West London Mental Health NHS Trust has reduced risk to patients but further progress is required, according to regulator

West London Mental Health NHS Trust (WLMHT) has made significant improvements in risk management to protect patient safety, according to a recent report by the Care Quality Commission (CQC).

The report examines the trust’s progress in implementing recommendations made in July 2009 triggered by concerns about the trust's response to suicides and other serious incidents. The original investigation highlighted delays in investigating incidents and a failure to learn from common themes identified and documented in action plans.

CQC completed its follow up inspection over five days (15 – 19 March 2010), interviewing service users, staff and board members and reviewing documented evidence. It commended improvements in assessing service users’ physical healthcare, risk management, the provision of primary care services and the cleanliness of wards. Challenges remain in care planning, improving communication between staff and service users and demonstrating that lessons learnt are shared across the whole trust.

Colin Hough, regional director for CQC, said:

“ West London Mental Health NHS Trust faces real challenges in caring for some of the most seriously unwell patients in the country. That is why it is so important that its risk management processes are robust and can protect these most vulnerable of service users.
We will continue to monitor the trust through our tough new registration system, which requires the NHS to meet essential standards of quality and safety. WLMHT has been registered with compliance conditions relating to our original recommendations and we have set out strict deadlines for improvement.
There is no question that the trust has made significant progress, particularly in the way it reports and investigates serious incidents and manages medicines and pharmacy support. But there is more to do to improve service users’ experience of care through better care planning and more meaningful interaction with staff. While the trust has already made changes to how lessons are shared across the trust a sustained focus on this is very important.”

During the inspection, the trust provided evidence of its progress against the majority of the nine recommendations made in July 2009. One area continues to be a concern and one recommendation was not assessed in depth as it will be addressed through a separate review of the trust’s Commissioners later in 2010. CQC commended the progress made but said that some areas require improvement and will continue to be monitored:

The nine (9) recommendations were:

1. Improving management of risk through reporting, investigations and the sharing of lessons learnt.
   Concerns were initially raised that the right actions weren’t being taken to prevent serious incidents being repeated. The trust has since reviewed the management of risk in the organisation and the reporting of risks and incidents now has a much higher profile. There is limited evidence of trust wide shared learning and embedding this will continue in phase two of the implementation process.
2. Assessing the risks that service users pose to themselves or others and reflecting them in risk management or treatment plans.
   CQC is concerned that delays in addressing known ligature risks may not be adequately highlighted in the risk register. Over 50% of service users interviewed were not aware that they had a plan of care or knew what arrangements were in place for their ongoing treatment. CQC would expect to have seen greater progress in this area.
3. Commissioners developing mechanisms for monitoring the reporting, investigating and learning from incidents in the services they commission:
   CQC will review the commissioning of services later in 2010 so this recommendation was not assessed.
4. Progressing the redevelopment plans for Broadmoor Hospital and Ealing.
   Many of the trust’s buildings are old and are not conducive to safe and high quality care. The trust has now reconfigured the wards at Broadmoor and is waiting for Department of Health approval to progress the site redevelopment. An inspection by the CQC Health Care Associated Infection (HCAI) team found no breaches of the Hygiene Code.
5. Ensuring there are sufficient beds for patients.
   Formerly, people slept on sofas or stayed too long on the intensive care unit due to overcrowded wards. The trust has confirmed that all service users are now admitted to an allocated bed.
6. Ensuring sufficient numbers of staff with the right skills.
   The trust has historically had problems maintaining adequate staffing levels. Human Resource support and recruitment processes have been reviewed to reduce the time taken to recruit new staff. Vacancies are now being filled more quickly and the total number of vacancies is steadily reducing.
7. Monitoring and reporting of staff attendance at mandatory training.
   Poor attendance at mandatory training was a natural side effect of low staffing levels. Staff attendance at training is now recognised as a key priority and attendance is monitored locally by the ward and reported monthly to the trust board. However, the inspection team is concerned that some service users report that they do not speak regularly to a member of staff and that staff attitude was poor.
8. Giving more priority to the physical healthcare of service users.
   While the trust’s approach to users’ physical healthcare was slow and fragmented in the past, they have now invested in the provision of primary care services to ensure service users have access to GP services. Service users in local units reported that their physical healthcare needs were addressed promptly.
9. Prioritising medicines management and strengthening resources for pharmaceutical advice.
   The original investigation uncovered variable pharmacy support across the trust but the chief pharmacist has now confirmed that a medicines management strategy has been implemented.

To see the full report into progress made at the trust, please visit CQC’s website - see link below.

About the CareQuality Commission: The Care Quality Commission (CQC) is the independent regulator of all health and adult social care in England. The CareQuality Commission inspects health and adult social care services in England, whether they're provided by the NHS, local authorities, private companies or voluntary organisations. It also protects the interests of people detained under the Mental Health Act. (Until 31 March 2009, this work was carried out by the Healthcare Commission, the Mental Health Act Commission and the Commission for Social Care Inspection.)

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