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Safety concerns raised at London mental health trust

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Camden and Islington NHS Foundation Trust has been rated “requires improvement” after inspectors highlighted safety concerns, including ligature risks and unsuitable places of safety.

Overall mental health crisis services and health-based places of safety were judged “inadequate”, following an inspection by the Care Quality Commission in February this year.

“Further training is under way to ensure staff are able to identify, assess, monitor and deal with ligature risks”

Angela McNab

Inspectors found facilities at two of the trust’s three health-based places of safety at other NHS hospitals “did not promote dignity, recovery, comfort or confidentiality” for people using the service.

There were particular concerns about “unsuitable” premises it used at the Royal Free Hospital, including the fact the toilet had ligature points which could be used by a patient to self-harm.

There were further concerns about ligature risks on the trust’s own wards.

Inspectors identified ligature points which had not been removed or where there were no measures in place to mitigate risks. Some wards were not equipped with ligature cutters or staff did not know where they were kept.

“While some services managed risks to patients well we also found examples of wards which were not safe for people who may be at risk of suicide,” said Paul Lelliott, deputy chief inspector of hospitals and lead for mental health at the CQC.

Care Quality Commission

Dr Paul Lelliott

Paul Lelliott

Other concerns included long waiting times for some psychological therapies – up to a year for people needing support from the complex depression, anxiety and trauma service.

The CQC’s report on the trust highlights variations in staffing with some teams fully established and all vacancies filled.

“Ward managers were able to adjust staffing numbers depending on the patient need on a day to day basis,” said the report.

However, the trust is reliant on bank and agency nurses to fill vacant shifts. “Patients and staff reported difficulties in accessing leave, ward activities and outside space when extra staffing was not available,” it added.

Wards for older people with mental health problems, community-based mental health services for older people, and community mental health services for people with a learning disability or autism were rated “good” overall.

Inspectors praised work to prevent pressure ulcers and falls with a full-time matron for fall and fractures prevention in post and regular staff training.

They also found senior nurses and managers in most teams to be “highly visible, approachable and supportive”.

Paul Lelliott, deputy chief inspector and mental health lead at CQC, said: “Some wards were safe, clean and well maintained – but we found room for improvement in acute wards for adults of working age.  The trust had not completed urgent repairs on three wards at St Pancras Hospital, in a timely manner.

“On a positive note we found that staff interactions with people using services and their families in a variety of settings was responsive and respectful and staff provided practical and emotional support,” he said. ”Staff supported families and carers to be involved in people’s care and offered families access to psychological therapies.”

He added: “Staff said they felt supported to raise concerns without fear of victimisation and told us that morale and job satisfaction was good.”

Trust chief executive Angela McNab said the CQC had identified many areas of good practice and described an overall rating of “good” for caring as “heartening”.

Camden and Islington NHS Foundation Trust

Safety concerns raised at London mental health trust

Angela McNab

“However, we recognise there needs to be consistency in standards across our organisation,” she said. “Many of the issues raised in the report, including places of safety, waiting times and ligature risks have already been addressed or are part of an immediate action plan.”

This included investing an extra £500,000 in work to make environments safer and remove ligature risks.

“Where this is not possible, due to the age and structure of very old buildings, further training is under way to ensure staff are able to identify, assess, monitor and deal with ligature risks,” said Ms McNab.

She said the trust was also working with acute trust partners to ensure appropriate facilities for people needing places of safety.

Meanwhile, innovative work to base mental healthcare teams within GP practices was helping to address lengthy waits for therapy.

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