- NHS mental health service
Maudsley Hospital
All Inspections
01 and 02 February 2022
During an inspection looking at part of the service
We carried out an announced focused inspection of healthcare services provided by South London and Maudsley NHS Foundation Trust (SLAM) at HMP Wandsworth on 1 and 2 February 2022.
Following our last joint inspection with Her Majesty’s Inspectorate of Prisons (HMIP) in September 2021, we found that the quality of healthcare provided did not meet the fundamental standards. We issued a Section 29A Warning Notice. We also issued a Requirement Notice in relation to Regulation 18, Staffing of the inpatient unit as well as the Assessment and Liaison Service (The Assessment and Liaison service forms part of the Outpatient Mental Health provision) under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
The purpose of this focused inspection was to determine if SLAM was meeting the legal requirements and regulations under Section 60 of the Health and Social Care Act 2008, and that patients were receiving safe care and treatment.
We do not currently rate services provided in prisons. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.
This was a focussed inspection, we looked at a range of areas, for staffing, we concentrated on the Inpatient unit as well as the Assessment and Liaison Service which forms part of the outpatient provision for Mental Health, having identified concerns with these two distinct areas as part of our September 2021.
At this inspection we found:
- Patients waiting to be assessed by mental health professionals were reviewed and welfare checks made for most patients.
- Staff understood and applied the Mental Capacity Act.
- Referrals were reviewed thoroughly by a team of clinicians.
- Staff understood the needs of patients they supported and helped them manage their treatment or condition.
- The service continued to have high staffing vacancy rates for the inpatient unit, although there had been some improvement in covering unfilled shifts.
- There had been a slight improvement in staffing of the Assessment and Liaison Service, which supported an improved referral and waiting list management process, however, more staff were needed to ensure the full range of therapeutic services were available to patients.
- Therapy cover was inadequate and therapeutic interventions had been stopped for new patients and significantly reduced for existing patients. There were no short-term crisis interventions available to patients, although welfare checks were made as required.
- Governance systems needed strengthening, performance monitoring was not comprehensive and some information was not accurately reported. Incidents were not always reported in line with policy.
- Patients who required transfer to secure mental health inpatient services waited too long.
The areas where the provider should make improvements are:
- Deploy sufficient numbers of suitably qualified, competent, skilled and experienced staff.
- Ensure all incidents are reported in line with its incident reporting policy.
- Produce accurate performance reports which contain meaningful information.
- Ensure all patients receive a welfare check and/or assessment as needed.
- Ensure therapeutic interventions are available for patients as needed.
- Ensure crisis intervention is available for patients as needed.
- Ensure all patients who require transfer to a secure mental health inpatient service are transferred in line with national timescales.
29 October 2013
During a routine inspection
Patients were encouraged to access the community. However, on one ward there were difficulties accommodating section 17 leave for patients that required escorting.
Care and treatment was planned and delivered in line with people's individual needs. There were health screening processes in place to identify any additional health needs people had. There was evidence of liaising with other health professionals to provide a joined up approach to care and treatment where patients required support for both mental and physical health needs.
Staff knew how to recognise signs of abuse and were aware of their reporting requirements. There were processes in place within the trust to review safeguarding concerns, and further work was being undertaken to improve this process.
The trust had identified there was a need to reduce the amount of violence and aggression on their inpatient wards. Staff were mindful of the need to review the risks of violent or aggressive behaviour on their wards daily and put additional measures in place to support people at risk of presenting with unwanted behaviour. A pilot initiative had been run on two wards regarding reduction of violence and aggression on wards and initial findings were positive.
The wards we visited did not provide a pleasant or safe environment for patients. There were ongoing maintenance requirements and concerns identified from previous environmental audits had not been addressed.
Staff were supported and there were processes in place to ensure they remained up to date with their required training. This ensured they had the skills and knowledge required to support their patients. There were supervision processes in place and there was access to their line manager if they needed any additional support or advice.
There were processes in place to assess the quality of service provision and to look at the effectiveness of service delivery. Complaints and incidents were appropriately reported and there were processes in place to review any trends or themes emerging.
Overall we found that staff were caring and responsive to people's needs. The service was well led and findings from clinical outcome tools showed the service was effective at meeting people's needs. The staff ensured that people remained safe but there were some environmental challenges to this.
11 September 2013
During an inspection looking at part of the service
At this inspection on 11 September 2013 we found that many improvements had been made.
We found the units to be visually clean and free from unpleasant odours. The service had processes in place to monitor the cleanliness of the units and reduce the risk and spread of infections.
The majority of staff had received their mandatory training. There were processes in place to provide regular supervision and annual appraisals. Staff felt supported and that their managers were approachable if they had any questions or comments about their role.
People had accurate and fit for purpose care records. We saw that care records were individualised and that care plans and risk assessments had been regularly reviewed to ensure they reflected the current needs of people using the service.
21 March 2013
During a routine inspection
Care and treatment was being delivered in line with people's individual needs and there were processes in place to ensure that staff were kept up to date with any changes in people's health. We observed staff explaining to people using the service what care was being delivered.
We saw evidence that actions had been taken in response to a recent infection control audit and there was continued liaison with the agency providing domestic staff to the wards. However, we saw that some areas of the wards were unclean on the day of our inspection.
Staff told us they felt well supported and they had access to senior members of staff if they needed any further advice or support. Staff told us they had received supervision, appraisals and attended training sessions. However, the records we reviewed showed that some of these processes were out-of-date.
There were effective monitoring systems in place and there was regular auditing of service delivery. All incidents were reported into a centralised system. However, we saw evidence that not all incidents fed into the care planning process.
Records were kept safely and securely. However, the care records we reviewed were out of date and did not always reflect the care and support needs of people using the service.
13 December 2011
During a routine inspection
Most people said that they feel involved in their care and treatment and that the staff are respectful of their needs.
Some people identified areas in the environment that they were not happy with, such as the cleanliness of the toilets and bathing facilities.
People using the service told us that they felt safe and would know who to speak to if they had any concerns.
People told us that they feel there are sufficient staff on duty and that there is usually someone available if they need them.