Oxleas Foundation NHS Trust, a well regarded mental health and community provider, has been rated as “requires improvement” by Care Quality Commission inspectors who found patients forced to sleep on sofas due to lack of available beds.
Following the inspection in April, the trust was rated as “good” for being effective, caring and responsive to people’s needs, but as “requires improvement” in both the safe and well led domains.
“A number of patients had to wait on sofas and mattresses until a bed became available”
The organisation, which is generally well regarded, provides a wide range of mental health and community care services across South East London, and into Kent.
Staff at the trust told the CQC team that patient numbers had put services under intense pressure. On three occasions the pressure for beds meant that patients were obliged to sleep on sofas or mattresses for one night until a bed became available.
Over-flow beds known as “surge beds” were used daily, with records showing that some patients remained in the surge bed for between two days and a week.
Pressure for beds was so intense that beds for patients on leave were sometimes used for new admissions. Staff were also obliged to move patients between wards and locations to accommodate new admissions.
The CQC’s report on the trust, which was published today, stated: “In the mental health acute care wards, it was clear that problems with patient admissions and the management of beds need to be addressed.”
“The pressure on mental health beds has been widely recognised”
Trust chief executive Ben Travis said: “The pressure on mental health beds has been widely recognised and the CQC report acknowledges that we have been seeking solutions – but highlights that more needs to be done and we are committed to solving this issue.”
Further concerns were raised by the CQC about safety. For example, some wards had fixtures and fittings that people at risk of suicide could use as a ligature anchor point. These potential risks had not been adequately assessed and addressed, the CQC report said.
CQC flags intense bed pressures at mental health trust
Nor did the seclusion room on one of the wards meet the guidance set down by the Mental Health Act Code of Practice, the regulator’s report noted.
Mr Travis said: “Ligature assessments are already carried out in all areas in our mental health units where patients may be alone and we remove, or manage, all ligature risks in these areas. However, we have now carried out ligature assessments in all communal areas of our inpatient units and will be extending this across our buildings where our community health mental health teams are based.”
However, the CQC report also found much to praise, highlighting that the trust “can be proud of many of the services that it currently manages”. “Staff were caring and patient focused with a good understanding of their individual needs,” it said.
”In the community learning disabilities service, which we rated outstanding for caring, we observed a culture that was always person-centred, with highly motivated staff. Staff supported people in innovative ways to be active and equal partners in their care,” it added.
Professor Edward Baker, CQC’s deputy chief inspector of hospitals, said: “Overall, Oxleas has a team who are providing care to a large geographical area with a diverse population. While we found many examples of good practice, there are a number of areas where improvements must be made.
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“In the mental health acute care wards, it was clear that problems with patient admissions and the management of beds need to be addressed. A number of patients had to wait on sofas and mattresses until a bed became available,” he said.
“At the time of inspection, CQC found that the trust had not adequately dealt with ligature points that can pose a danger to people at risk of suicide. When we visited the trust’s places of safety, CQC found that some areas were not fit for purpose and had several ligature points exposed,” he added.
The trust’s previous chief executive Stephen Firn retired from the post in the spring and took up a part-time national role with NHS England.