West London NHS Trust

Updated 27 March 2024

Our rating of the trust stayed the same. We rated it as good because:

• We rated the trust as good for effective, responsive and well-led. Caring was rated as outstanding and safe as requires improvement. We rated three of the four core services we inspected this time as good and one as requires improvement. In rating the trust, we took into account the previous ratings for the core services not inspected this time.
• We rated well-led for the trust overall as good.
• The overall rating for West London NHS Trust remained as good overall and it was evident that many improvements had been made. Leaders had completely revitalised much of the trust infrastructure, such as information governance, repairs and maintenance, complaints investigations, data quality and performance monitoring, which underpinned the clinical work. This put their clinical leadership teams in a strong position to develop their services further and improve consistency in order to achieve their ambition to become an outstanding trust.
• The trust had sustained and, in many areas, enhanced the core service improvements required following our last comprehensive inspection in 2018. In three of the four core services we inspected this time we found that all the requirements and recommendations from our previous inspections had been rigorously addressed with board level monitoring.
• Where problems remained, they were linked to individual teams, rather than issues with the trust’s systems or processes.
• The trust had particular strengths in the following areas; leadership at all levels, the positive culture of the organisation, the strong patient-focus, partnership working, pro-active engagement and co-production with patients, carers, staff and other stakeholders, creative recruitment and retention, training and development opportunities for staff and timely and effective completion of action plans and similar.
• Patients and carers spoke well of staff.
• Staff told us the trust had become a kinder place to work and they had confidence in their leaders who were very visible. The trust had implemented new practices to root out any accidental or deliberate unfairness to staff.
• The new Broadmoor Hospital demonstrated a bespoke and well-designed clinical environment for patients and staff and patient transfers to the new building had been without fault.
• There were several areas of outstanding practice which are detailed in this report.

However:

• The trust still has a number of sites which are not fit for delivering modern health services.
• The trust had not paid sufficient attention to its child and adolescent mental health ward (The Wells Unit) whilst it was waiting for a decision from commissioners and this had led to a drop in standards. The trust gave six months’ notice to NHS England to end the contract shortly after our site visit concluded.
• Some specific safety issues had not been resolved within certain inpatient wards, although the trust was working to address them.
• The trust had not yet fully implemented the accessible information standard.

Updated 9 February 2017

We rated community health inpatient services as good because:

• Magnolia ward provided support to patients so they could avoid an acute hospital admission, be supported with their rehabilitation and ideally regain enough independence to return home.

• Staff were very caring and provided support in a sensitive manner that met the needs of each patient and their carers.

• Magnolia ward was a safe and clean environment that was well maintained.

• Magnolia ward had a skilled multi-disciplinary team that considered the needs of each patient and provided appropriate care and treatment. Medicines were managed well on the ward.

• Staff were mindful of potential risks for patients, such as the risk of falls and worked to mitigate these as far as possible.

• Staff on the wards worked well with other professionals such as GPs and social services to ensure patients needs were fully met.

• Staff on the ward were skilled and had opportunities for learning and development.

However:

• Staff needed access to regular individual supervision that was recorded. They also needed to attend regular team meetings.

• More work was needed on staff engagement, especially while the service was going through ongoing review and change.

• Managers needed to have clear performance information, well presented to facilitate their management of the service.

Patient records needed to be reviewed to move away from using paper records.

Updated 23 June 2022

We carried out this announced focused inspection to check on the safety and quality of the service at Broadmoor Hospital and whether improvements had been made as a result of the requirement notices issued at our previous inspection in June 2018. In December 2019 the hospital moved into purpose-built accommodation on a new hospital site. In addition, four existing wards were retained and incorporated into the new hospital. Unfortunately the patients had not yet fully benefitted from all the facilities and communal areas due to restrictions on patients mixing as a result of COVID-19 but the new ward areas had played a vital role in preventing the spread of infection as all patients now had ensuite bathrooms and easy access to fresh air.

Our rating of the service stayed the same. We rated them as good because:

The trust had successfully opened the new hospital and the patients had transferred across without incident.

Staff and leaders had worked hard to minimise the impact of the COVID-19 pandemic on the quality of care and treatment and patient safety. They had carefully explained the need for infection prevention and control measures to patients and received good cooperation when additional restrictions had to be imposed. As a result COVID-19 outbreaks had been well-contained.

Staff and leaders did their best to minimise the impact of national staff shortages on care, treatment, safety and security. Numerous recruitment initiatives were ongoing and the impact on patients and existing staff was kept under constant review.

Staff treated patients with compassion and kindness. Patients received exemplary care and treatment that was tailored to meet their individual needs and preferences. Staff spoke about patients with hope and had an excellent knowledge of each patient and the best way to respond to and interact with them.

