MAUDSLEY ACUTE WARDS REPORT: Failure on checks, physical restraints and staff struggling with high demand

Katherine Johnston (21 November, 2018) Health

The report paints a picture of staff struggling with high demand and limited resources

23054Maudsley Hospital, Camberwell

Patients receiving intensive psychiatric care in South London and Maudsley NHS Trust’s ‘inadequate’ acute care wards were restrained and tranquilised by staff, who failed to carry out necessary health and safety checks, its inspection report claims.

As the News reported last week, although the NHS Trust achieved a ‘good’ rating overall, its acute wards were deemed ‘inadequate’.

The latest report from the Care Quality Commission, or CQC, said the trust had failed to improve certain wards inspected last year.

It catalogued ‘breaches of fundamental standards of care on the acute wards’ which it claimed ‘had not been appropriately escalated to senior leaders in the trust’.

Shockingly, out of 32 recorded cases of patients being physically restrained, not one included details of the types of holds used by staff, or which staff members were involved.

The report paints a picture of staff struggling with high demand and limited resources. Last year, a total of 31 patients were left sleeping on sofas or on temporary facilities.

Empty posts and high turnover have left remaining staff struggling. Seven vacancies were listed on one ward alone, while on another staff turnover was higher than 25 per cent.

South London and Maudsley NHS Trust provides mental health services to 1.3 million people across Southwark, Lambeth, Lewisham and Croydon. More than 1,200 nurses are employed among its 5,000-strong staff.

The trust was rated ‘good’ overall, with the ‘kindness and compassion’ of staff particularly praised. Its eating disorders service and community-based work was also praised.

In a statement published on October 23, Chief Executive Dr Matthew Patrick said: “An overall Good rating reflects the care and compassion of our staff who do their best every day, often in difficult circumstances, to improve the mental health of our service users.

“Quality is our number one priority and we are working constantly to improve our care. We regard the CQC’s findings as a further opportunity to make positive change and we have submitted comprehensive improvement plans to them regarding the action we are taking as a result of this report.”

A spokesperson from Healthwatch Southwark, which lobbies on behalf of patients, told the News: ‘The pressures on the NHS in general, and mental health in particular, are well known.

“There is a shortage of trained staff and a lack of resources, reflected in the nineteen per cent staff vacancy rate facing the SLaM acute and intensive care wards.

“Sadly, the CQC report paints an upsetting picture: concerns about safety, failure to properly manage the use of restraint, and patients having to sleep on sofas due to a lack of beds.

“Healthwatch Southwark will continue to keep a close eye on what is happening and do all it can to support patients and their families to achieve better care.

“We look forward to hearing the findings from Healthwatch Lambeth’s ongoing visits to SLaM’s acute and forensic wards to find out how people experience care there.

“We will also shortly be publishing our own report on the mental health crisis pathway.”

 

Why did the Care Quality Commission rate its acute care wards ‘inadequate’? 

– Staff did not always carry out health checks after using rapid tranquilisers, even though side-effects include seizures, airway obstruction and even cardiac arrest.

– Following the use of restraint, staff did not record in sufficient detail what had taken place including the staff involved, the holds used or duration of the restraint

– A high number of patients were not leaving care as soon as they were ready, and beds were not always available when needed.

– Staff did not always record when safety incidents took place with many colleagues unaware of serious incidents

– Some staff had training and skills gaps, and the overall vacancy rate ran at nineteen per cent

– Patients on one ward had no direct access to drinking water

– Staff were not consistently taking blood tests when needed or acting on concerns patients were not drinking enough

– Emergency equipment was not being renewed before expiry

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