Care Quality Commission inspection finds staff ‘caring’ - 16 June 2016

The Care Quality Commission (CQC) rated seven of the ten services that were inspected as Good and three as requires improvement. In particular the CQC commended the Trust on the positive developments it has made in acute inpatient services, community learning disability services and child adolescent and mental health services.

The services that require improvement are the community based mental health services for adults of working age and for older people and the rehabilitation mental health wards for working age adults.

The Inspectors confirmed that SWLSTG is a 'well-led' organisation with 'a healthy culture and works hard to engage with people who use services and staff'. The report findings highlighted that the Trust 'had robust governance processes in place from ward to board and the quality of information enabled staff across the trust to know where improvements were needed'.

Overall the CQC report praised caring staff across all services that were inspected saying 'staff were enthusiastic, passionate and demonstrated a clear commitment to their work. Care was delivered by hard-working, caring and compassionate staff'. The inspectors said that they 'saw many examples of where staff really knew the patients and their carers well and were attentive to their individual needs'.

The Chief Inspector of Hospitals reported that 'throughout the inspection there were many examples of patients and their carers being involved in assessments, care plan reviews and decisions about their care'. The inspectors found that 'young people and their families were treated as partners in their care' and stated that 'staff treated young people and their families with kindness, dignity and respect'.

Inspectors reserved special praise for the Trust's record of challenging stigma and discrimination saying that 'excellent work is taking place with local communities to break down the stigma associated with mental illness' and make services more accessible.

The Inspectors found several other areas of good practice, including:

• There had been significant improvements in the acute care pathway. Whilst demand was still very high and this presented a daily challenge, patients had an improved level of support to access the services they clinically needed.
• There were many positive examples between staff and patients throughout the inspection visit. For example on Jasmines ward for older people, the staff knew the patients very well including small but important details such as whether they preferred to spend some time in their bedrooms rather than always being in the communal areas.
• Staff said how much they enjoyed working for the Trust and valued the leadership provided by the senior team. Many specifically mentioned the role played by the chief executive.
• Staff are caring, professional and in many cases innovative in their work. The culture of the Trust was largely healthy with patients and staff feeling able to raise issues they felt needed to improve without fear of retribution.
• The Trust Board provided effective challenge and helped to ensure the Trust met its strategic objectives. The senior executive team is committed to improving services and providing a high standard of care for patients.

David Bradley, SWLSTG Chief Executive, said: "We are grateful to the inspectors for their root and branch examination of our services and for recognising the excellent work provided by our caring and professional staff. The inspection was tough but fair and gave us the extremely valuable opportunity to examine the services we provide and look at how we can make them better for patients, carers and our staff."

The Inspectors noted that there are many areas of ongoing work within the Trust including developments to improve patient and staff engagement which will need time to progress.

The inspection team are confident that the trust has the necessary leadership in place to take forward the improvements that are required.

Despite seven out of ten services being rated as 'good' the Trust received an overall rating of 'requires improvement'.

The main areas for improvement included:

• Most wards providing rehabilitation were not supporting patients to achieve greater independence
• Across a number of wards and teams staff were not being supported with regular one to one supervision
• Administrative changes meant some patients were not receiving appointment letters, with delays in information reaching GPs and staff at the Trust were not able to access patient information they needed for outpatient appointments.

Mr Bradley added: "I am proud of what our staff have achieved and we will never be complacent in making services better for our patients. We are very aware that there is a great deal of work still to be done and we are ready to meet the challenges ahead. Building on the improvements we have already made in the acute care pathway, we will use the same successful approach for improving our rehabilitation and community services.  We have already begun working at implementing robust action plans on the areas highlighted by the Chief Inspector of Hospitals.

"Our Trust is committed to providing good patient care. We have ambitious and innovative plans to transform mental health services across South West London in partnership with local stakeholders and invest £160m in rebuilding our hospitals to provide the very best health and social care for our patients."

Paul Lelliott, the Deputy Chief Inspector of Hospitals and CQC's lead for mental health, said:  "There was much for the Trust to be proud of. The senior executive team were committed to improving services and providing a high standard of care for patients. Most staff said they enjoyed working for the Trust, were caring, professional and in many cases innovative in their work.

"We will expect the Trust to address the issues we found during our inspection and we will be returning to inspect again in due course" he concluded.