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Low staff morale and high use of restraint at Broadmoor trust

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Low staffing levels and an “unacceptable variation” in the use of restraint at West London Mental Health NHS Trust has caused regulators to call for it to make improvements.

During the inspection in June the Care Quality Commission said it was most concerned by the forensic and high secure services, which they gave “inadequate” ratings.

“I apologise to patients and their families if they have received poor care from us”

Steve Shrubb

Inspectors found there was “unacceptable variation in the use of restraint, including a high use of prone restraint” across the trust, which runs Broadmoor Hospital.

Inspectors concluded the trust had a “substantial” problem with staff recruitment and retention, and there were too few employees to “consistently guarantee safety and quality in the forensic services, high secure services and community based mental health teams”.

There was a low morale among staff and “poor engagement” with frontline staff in some of the services, said the CQC in its latest inspection report on the trust, which was published today.

In the forensic services staff had concerns about a “longstanding culture of bullying linked to race, religion and culture”, said the report.

Some patients were being prescribed medication at higher levels than the recommended dose, it said.

The Lakeside Mental Health Unit at the trust was “not considered fit for purpose” because it was “compromising patients’ privacy and dignity”.

In a six month period restraint was used 432 times and in 179 of these incidents patients were restrained in the prone position.

However, inspectors found the low morale problem was not endemic and in many services staff were “very positive” about the trust.

“We believe that our inspection has identified that the scale and speed of change that is needed is very significant. They must address our findings as a matter of urgency”

Paul Lelliott

They found in most places that “care was delivered by hard working, caring and compassionate staff”, particularly at the high security prison Broadmoor where staff showed “real concern” for patients.

Chief executive Steve Shrubb, who will be leaving the trust in November, said: “The inspection was rigorous and the CQC’s assessment of the trust is very fair.

“They recognised our staff’s hard work and compassion, many of our services were found to be good, and all of our services were found to be caring and staff should feel rightly proud of this,” he said.

“However, we know that we have more work to do and need to deliver improvements if we are to deliver consistently high quality care to every single patient. I apologise to patients and their families if they have received poor care from us,” he added.

Paul Lelliott, the CQC’s deputy chief inspector of hospitals and lead for mental health, said: “The trust is developing a leadership team which has a good insight into the challenges they face. 

“However, we believe that our inspection has identified that the scale and speed of change that is needed is very significant,” he said.

“They must address our findings as a matter of urgency,” he said. “We will be working with the trust to agree a plan to assist them in improving their standards of care and treatment.”

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Readers' comments (1)

  • Well this is what happens when the people in charge are so detached from providing care that they just don't have a clue. so much money is wasted in the NHS it is juts unreal and when people on the floor give ideas to save money they just get ignored. Furthermore the NHS really need to up wages and encourage people to get a job in the NHS as opposed to going private or joining agency. At the moment I see nurses leaving to the agencies every week and then coming back to be paid twice as much to do half as much because they have less responsibility than the full time employed staff. of course this leaves poor care and low moral for those full time workers who feel under appreciated. when a single ward can spend the best part of £100,000 a year on different agency staff this is going to lead to inconsistent care because no one stays around long enough to constantly work with the patients. there is no team, no bonding and no moral. also this is massive amounts of money which could be much better spent on other more important things like psychology, more full time staff, activities for patients... and the list goes on. On the subject of prone restraint the DOH have said it should be banned completely but I have not seen one person who developed that policy come to a ward and show staff another safe and effective way. At the end of the day staff work so hard to not use restraint at all and I see this every day but on occasions it is necessary for the safety of patients, staff, visitors, property and the public. Rather than banging on about how rubbish the NHS and staff are which succeeds in only lowering moral further how about the people at the top come to the wards and show us how we should be doing the job better and safer. I see the CQC come round to the wards and put up notices saying this that and the other are inadequate but I am yet to see any constructive advise on how to improve and I am yet to see a better care provider than the NHS world wide.

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