Trust "tolerated poor and mediocre practices"
West London Mental Health NHS Trust has accepted recommendations contained in a damning report released this week by independent regulator the Care Quality Commission.
The Commission investigated community and other inpatient services in Hammersmith and Fulham, Hounslow and Ealing.
Its report highlighted concerns relating to sub-standard buildings, poor physical healthcare, not enough staff, lack of staff training and not enough beds.
In the case of Hammersmith and Fulham Mental Health Unit, based at Charing Cross Hospital, the report said there were 76 occasions between January and September last year when patients could not sleep in beds because none were available. Staff reported that this caused some patients to become upset and angry.
Psychiatric Intensive Care Units, or PICUs, are for patients in an acutely disturbed phase of a serious mental disorder and are intended for short periods of care until the acute episode is over. However, patients were often forced to remain in the Hammersmith and Fulham PICU for longer than necessary because no beds were available on other wards.
In one case, a patient remained in the PICU for four months longer than necessary. Spare beds in the PICU were also used to accommodate patients overnight when beds could not be found for them on other wards. Accommodating people in such settings could adversely affect their recovery.
The report added that despite this shortage of beds, there was no evidence that until recently, the trust robustly reviewed its services to determine whether it had the right number of beds in the right type of services.
The Commission said problems had persisted over a number of years, yet the trust's leadership had repeatedly failed to address issues.
Since the investigation began, the trust has taken action to address some concerns, particularly by implementing a new system to report and investigate serious incidents and strengthening their arrangements to monitor safety and drive improvements in care. However, CQC said much work was still to be done.
Barbara Young, CQC's chairman, said: "Mental health services are inherently risky environments and this trust cares for some of the most seriously unwell patients in the country.
"Given the nature of its services, the organisation should be leading the way in managing risks, yet in some instances they tolerated poor and mediocre practices.
"The same problems about managing risk, overcrowding, sub-standard buildings and staff shortages were raised on a number of occasions, yet the trust's response was slow and piecemeal. The trust was good at writing policies, but not good at putting them into action.
"Lack of staff and beds meant that some patients had limited access to leave, therapeutic activities and physical healthcare, which are vital for a patient's recovery. Patients were considered to be at greater risk of harming themselves or others, because the trust's systems to manage risk were seriously flawed.
"This would not be acceptable in an acute hospital and people who need mental healthcare should not have to accept it either."
Barbara Young emphasised that all mental health trusts should take note of the Commission's recommendations. "From next year, all NHS trusts will need to register with CQC. Mental health trusts that don't have good systems in place to report, investigate and learn from serious incidents could find themselves facing sanctions," she said.
"Looking across the sector, there is good practice out there but services are still highly variable. Acceptance of low standards is highly troubling. That mindset needs to change."
Following the report's release, West London Mental Health NHS Trust's New Chief Executive, Peter Cubbon said: " There are lessons to be learnt from the investigation. The trust has already made progress in implementing a number of the recommendations and I am totally committed to working with the board to make sure that appropriate action is taken to address all of the outstanding issues.
"Working with our commissioners and NHS London we will ensure that patient safety is a top priority for all at West London Mental Health Trust."
Though the Commission had no concerns about the modern inpatient facilities at Hounslow and Hammersmith and Fulham, it said that St Bernard's Hospital, a secure service in Ealing, has buildings dating back to 1830 and needs to be upgraded urgently.
Recently appointed Chairman Nigel McCorkell said: "The trust recognises the limitations of some of our buildings. We are working on a strategic outline case for the redevelopment of our St Bernard’s site in Ealing and this will go to the trust’s board in the autumn.
"In Hammersmith & Fulham we have worked with our PCT and local authority partners to make changes to the way patients are admitted to the wards to ensure the bed pressures highlighted by the report do not reoccur.
" The Commission says we must 'aspire to become a leader in, and an example of excellence in, mental healthcare, and in particular forensic mental healthcare.' We agree.
"Our aspiration going forward is to use the report and the learning from it to improve governance and patient care at the trust and to continue to strive to become an exemplar employer and provider of mental health services."
July 24, 2009
|