South London and Maudsley NHS Trust’s children’s services rated ‘good’ by Care Quality Commission

Katherine Johnston (18 December, 2020)

COVID-19 has placed extra strain on mental health services - with long waiting lists frustrating families and staff

40550The Maudsley Hospital in Denmark Hill

South London and Maudsley NHS Foundation trust’s mental health services for children and young people was rated ‘good’ overall by regulators this week – but inspectors also highlighted delays in treatment and staffing issues.

In a report published today (Friday, December 18), the Care Quality Commission (CQC) said the department had been rated good overall following an inspection in September.

NHS services are also rated in certain fields including being ‘caring and well-led’ and responsiveness.  The trust, which includes the Maudsley Hospital at Denmark Hill, was assessed as ‘good’ in terms of being well-led but it ‘requires improvement’ for being responsive. Staff turnover was among the issues identified holding the trust back; with some patients not receiving the right care.

The CQC’s team focused their attention on the Child and Adult Mental Health Services (CAMHS) and the Service for People with Complex Autism Associated Neurodevelopmental Disorders (SCAAND).

The CQC’s head of hospital inspection for mental health and community health services, Jane Ray, said: “During our inspection of South London and Maudsley NHS Foundation Trust we found there were enough trained and experienced staff who were able to give the children and young people the time that they needed. 

“Our inspectors heard from young people and parents that staff really cared, wanted to help, and felt that they provided invaluable support when they were struggling. 

“We did see some challenges with a high turnover of staff, which resulted in some patients not having the continuity of care they needed. The trust was told they must continue to work hard to address this.

“Despite these challenges we saw committed and enthusiastic staff throughout the trust, working hard to deliver care for patients. They demonstrated creative ways of working with young people to improve the quality of care they receive.

“Credit must be given for the hard work and commitment of the staff and leadership team. We will continue to monitor the trust’s performance and visit in the future to check if the improvements have been sustained.” 

Particular praise was singled out for the staff’s ‘compassion and kindness’, and the smooth transitions when working with other agencies to help patients access further care and support.

As part of the inspection, the CQC’s team spoke with twelve young people who were in treatment or had recently been helped by these services, along with dozens of parents and carers.

The responsiveness assessment was the only area of the services’ work that had its rating downgraded. As of 30 September 2020, the vacancy rate for the local borough CAMHS services inspectors assessed was 17 per cent, with a turnover rate of 13.6 per cent.  Lambeth CLAMHS, which focuses on looked after children, had the highest turnover rate at 47 per cent. 

There were also significant issues with resources and demands on the service, with long waiting lists and a lack of communication. COVID-19 had also exacerbated the difficulties families waiting for treatment faced.

The report notes: “Some children and young people not assessed as needing urgent care, had significant waits for assessment and treatment. 

“There were long waits for treatment of trauma, obsessive compulsive disorder, attention deficit hyperactivity disorder and for autism assessments (which had been exacerbated by COVID-19 restrictions).

“Many parents/carers and education staff told us that they thought the thresholds for acceptance to services were sometimes too high, and that they had not received communication or support whilst waiting for assessment or treatment.” 

Some told inspectors that things deteriorated to such a point during long waits that they found themselves in crisis – with staff left frustrated they were unable to intervene quickly enough. 

The trust has now been told it must remedy these problems before reinspection.

Vanessa Smith, the trust’s interim executive director of nursing said: “An overall Good rating reflects the care and compassion of our staff who work very hard to support the children and young people who use our services, their families or carers. 

“We were pleased that inspectors commended the commitment and enthusiasm of staff and recognised that people who use our services are treated with the compassion and kindness they deserve.

“Inspectors also praised the creative ways our staff work with young people to improve the quality of care they receive.

“There is always more to be done but we are very proud of our Children and Adolescent Mental Health Services for this rating, particularly given the challenges posed by the Covid-19 pandemic this year.”

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