Agenda item

To receive a presentation from South London and Maudsley NHS Trust, providing an update on activity following the outcome of their CQC inspection, as per their request.

 

Background to the inspection is available via the following link SLAM inspection summary

 

The committee received a presentation from representatives of South London and Maudsley NHS Foundation Trust providing an update on activity following the outcome of its CQC inspection.

 

The committee then heard from Professor Derek Tracy, Chief Medical Officer, who explained that he would provide a strategic overview on organisational issues. The committee also heard from the Service Director for Southwark Services for adults aged 18 to 65.

 

The committee then heard from the CQC representatives on issues in areas including:

 

·  patient safety, forensic services, community services for adults of working age.

 

·  acute adult working age services.

 

·  documentation, seclusion rooms, enhanced care and observations, care planning, emergency alarm systems

 

·  privacy and dignity, risk assessments, mandatory training restraint documentation, medication documentation

 

·  physical health checks, waiting times, Mental Health Act assessment delays

 

·  supervision and patient rights, the place of safety environment

 

The committee then heard that the trust had worked with the CQC to develop an improvement action plan, covering areas including:

 

·  place of safety and home treatment services, construction of a garden for the place of safety

 

·  mandatory training compliance, personal alarms for community staff, crisis services, including development of a mental health urgent treatment centre

 

·  risk assessments and care plans, use of Dialogue and Dialogue Plus, zoning protocols for community patients, monitoring patients in the community, inpatient observation systems

 

·  physical health monitoring, links with partner acute trusts

 

The committee then asked questions on the following themes:

 

·  the three most significant findings from the inspection, timetable for implementing outcomes from the inspection.

 

·  well-led concerns and management response, CEO and senior leadership portfolios, staff morale and staff feedback

 

·  professional challenge and clinical leadership, day-to-day changes to leadership arrangements

 

·  CAG standards and clinical academic groups, governance and board changes, non-executive director roles

 

·  digital and clinical oversight, assurance to Southwark residents risk assessment and care planning

 

·  identifying and monitoring high-risk individuals, working across organisational boundaries, links with the council and MARAC arrangements

 

·  documentation and audit confidentiality and patient records, good practice identified by the CQC, risks to patients where services require improvement

 

The committee heard from the trust representatives that the three major concerns were waiting times in community services, Mental Health Act assessment delays for people who were unwell in the community, and the condition and capacity of the place of safety.

 

The committee heard that some actions had been taken immediately, including work on waiting lists, changes to the place of safety and changes to the way care was approached. The committee also heard that other actions would require longer timeframes, including work with partner organisations such as the police.

 

Professor Derek informed the committee that the well-led issues reflected a cultural challenge. He explained that the trust was seeking to strengthen the role of clinicians, including nurses, doctors and psychologists, in leadership positions. He also explained that the trust was rebalancing operational and clinical leadership responsibilities through the executive triumvirate of the Chief Medical Officer, Chief Nurse and Chief Operating Officer.

 

The committee heard that the trust was seeking to give clinical academic groups more influence over standards of care. As an example, the committee heard about work to identify frequently readmitted patients and consider the use of long-acting injectable medication, and work in Southwark on clozapine prescribing by ethnicity.

 

The committee then asked questions on governance and board oversight.

 

The committee heard that there had not been direct changes to posts as a result of the CQC report, but that there had been a turnover, including a new chief executive due to start in July and a new chair who had started around six or seven months previously. The committee also learnt that two new non-executive director positions had been created, one with a digital focus and one with a clinical focus.

 

The committee was informed that there had been increased visibility of senior executives and non-executive directors in services.

 

The committee asked whether the trust could give assurance to Southwark residents that robust governance was in place.

 

Professor Derek stated that he could give that assurance and referred to changes over the previous six months and movement in the National Oversight Framework.

 

The committee then asked questions on risk assessment, care planning and cross-organisational working.

 

The committee learned that the trust had introduced a new zoning framework for community patients and daily meetings, Monday to Friday, to discuss patients who were becoming unwell, their risks and the support needed. The committee heard that the trust was prioritising those at greatest risk when working with the police and was providing more robust support for patients waiting in the community, including through home treatment teams and multi-agency arrangements.

 

The committee heard that since the CQC inspection there had been monthly executive oversight of patients waiting, reasons for waiting, the length of wait and support in place and also heard that the trust was undertaking community transformation, with fewer teams, fewer handovers, alignment with integrated neighbourhood teams and closer working with primary care, voluntary sector organisations and community groups.

 

The committee then asked questions on working with the council and MARAC.

 

The committee was informed that South London and Maudsley NHS Foundation Trust had faced challenges in multi-agency working but had changed its arrangements so that every MARAC meeting would have a representative from the trust. The committee heard that issues would be escalated to the Service Director and Deputy Director, with an agreement with the local authority director to address attendance and other issues.

 

The committee then asked questions on documentation.

 

The committee learnt that documentation was important to support risk assessment, planning and communication with partner agencies. The committee heard that CQC had found examples of documentation not being sufficiently detailed. The committee also heard that the trust had introduced training, clearer points of reference in its systems and regular audits of records.

The committee heard that the trust was changing its electronic patient record system and that the new system was expected to make recording and finding information more efficient.

 

The committee asked about confidentiality and patient records.

 

The committee heard that records were held in a closed system and that any information leaving the system would go through information governance processes. The committee also heard that the trust wanted to ensure patients had access to their records as much as possible where required.

 

The committee asked about good practice identified by the CQC and risk to patients.

 

The committee heard that the CQC report identified good practice, including compassionate care from staff. Professor Derek Tracy told the committee that staff had been found to be caring, kind and thoughtful to patients. He also explained that the trust wanted to make better use of its relationship with the Institute of Psychiatry, Psychology and Neuroscience to set clinically relevant standards of care.

 

The committee then discussed possible recommendations.

 

The Chair asked whether the trust would be willing to share a quarterly progress report with the Health Scrutiny Commission on progress against the CQC action plan. The trust agreed.

 

The Chair also asked whether the trust would be willing to consider a working group between Southwark Council and the trust, including the patient voice. The trust agreed.

 

Members suggested that Health Scrutiny Commission should receive written updates and that, where concerns were raised, the trust should be willing to attend a future meeting or answer focused questions.

 

A member suggested that there should be a recommendation on giving confidence directly to patients, residents and families, noting that some of the language discussed was technical.

 

The committee thanked the trust representatives for attending.