Barking and Dagenham, Havering and Redbridge mental health NHS trust downgraded from Good to Requires Improvement
PUBLISHED: 07:09 10 September 2019 | UPDATED: 07:09 10 September 2019
The NHS trust responsible for mental health support services in Barking and Dagenham, Havering and Redbridge has had its quality rating cut from Good to Requires Improvement by health watchdogs.
Care Quality Commission inspectors visited the North East London Foundation Trust (Nelft) in May and June this year to check the quality of eight core services and review its leadership.
It published its findings on Friday, September 6, alongside the news that the trust was being downgraded.
In terms of responsiveness, effectiveness and level of caring, Nelft was still rated Good, but inspectors had a number of concerns regarding the safety of services and the trust's overall leadership.
Jane Ray, CQC's head of hospital inspection and lead for mental health, said: "The inspection of North East London NHS Foundation Trust was one of great contrast.
"On the one hand we inspected some outstanding services that were going the extra mile to meet the needs of every patient.
"On the other hand, we saw services where the care was unsafe.
"The services for adults who needed acute inpatient mental health treatment were under extreme pressure.
"This impacted on the safety and quality of patient care.
"A combination of new concerns and previous issues still needing to be fully addressed meant the trust's overall rating has moved from Good to Requires Improvement.
"We have made it clear to the trust where it must take action to improve and we will return in due course to ensure that these changes have been made."
Inspectors found leadership was not always taking the views of staff seriously, in particular flagging up "an unhealthy culture" that had developed due to some clinical staff - particularly junior doctors - "feeling a lack of respect or professionally undermined".
There was also, the report reveals, "a culture of blame rather than learning" when things went wrong.
The CQC's largest concern around safety involved the trust's use of rapid tranquilisation.
Its report notes: "The trust had not yet ensured that patients were kept safe following the use of rapid tranquilisation.
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"In the previous calendar year rapid tranquilisation was used on 322 occasions.
"Staff did not always complete post-dose physical health monitoring after patients had received medication by rapid tranquilisation.
"This meant there was a risk of not identifying a deterioration in a patient's physical health.
"The same concern was identified at the previous inspection and whilst the trust had implemented systems to try and address this matter, they were not yet embedded."
Further safety concenrs were noted around the hospital environment itself.
One inspector noted: "Whilst a need for call alarms in patient bedrooms had been identified, no dates for these works had been set.
"Staff did not describe how they were managing this risk until the alarms were installed.
"This meant that patients might not be able to call for help in an emergency."
However, it was noted that "inpatient wards and community bases were clean, well equipped, well furnished, well maintained and fit for purpose".
The inspection also found some very positive and innovative practice.
The trust continued to progress work on equalities, diversity and human rights.
This included the development of staff networks and work to improve the trust's performance in relation to the Workforce Race Equality Standard.
Nelft was also praised for its use of technology to support mobile working.
This also included innovative use of digital technology to meet the needs of patients and staff.
Professor Oliver Shanley OBE, interim Nelft chief executive, said: "No improvement journey is ever linear and although the CQC has highlighted areas for improvement, they have also highlighted many areas of good practice.
"I know this news will be disappointing for our staff and stakeholders but I would like to reassure you we are already taking action to make improvements in the areas highlighted.
"Our staff are committed to delivering the best care to the communities we serve and I know we will continue to work hard on our journey towards delivering outstanding care across the trust."