was very positive, indicating good involvement in patients’ care when possible, and welcoming, and professional staff.
Managers were accessible to patients and staff. The governance system ensured that senior managers and clinical leaders had sight of most areas of practice requiring improvement. Managers had good access to information about the performance of their ward. Staff, patients and carers had the opportunity to give feedback on the service, and the ward was involved in quality improvement projects to improve the service.
As part of the trust modernisation programme, the Ward in the Community was scheduled to relocate to the Bethlem Royal Hospital. Some staff expressed concerns about the forthcoming move, and how this would affect them.
People's experience of this service
We saw staff engaging positively with patients on the ward during the inspection. Few patients wanted to speak with us, but those who did told us that staff were caring and helpful. They described being able to take their agreed leave when they wanted to, and activities that they enjoyed including playing on the PlayStation, accessing a bike and a skateboard, and access to cultural meals of their choice.
Staff demonstrated a good knowledge and understanding of patients’ individual needs.
Carer feedback was very positive, indicating good involvement in patients’ care when possible, and welcoming, approachable, and professional staff.