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Midlands trust warned over 'unsafe' mental health wards

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Eleven-month waiting lists, high levels of restraint and out of date medicine have been experienced by patients with mental health conditions at an NHS trust in the Midlands, an inspection has revealed.

A Care Quality Commission inspection of Coventry and Warwickshire Partnership Trust, which provides inpatient and community mental health and learning disability services, found that some of its hospital wards “did not provide a safe environment”.

High numbers of empty posts – including a 24% vacancy rate for community nurses working in child and adolescent mental health services – were also a concern at the trust, which was rated by the CQC overall as “requires improvement”.

Across two hospitals and one community centre that was reviewed, the organisation was criticised for:

  • Patients being subjected to a continued “high level of use” of face-down restraint and a lack of a follow-up safety checks by doctors, despite the CQC warning the trust about its concerns in 2014.
  • An “unacceptable number of ligature risks” on its acute wards, compounded by blind spots where staff could not observe patients.
  • Using bottles of medication that were out of date and leaving drugs unsecured around people with learning disabilities, breaches that staff “could not account for”.
  • Long waiting times to access community services, with 117 young people waiting 6-11 months to access treatment from CAMHS and a further 138 waiting up to 24 weeks.

The inspection, which took place in April, also found multiple incidences of poor record keeping, with patients not being told of the right to an independent mental health advocate or automatically being referred to one if they were found to lack mental capacity.

High levels of staff vacancies were noted across the trust. In addition to CAMHS nurse vacancies, inspectors found 18.5% of staff posts empty on mental health learning disabilities wards.

”We have done an immediate comprehensive audit and moved very quickly on anything that might pose a risk [to patients]”

Simon Gilby

Meanwhile, acute mental health wards filled more than 2,500 shifts with bank and agency staff in the last year.

The CQC did however praise the trust for having staff that “treated patients with care and respect and communicated in ways patients understood”, as well as for recognising and managing the physical health needs of patients.

The CQC has issued four notices requiring the trust to take action against regulation breaches around safe care, dignity, good governance and staffing.

Trust chief executive Simon Gilby said: “Whilst we recognise and accept key areas for improvement identified in the report there are also a huge number of positive areas identified.

“We are a learning organisation so we take this as constructive feedback and welcome input from the CQC but we also need to clearly work on the issues identified.”

“We have done an immediate comprehensive audit and moved very quickly on anything that might pose a risk [to patients],” he said.

“There are still issues around how our clinical staff approach [prone restraint] and that specifically is an area we need to continue to make progress in,” added Mr Gilby, who also said the trust was in talks with commissioners to address capacity issues.

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