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

The service provided evidence-based care and treatment in line with national guidance and measured outcomes for patients to determine the effectiveness of treatment. Treatment included medication, psychological therapies and occupational therapy support.

Staff completed a comprehensive mental health and physical health assessment of patients’ needs in a timely manner. Staff noted that the absence of an occupational therapist at the time of the inspection caused a delay in assessments. However, a new occupational therapist was due to start in January 2025. 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 with recovery goals were determined by their needs. 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. Patients were encouraged to live healthier lives. Staff encouraged patients to reduce or stop smoking and supported patients to eat healthily and take exercise.

Managers made sure staff had the necessary skills to carry out their role safely and effectively. Managers held supervision meetings with staff and annual appraisals to provide support and encourage professional development. Where clinical audits identified areas for improvement, action plans were put in place.

The ward had a weekly multidisciplinary team (MDT) meeting that staff from all disciplines attended. Staff worked together effectively to review each patient and manage their progress as well as their discharge or transfer. The team had effective daily handovers between changes in nursing shifts. Staff liaised with patients’ community care coordinators, and other wards across the hospital. Staff also communicated with social services as well as the patients’ GPs and other organisations that provided support to the patients. Where relevant staff worked with patients’ offender managers, and specialist teams responsible for managing registered sex offenders and ensuring public protection, working under the Multi-Agency Public Protection Arrangements framework.

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 completed a comprehensive mental health and physical health assessment of patients’ needs in a timely manner at, or soon after, admission. Staff noted that in the absence of an occupational therapist at the time of the inspection, this was causing a delay in assessments. However, a new occupational therapist was due to start in January 2025.

Staff used the national early warning score (NEWS) tool to monitor and manage patients’ physical health and identify any deterioration

Staff developed care plans that met the needs of patients identified during their assessments. Staff regularly reviewed patient care plans and involved the patient and their family or carer in this process when appropriate. Care plans were personalised, holistic and recovery oriented.

Staff provided a range of care and treatment interventions suitable for the patient group. The interventions were those recommended by, and were delivered in line with, guidance from the National Institute for Health and Care Excellence (NICE). This included medication, psychological therapies and occupational therapy support.

The medical team prescribed medicines to treat patients’ conditions, which were safe, effective, and evidence based and in line with the trust’s policy. For example, when doctors prescribed anti-psychotic medication, staff regularly monitored the patient’s physical health.

Clinical psychologist input included cognitive behavioural therapy, schema therapy and a regular health and wellbeing group. There were plans to start a behaviour treatment substance abuse group for patients starting in January 2025.

At the time of the inspection, there were no jobs for patients on the ward, but 1 patient was being supported to do voluntary work off the ward, and one patient was planning to undertake a college course. Patients were also supported to attend a boxing gym. Staff said that it would be helpful to have more support for patients with learning disabilities on the ward.

Patients had access to a multidisciplinary team including an activity coordinator, psychologist, and social worker. An occupational therapist was due to begin work on the ward in January 2025. There was daily cover from medical and nursing staff. The activity coordinator had received additional training to deliver therapeutic activities including supporting patients to develop their independent living skills.

Staff were appropriately qualified, experienced and had the right skills and knowledge to meet the needs of the patient group. Registered nurses and non-registered nurses received support from the psychologist to implement psychologically informed practices as part of routine care.

The trust provided new staff with a corporate and local induction. The local induction included orientation to the ward and reading various policies and procedures. There was a preceptorship programme in place for newly qualified nurses.

Managers provided staff with supervision and appraisal of their work performance and completed detailed supervision and appraisal records for each member of staff. At the time of the inspection there was 94% compliance with staff supervision on the ward, and this had remained high in recent months.

The wards had weekly multidisciplinary team (MDT) meetings that staff from all disciplines attended. Staff worked together effectively to review each patient and manage their progress as well as their discharge or transfer. There was also a referrals and admission meeting where new referrals were discussed amongst the ward managers and consultants.

Staff attended regular business meetings, and the managers supported staff to attend. Managers dealt with poor performance promptly and effectively.

The teams had effective daily handovers between changes in nursing shifts briefing all on-coming staff about each patient on the ward as well as any incidents, which had occurred.

Staff liaised with patients’ community care coordinators, and other wards across the hospital. Staff also communicated with social services as well as the patients’ GPs and other organisations that provided support to the patients. We saw examples of good joint working with external specialists regarding patients’ physical health conditions, such as diabetes and chronic obstructive pulmonary disease(COPD). A clozapine pharmacist visited the ward regularly to ensure that appropriate monitoring was in place for patients prescribed this medicine.

Where relevant staff worked with patients’ offender managers, and specialist teams responsible for managing registered sex offenders and ensuring public protection, working under the Multi-Agency Public Protection Arrangements framework.

Staff supported patients to live healthier lives if they wanted to. Staff assessed all patients for their weight and height and checked whether they smoked and or misused substances. Staff encouraged patients to give up smoking and provided patients with nicotine replacement therapy because the trust had a no smoking policy, in line with national guidance.

Staff supported patients to attend appointments for their physical healthcare and made referrals to other hospitals if they required advice or treatment about their physical health needs.

Audits of physical health recording in September 2024 indicated 91% compliance with drug and alcohol assessments, and 82% compliance with the physical health hub recording.

Staff completed a range of audits to provide assurance on regulatory compliance. For example, there were audits on the completion of risk assessments, care plans, hand hygiene, infection control, and physical health monitoring. Audits of records indicated compliance with contacting carers if appropriate (with 91% compliance at the time of the inspection) and providing accessible information (also with 91% compliance). Results of audits were discussed in handover meetings and supervision, with action plans put in place to improve performance.

A pharmacist or pharmacy technician visited the ward regularly. The pharmacist carried out a monthly audit of medicines on each ward. The pharmacist raised any concerns about the prescribing for individual patients with the doctor concerned and nurse in charge.

Staff completed Health of the Nation Outcome Scales for all patients, with the most recent audit indicating 100% compliance, although allocation of patients into valid clusters was rated at 55% at this time.

We did not look at Consent to care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.