Lack of sufficient staffing and inappropriate use of restrictive practices led to the temporary closure of a unit for children and young people at a mental health trust, after an inspection by regulators.
North East London NHS Foundation Trust, which provides services across the border areas between the capital and Essex, was overall rated as “requires improvement” by the Care Quality Commission.
“There are many areas where the trust needs to improve”
The trust was also rated “requires improvement” for being safe, effective, responsive and well-led. However, it was rated “good” for being caring following the inspection in April.
Inspectors identified a number of areas where the trust needed to improve services as a priority, said the CQC.
The child and mental health wards at the Brookside unit were a particular concern, said the CQC’s report on the trust, which was published this week.
Concerns were raised around staffing, restrictive practices, lack of incident reporting and lack of recovery orientated care planning.
Shortly after the inspection, the trust temporarily closed the Brookside unit in response to the CQC issuing a warning notice requiring significant improvements. The unit is due to reopen this month.
In future, no restrictive practices should be used in the unit, patients must not be secluded without proper safeguards and patient searches must be done according to a clear policy, said the CQC.
Elsewhere in the trust, inspectors found that risks to mental health patients were not always dealt with properly.
“We are disappointed to say the least”
The organisation had failed to ensure that the risks to patients at risk of suicide from ligature anchor points were identified, and made safe, noted the regulator.
The trust was told it must reduce the use of restraint and prone restraint, ensure mental health staff were properly trained and ensure consistent patient access to psychological therapies.
Meanwhile, major staffing shortages were identified in the trust’s community services, with recruitment challenges across all staff groups and localities.
There were high caseloads for staff, high use of agency and bank staff, all which had an impact on the delivery of the services, warned the CQC.
However, the regulator did commend the work of the trust’s diabetes team in the Essex community health adults’ service.
It had developed a number of initiatives such as providing Skype appointments and telephone assessments depending on needs, and texting blood results to spare patients an appointment.
Dr Paul Lelliott
Dr Paul Lelliott, deputy chief inspector of hospitals and CQC lead for mental health, stated that there were “many areas” where the trust needed to improve, including providing more training to staff.
“In particular, I am concerned that the Mental Health Act was not part of the mandatory training for all staff in the mental health services,” he said.
But John Brouder, the trust’s chief executive, said: “We are disappointed to say the least, given the number of service areas that were rated as good and the amount of positive feedback in the report.
He noted that CQC had rated nine of the 14 services that were inspected as “good” and that it had particularly commended the caring nature of staff.
“However, as an organisation that strives to deliver the best possible care to our patients and our belief in continuous improvement, we take on board the feedback from the CQC,” said Mr Brouder.
“We have already made significant improvements across the majority of areas highlighted in the report in the five months since the inspection and where we have not yet made the necessary improvements we have action plans in place,” he said.
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He highlighted that, in the five months since the inspection, the organisation had “made huge progress in terms of staff recruitment and retention”.
Most significantly, he said it had refurbished the Brookside unit and put a “new and innovative model of care in place for young people”.
Mr Brouder added: “I am proud of all our staff. We have a committed, dedicated workforce who want to deliver the best possible care to the patients we see.”
The trust provides community health and mental health services in Essex and across the North East London boroughs of Barking and Dagenham, Havering, Redbridge and Waltham Forest. It employs around 6,000 staff.
During the announced inspection visit from 4-8 April, and unannounced inspection on the 14 April, the inspection team visited 62 wards, teams and clinics.
Inspectors visited all of the trust’s hospital sites and a sample of community services. They inspected all adult acute services, the psychiatric intensive care unit, community hospitals, the forensic ward, health centres and older people’s wards.