Agenda item

3.1    David Norman (Service Director, South London and Maudsley NHS Foundation Trust) and Amanda Pithouse (Deputy Director of Nursing, South London and Maudsley NHS Foundation Trust) introduced the report. The following key points were noted:

·      The results of the CQC inspection were made public on 8 January 2016. The overall rating for the trust was ‘good’. The report presents a summary of the general conclusions reached by the CQC after its inspection of the trust in autumn 2015. Some areas may be more relevant to Lewisham specifically. The trust has developed a detailed action plan which contains actions the Trust ‘must do’ as well as actions the trust ‘should do’.

·      The trust needs to ensure its risk assessments are sufficiently detailed and consistent across the trust. The actions it will take to ensure this is to redesign the electronic Patient Journey System (ePJS), so any risk assessments are consistently captured and can be found in one place. The electronic observations (EObs) are being adapted so more time can be spent with the service users.

·      The trust needs to reduce the incidents where restraints are being used, as well as the reporting system for restraints in the trust’s electronic reporting system DATIX. More detail needs to be captured about when a restraint is used, by whom, and when the restraint is removed again. The trust is doing a project together with the Devon Partnership NHS trust, funded by the Health Foundation, to reduce any incidents of violence in all inpatients wards. This project will support the work done to reduce the use of restraints.

·      The CQC made a number of comments in the area of environmental risk. Some locations the trust operates out of needed to improve their fire escape routes as well as ensuring the buildings were properly maintained overall. The trust has also instigated an audit of the risk for ligatures across the sites it operates out of, and has instituted a capital programme to reduce such risks.

·      In some areas, there were concerns that there weren’t the right numbers of staff. The trust has put in place a reward scheme for staff in areas where recruitment is difficult. It is also looking at increasing its notice periods. There is also a review of the need for training in dementia for staff in older adults services. Those staff that have received dementia awareness training are good, but the trust now needs to ensure that mostly unqualified staff in bands 2 and 3 receive dementia awareness training.

·      The CQC also raised concerns around patient dignity. In some inpatient wards there are windows in the doors of bedrooms which restrict patients’ privacy. This was the case in the Heather Close unit. The trust is also reviewing its use of any blanket restrictions to ensure individual patients’ needs can be met.

4.2    David Norman and Amanda Pithouse answered questions from the Committee. The following key points were noted:

·      The CQC’s inspection was conducted by more than 100 inspectors over the course of one week in September. The inspectors were able to visit the trust at any time during the day or night, although none visited during the night. The Child and Adolescent Mental Health Services (CAMHS) and older adults units both had unannounced visits in the week before the formal inspection which fed into the overall assessment of the trust.

·      The CQC raised concerns about the quality of the trust’s places of safety. The staffing levels across the places of safety are being reviewed. There were also concerns around the on-going maintenance of the physical environment.

·      In some areas, it is difficult to recruit the necessary staff so the trust relies on agency staff. In those cases it is more difficult to ensure that all teams are run in the best possible way. The trust is investing in a recruitment drive to ensure the necessary staff can be recruited. It is generally difficult to recruit staff in band 5.

·      The DATIX electronic reporting system allows any incidents of restraints to be captured by clinical staff and ensure that information is held in one central place. Cases of the use of restraint would then be anonymized and shared with larger groups of staff for learning.

·      The trust was capturing data on incidents where restraints were being used, but not data on how long restraints were in place.

·      The fit and proper person’s tests had been carried out for all trust board members as required, but the data was not present in every board member’s files when the CQC inspected them. The action listed in the report related to the trust ensuring the files of their board members were all up to date.

3.3    The Committee made a number of comments. The following key points were noted:

·      In some areas, it may be difficult for the trust to ensure improvements are being made, especially when it comes to changes in staff attitudes and ways of working. Medical information is captured on a patients’ chart which provides a method to ensure the right actions are taken consistently across the trust. With improvements to patient’s rights and dignity, it would be more difficult to capture and track changes.

·      The trust may want to consider the option of in-house provision of their catering during the tendering process. It may be economical to share this kind of service across multiple trusts if other trusts are also about to retender their catering contracts.

3.4    RESOLVED: that the Committee noted the report.