Agenda item

This report presents the West London Mental Health Trust CQC rating and associated action plans (separate document).

The Committee received a report on the CQC inspection of West London Mental Health Trust (WLMHT) and the quality improvement plan. The Trust had received an overall rating of ‘Requires Improvement’ and ‘Good’ in respect of being ‘Caring’ and ‘Responsive’. 12 regulatory requirements had been placed upon WLMHT.

The presentation set out the CQC judgement in respect of the Trust’s strengths and the key areas for improvement. The recruitment and retention of trained nurses remained a major issue, and impacted on morale and safety. This was a particular London problem, linked to the cost of accommodation.

The presentation set out the key points in respect of transforming local services. Ms Rushton gave examples of some of the training needs, which were being addressed: staff did not understand what might be considered a ‘restrictive practice’, for example holding or a guiding arm for an elderly person; moving and handling techniques; and advocacy arrangements.

There were issues in respect of the physical environment. Some bedrooms did not have call bells. There were no seclusion facilities for female patients. Whilst work was ongoing to minimise the need for seclusion, if required for a female patient, a room on a male intensive-care ward had to be used. The longer term plan was to make some separate space, but this would mean losing bed space. To provide privacy and dignity, there needed to be some re-positioning of CCTV. 

Whilst some issues were easy to resolve, there were also some which were longer term. WLMHT would work with community care leads to ensure that only the right patients were treated in secondary care.

Councillor Perez referred to the recruitment and retention of trained nurses impacting on morale and safety, and queried what this meant and what was being done to recruit and train staff to deal with difficult patients.

Dr Broughton responded that the Trust Board received a monthly report. Staffing every shift was dependent on bank and agency staff, and it was not always possible to provide the same quality of care. The CQC was concerned that the use of agency staff could not be considered safe and could increase the likelihood of things going wrong.

Ms Rushton stated that the Hammersmith & Fulham in-patient unit was fully staffed. There were a variety of initiatives to improve recruitment and retention including:  developing strong links with local colleges so that students would want to stay at WLMHT after their training; career progression with training opportunities; conversations around affordable housing; greater staff engagement and influence at all levels; and quality improvements through latest methodology. There was evidence of improvements in recruitment and retention.

Councillor Carlebach queried whether the ‘Requires Improvement’ rating had occurred because the Trust’s focus was split between community mental health services and a secure unit with the high profile of Broadmoor Hopital. Ms Rushton responded that the new clinical model was split into two directorates: high secure and forensic services including Broadmoor Hospital, and local and specialist services at Ealing Hospital. There were five service lines focusing on key areas: liaison and long term conditions; access and urgent care; primary and planned mental health care; cognitive impairment and dementia; and Children and Adolescent Mental Health Services and developmental services.

WLMHT would not be allowed to separate Broadmoor Hospital. Dr Broughton added that there were inherent advantages in pooling resources and skills across the two directorates. Experience of all mental health services was beneficial to career progression.

Mr Naylor stated that a year previously, the Healthwatch dignity champions had visited the mental health unit at Charing Cross. They had submitted a report, but had received no feedback. Ms Rushton responded that a meeting had been arranged with Healthwatch in respect of this report and other issues.

Mr Naylor queried whether WLMHT was prepared for an expanded role in respect of the growing older population and increase in dementia and how it would work with elderly carers of dementia patients. Ms Rushton responded that WLMHT was working with Ealing and Hounslow Councils to progress plans, but Hammersmith & Fulham had decided to put the service out to tender. The specification was similar to the service which WLMHT had been commissioned to deliver to Ealing and Hounslow. WLMHT would try to work collaboratively to get the right service delivered.

Councillor Brown queried whether there was anything with which the Council could help WLMHT. Ms Rushton responded that a meeting had been arranged with Councillor Lukey and Mrs Bruce and the CCG in respect of mental health planning in the borough. However, housing was equally important and WLMHT would welcome more discussion.

Councillor Lukey commented on a meeting between Housing and Adult Social Care at which both had brought their most difficult cases. The discussion had highlighted the need to get involved earlier. Councillor Lukey stated that the Council was committed to working with mental health partners and the voluntary sector.

Councillor Vaughan thanked WLMHT for attending the meeting.

RESOLVED THAT:

1.    The report be noted.

2.    The action plan be noted and specifically in respect of the regulatory requirements and recruitment and retention of staff issues.

3.    The CQC rating of ‘Requires Improvement’ was disappointing.

4.    It was recommended that the Council should work with WLMHT in respect of housing and other matters.

5.    It was recommended that WLMHT should feedback to and work with Healthwatch.

6.    The implementation of a model which prioritised local services was welcome, and an update report on its success should be added to the work programme. In addition, the report should include examples of a career model at WLMHT.