Barnet, Enfield and Haringey Mental Health NHS Trust has been that it “requires improvement”, especially the need to solve a “substantial problem” with recruitment.
The Care Quality Commission rated the trust as “requires improvement” following an inspection during November and December last year.
“We expect them to address the issues we have identified”
CQC inspectors rated five of 11 core services as “good” and the forensic services as “outstanding”, but five were rated “requires improvement”.
The trust had a “substantial problem” with staff recruitment and there was a high use of temporary staff, which was affecting the “consistency of care”, warned the CQC in its latest report.
There were too few regular staff to consistently guarantee safety and quality in the acute mental health wards, the child and adolescent ward and in the Enfield health visiting services. There were also staffing problems in some other areas but these were not as severe.
In addition, the regulator noted a lack of experienced leaders and that a significant number of new or interim managers provided important support roles or directly led teams providing care.
Risk management was “variable” across services, the CQC said. In some cases, staff had not considered individual risk or updated records following specific incidents, while sometimes record keeping needed to improve.
Meanwhile, the trust did not operate lone working arrangements “robustly” in some of the community mental health services, meaning staff safety was “potentially compromised”.
Dr Paul Lelliott
Patients had absconded from mental health inpatient wards while detained under the Mental Health Act, but the incidents and the learning from them had not been addressed, according to the CQC.
Staff in acute mental health inpatient wards did not always recognise when a patient’s physical health was deteriorating and ensure they received timely input, it added.
The trust’s communication with primary care also needed to improve, both when patients were being discharged from inpatient services, and throughout their ongoing care and treatment.
Additionally, the CQC criticised the telephones and IT systems for not providing effective support to staff working in the community.
However, the inspectors highlighted there was also “much for the trust to be proud of”, praising the leadership provided by the trust’s senior team.
Most of the staff inspectors met were described as caring, professional and working “tirelessly” to support patients.
The trust was commended for working to reduce the use of physical interventions, with the use of restraint low and forensic wards making “good use” of relational security.
Staff had access to a wide range of opportunities for learning and development, which was helping many staff to make progress with their career, noted the CQC.
“We will continue to focus on these five services to ensure they match the quality of the rest of our provision”
It added that staff morale was good and most staff told inspectors how much they enjoyed working for the trust. Staff also said they felt able to raise concerns and most had done so where needed.
Dr Paul Lelliott, CQC deputy chief inspector of hospitals and lead for mental health, said: “It is clear that over the past couple of years there has been progress at Barnet, Enfield and Haringey Mental Health NHS Trust.
“Although the trust recognises there is still further progress to be made, we expect them to address the issues we have identified on this inspection,” he said, adding there was still a “great deal to do” for services to be a consistently high standard.
Dr Lelliott said the trust’s challenges were greatest in the borough of Haringey, where more improvements are needed.
In response, trust chief executive Maria Kane said: “It is important to note that just because five of our services need to improve it does not mean they are unsafe.
“We will continue to focus on these five services to ensure they match the quality of the rest of our provision,” she said.
She added: “We were already working on improvement plans for these areas and will now work even closer with our partners and with the CQC to ensure the required actions take place.”
The trust currently employs around 2,800 staff and has an annual income of about £190m.
Trust services rated by the CQC as follows:
- Forensic inpatient wards
- Wards for older people with mental health problems
- Community Health Services for adults
- Community health inpatient services
- Community health services for children, young people and families
- Community based mental health services for older people
- Child and adolescent mental health wards
- Specialist community mental health services for children and young people
- Community based mental health services for adults of working age
- Acute wards for adults of working age and psychiatric intensive care units
- Mental health crisis services and health-based places of safety