Staff morale has “greatly improved” at a London mental health trust, but problems persist with workforce recruitment and retention, according to regulators.
West London Mental Health NHS Trust has been rated as “requires improvement” overall, following its latest inspection in November by the Care Quality Commission.
“Recruiting and retaining registered nurses continues to be a challenge for us”
The CQC acknowledged that its visit took place while the trust was going through “considerable strategic change”, as it sought to reduce inpatient beds and increase community services.
The overall score was based on the CQC rating nine of the 11 core services it inspected at the trust as “requires improvement” and the other two as “good”.
The trust was also rated “requires improvement” for being safe, effective, responsive and well-led, but was rated “good” for being caring, according to the inspection report published last week.
As during its last comprehensive inspection in June 2015, the CQC said the trust continued to have a problem with staff recruitment and retention, which was having an “impact on care”.
At the time of the latest visit last year, the overall trust vacancy rate was 17% but rose to 28% for qualified nurses, which the CQC said was of “significant concern”.
The staff turnover rate for the 12 months up to October 2016 was 14%. The trust had noted that many of the staff leaving were doing so within their first year of employment.
“We were able to see many areas of improvement, however, there was more to do”
Across the trust safe staffing levels were being achieved most of the time although there was a high use of agency staff which represented just over 12.3% of staff expenditure.
“The most significant concern was in the high secure services where access to therapeutic activities and time with staff and other patients was restricted,” said the CQC in relation to staffing levels at the trust’s high profile Broadmoor site.
“This was an ongoing concern from the previous inspection and as a consequence a warning notice was served,” warned the CQC in its report.
It highlighted that there were “frequent breaches in safe staffing levels” at Broadmoor. At night, nine of the 15 wards there had below 80% of qualified staff and six of these were between 50-65%.
“This was a concern as it meant there were not enough qualified staff working at especially at night to provide experienced nursing care,” stated the report.
Trust chief executive Carolyn Regan said “Like many other trusts, recruiting and retaining registered nurses continues to be a challenge for us and we have put in place a wide range of measures to increase the number of registered nurses in post and reduce our reliance on agency staff.
Broadmoor trust’s nurse staffing problems remain
“We have made it our priority to invest in the development of our staff,” she said. “We have a preceptorship programme already in place for newly qualified nurses and are have a successful development pathway for healthcare assistants working to become more senior assistant practitioners.
“We are already seeing some improvements but we know we need to do more and over the coming weeks we will be developing additional measures,” she said. “Our staff continue to work hard and often in challenging conditions.”
On the plus side, the CQC highlighted that morale was “greatly improved”, with staff talking about how the culture of the trust had changed and most people felt this was now much more open.
In a similar way, more incidents were being reported and the trust had promoted a culture where staff understood the importance of doing this, said the regulator.
However, the CQC flagged several other areas where improvement was still needed, in addition to recruitment and retention.
For example, the trust had made improvements in the assessment, monitoring and treatment of patients’ physical health, which had been implemented well in some areas but less in well in others.
The trust was not always able to provide a bed on an acute ward for patients who had a clinical need for this service, and some inpatient environments were of a poor standard, said the CQC.
Jane Ray, the CQC’s head of hospital inspections for mental health, said: “The inspection took place at a time when the trust was going through considerable strategic change.
“It was in the process of transforming its adult inpatient services to reduce the number of people needing inpatient beds,” she said. “This involved increasing services in the community.
“Since the previous inspection the trust had created a single point of access, enhanced assessment and treatment teams and a new primary care mental health service,” she noted.
“The trust was also working to improve existing care and the processes that support this,” she said. “We were able to see many areas of improvement, however, there was more to do.”
In addition, Ms Ray highlighted that there had been a number of changes in the leadership of the trust, including a new chief executive.
“The senior leadership team at the time of the inspection was capable and had the potential to make the necessary improvements, although there was a great deal to be done,” she said.
West London Mental Health NHS Trust provides mental health services to a population of 700,000 people for local services and a wider population for specialist services.
The trust supports adults and children in Ealing, Hammersmith and Fulham and Hounslow. It also provides specialist community mental health services to children and young people in Brent.
Its forensic mental health services provide a medium and low secure service to male patients from North West London. The male adolescent medium secure unit and women’s enhanced medium secure services have a national catchment area.
Meanwhile, the trust’s high secure services at Broadmoor in Berkshire have a catchment of London and the South. The redeveloped Broadmoor site is due to open later in 2017.
Since the last CQC inspection, the trust has started to offer integrated physical and mental health services. This has included “home ward” intermediate care services and health promotion in Ealing.