Staff morale ‘greatly improves’ at a London mental health trust, but problems persist with workforce recruitment and retention

West London Mental Health NHS Trust has overall been rated as “requires improvement”, following its latest inspection in November

The overall score was based on the CQC rating nine of the 11 core services it inspected at the trust as “requires improvement” and the other two as “good”.

The CQC did acknowledge that its visit took place while the trust was going through “considerable strategic change”, as it was in the midst of trying to reduce inpatient beds and increase community services.

According to the inspection report, the rating “requires improvement” was also received for being safe, responsive, effective and well-led, but was rated “good” for being caring.

During its last comprehensive inspection in June 2015, the CQC said that the trust continued to have a problem with staff recruitment and retention, and this in turn was having an “impact on care”.

At the time of the latest visit, the overall trust job vacancy rate was at 17% but rose to 28% for qualified nurses, which the CQC said was of “significant concern”. Staff turnover rate for the 12 months up to October 2016 was 14% and the trust had noted that many of the staff who left their positions, did so within their first year of employment.

Safe staffing levels were being achieved most of the time, although there was a high use of agency staff which represented just over 12.3% of staff expenditure.

“The most significant concern was in the high secure services where access to therapeutic activities and time with staff and other patients was restricted,” said the CQC in relation to staffing levels at the trust’s high profile Broadmoor site.

The CQC warned in its report, “This was an ongoing concern from the previous inspection and as a consequence a warning notice was served.”

“Frequent breaches in safe staffing levels” at Broadmoor were highlighted with nine of the 15 wards having below 80% of qualified staff on the night shift and six of these were between 50-65%.

“This was a concern as it meant there were not enough qualified staff working at especially at night to provide experienced nursing care,” stated the report.

Trust chief executive Carolyn Regan said “Like many other trusts, recruiting and retaining registered nurses continues to be a challenge for us and we have put in place a wide range of measures to increase the number of registered nurses in post and reduce our reliance on agency staff.

“We have made it our priority to invest in the development of our staff,” she said. “We have a preceptorship programme already in place for newly qualified nurses and are have a successful development pathway for healthcare assistants working to become more senior assistant practitioners.

“We are already seeing some improvements but we know we need to do more and over the coming weeks we will be developing additional measures,” she said. “Our staff continue to work hard and often in challenging conditions.”

On a positive note, the CQC revealed that staff morale was “greatly improved”, with staff talking about how the culture of the trust had changed and most people felt this was now much more open.

However, the CQC did flag up several other areas where improvement was still needed, in addition to recruitment and retention.

For example, the CQC said that the trust was not always able to provide a bed on an acute ward for patients who had a clinical need for this service, and some inpatient environments were of a poor standard.

Jane Ray, the CQC’s head of hospital inspections for mental health, said: “The inspection took place at a time when the trust was going through considerable strategic change.

“It was in the process of transforming its adult inpatient services to reduce the number of people needing inpatient beds,” she said. “This involved increasing services in the community.

“Since the previous inspection, the trust had created a single point of access, enhanced assessment and treatment teams and a new primary care mental health service,” she noted.

“The trust was also working to improve existing care and the processes that support this,” she said. “We were able to see many areas of improvement, however, there was more to do.”

In addition, Ms Ray highlighted that there had been several changes in the leadership of the trust, including a new chief executive.

“The senior leadership team at the time of the inspection was capable and had the potential to make the necessary improvements, although there was a great deal to be done,” she said.

West London Mental Health NHS Trust provides mental health services to a population of 700,000 people for local services and a wider population for specialist services.

Since the last CQC inspection, the trust has started to offer integrated physical and mental health services. This has included “home ward” intermediate care services and health promotion throughout Ealing.

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