Patients felt respected and valued as individuals and were empowered as partners in their care, both practically and emotionally. There was a strong person-centred culture and staff put the patients’ needs at the heart of care and treatment.

Staff provided care that was personalised, holistic and recovery-oriented. They respected patients’ privacy and dignity. Staff were proactive in involving families and carers in patient care, when appropriate. Staff understood how to protect patients from abuse and the hospital worked well with other agencies to do so.

Co-production with patients was central to the service. Staff were committed to ensuring the patient voice was embedded in decisions about the hospital, when appropriate. Their input was valued and patients had a significant influence on service improvement through patient forums, research and feedback.

The new hospital had been designed with full regard to the physical and emotional well-being of patients and safety for all. All patients, staff and carers described the new facilities as outstanding. Wards were clean and well maintained.

Staff proactively assessed and managed risks to patients well and achieved the right balance between maintaining safety and providing the least restrictive environment possible to facilitate patients’ recovery. One ligature risk in some garden areas had been identified but required further action and the hospital attended to this immediately. Staff followed best practice in anticipating, de-escalating and managing distressed behaviour. The hospital was piloting the use of a long-term segregation pathway which had resulted in segregated patients spending more time out of their bedrooms.

Staff had training in key safety skills and managed safety incidents well. The hospital had clearly defined and embedded systems, processes and policies to keep people safe.

Managers investigated incidents and complaints and shared the lessons learned with staff to minimise the risk of them happening again.

Staff from different disciplines worked together professionally and with mutual respect to achieve the best possible outcomes for patients using the service. They provided a range of care and treatment interventions consistent with national guidance on best practice.

There was a multi-disciplinary approach towards every aspect of the patient journey from admission to discharge. Staff were committed to partnership and collaborative working in order to deliver holistic care. Teams collaborated with each other and with external agencies.

Staff reported the hospital strongly promoted equality and diversity in its work with patients. The hospital had set up a Black, Asian and minority ethnic (BAME) carers forum to specifically address concerns raised as a result of the Black Lives Matter movement. Work was progressing with cultural formulation and cultural care plans.

The hospital had a positive, open and inclusive culture which centred on improving the quality of care patients received through empowerment and involvement. Throughout our inspection we saw that staff promoted the values of the trust in all aspects of their work and spoke about the patients being at the heart of the service.

Managers demonstrated that they were very experienced, knowledgeable and highly skilled in their roles. They have been consistently open and honest with the Care Quality Commission about their successes and the challenges within the service during inspections and routine engagement.

The hospital collected, analysed, managed and used information well to support all its activities. Managers had access to the information they needed to provide safe and effective care and used that information to good effect.

However:

Whilst the hospital had made many improvements since our last inspection in June 2018, there were still high vacancy levels for registered nurses. This impacted on the care and treatment that patients received, affected staff morale and staff ability to participate in supervision sessions and team meetings. Staff recruitment campaigns and efforts to retain staff were comprehensive and ongoing.

Some ligature risks required further mitigations on Embankment, Victoria and Chepstow wards.

For some patients, multiple medicines were prescribed to manage the same health condition. Where patients had ‘when required’ oral and intramuscular medicines prescribed the care plans did not detail which medicine was preferred in which circumstances.

On Kempton Ward some staff had not completed the knowledge and understanding framework required to work with people on the personality disorder pathway, so may not have been fully equipped for their roles.

Patients on Kempton Ward had reduced access to psychology and occupational therapy.

Not all staff were familiar with the role of the Freedom to Speak Up Guardian or the process for raising concerns.

Updated 2 June 2020

Our rating of this service improved. We rated it as good because:

• The service had made the required improvements since our last inspection in November 2016. This included ensuring environments met young people’s and visitors’ needs, ensuring medical equipment worked, ensuring staff learnt from incidents and improved staff engagement across the children and adolescent mental health service.

• The service provided safe care. Clinical premises where patients were seen were safe and clean. The number of patients on the caseload of the teams, and of individual members of staff, was not too high to prevent staff from giving each patient the time they needed. Staff managed waiting lists well to ensure that patients who required urgent care were seen promptly. Staff assessed and managed risk well and followed good practice with respect to safeguarding.

• Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment and in collaboration with families and carers. They provided a range of treatments that were informed by best practice guidance and suitable to the needs of the patients. Staff engaged in clinical audit to evaluate the quality of care they provided.

• The teams included or had access to the full range of specialists required to meet the needs of the patients. Managers ensured that these staff received training, supervision and appraisal. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation.

• Staff understood the principles underpinning capacity, competence and consent as they apply to children and young people and managed and recorded decisions relating to these well.

• Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.

• The criteria for referral to the service did not exclude children and young people who would have benefitted from care.

• The service was well led, and the governance processes ensured that procedures relating to the work of the service ran smoothly.

However:

• Some pathways within the service were not always easy to access. Some young people and families waited a long time for an assessment or to start treatment. In Ealing, the wait for 55 young people and their families to access a neurodevelopment assessment had been in excess of three years.

• Staff could not always access electronic records easily. We noted during the week of the inspection that there was a delay in staff being able to access documents that had been uploaded. Staff, particularly in Hounslow, commented on how the delays caused disruption to their work.

• Across the teams we visited, staff were recording children and young people’s care and treatment plans and risk information in different parts of the trust electronic system. This meant there could be delays in accessing key information across teams.

• Staff identified as having responsibilities to develop user involvement felt they did not have enough protected time to complete this work.

• Some line managers were not confident in using the electronic system to upload supervision records and continued to maintain paper supervision records. This meant that data regarding the frequency and overall compliance with supervision was not accurate.

Updated 9 February 2017

We rated community-based mental health services for older people as good because:

• At our last inspection in June 2015, we found that nurse caseloads in Ealing and Hounslow were higher than the target of 60 set by the trust. At this inspection, we found that the trust had taken action, in partnership with other agencies, to develop the service. At this inspection, caseloads in Ealing and Hounslow had started to reduce due to the fact that cases were being transferred to five new link workers in Hounslow and seven new link workers in Ealing.
• All the CIDS teams operated from safe and suitable premises. The trust had improved the waiting area for patients and carers at Ealing east since our June 2015 inspection.

• Patients and carers were able to access information and leaflets in languages other than English. This had improved since our June 2015 inspection.

• CIDS teams were well staffed, with agency staff covering vacant posts. Permanent and agency staff were skilled and experienced. Managers ensured staff received one to one support and training to carry out their work role. Staff were positive about their work and the support received from their managers.

• Patients and carers were fully involved in assessments of need and care and treatment processes. Carers and patients gave us very positive feedback about the sensitivity and professionalism of staff. Carers spoke very highly about the support staff gave them. They said staff treated them and patients with dignity and respect. Care and treatment plans complied with best practice guidance. The CIDS offered a range of psychosocial interventions to patients and carers. The service supported care homes in relation to managing behaviour which challenged staff.

• Staff knew how to recognise abuse and neglect. They raised safeguarding alerts when necessary. Staff understood and put into practice the key principles of the Mental Capacity Act.

• The Ealing and Hounslow teams were accredited by the Royal College of Psychiatrists in January 2016. The CIDS included a clinical trials unit. This helped to promote a learning culture within the service and enabled patients to participate in research if they wished.

However:

• Although nurse caseloads in Hounslow and Ealing CIDS had started to reduce, in some instances caseloads were still high, for example at 90 in one instance.

• The site used by the CIDS team at Hammersmith and Fulham was leased by the trust from another organisation. The trust had identified issues with the safety and suitability of the premises and was in communication with the owner of the property. However, at the time of the inspection there was not an agreed action plan in place to resolve these issues.

Updated 21 December 2018

Our rating of this service improved. We rated it as good because:

• Care professionals in the trusts single point of access worked closely with the health based places of safety and crisis assessment and treatment teams to ensure patients had access to services in a timely manner. For example, the health-based places of safety were open to young people under the age of 18, as well as adults and they did not turn away people who presented as intoxicated. Also the CATTs were now operating 24 hours a day.
• The crisis services worked closely with other stakeholders including the police, local authority AMHP leads and psychiatric liaison teams to review services and address challenges in joint working.
• Staff monitored patients’ physical health needs and ensured that any issues identified were addressed appropriately. Each CATT had specific physical health clinics to ensure that basic checks could be carried out and this information was recorded. In the health-based places of safety, each patient had a physical health check on admission and their physical health was monitored while they were awaiting an assessment. This was an improvement since our last inspection.
• Staff in the CATTs offered a range of brief interventions and support groups which enabled them to provide care and treatment to a wide range of people. This was in line with recommendations in national guidance.
• Staff teams were highly motivated and morale was strong in the teams we visited. Staff were positive about the support they received from managers and felt they were supported to develop, personally and professionally by the trust.

However:

• In the health based places of safety, staff had not ensured that key information relating to the operation of the service was effectively captured and that other systems were working well. For example, data was not being collected accurately, such as the time the patient arrived (and therefore their length of stay) or when the service was closed due to staff shortages. Other essential records such as physical health observations and a record of patients being told their rights were not stored consistently in each service. Environmental audits and ligature risk assessments had not been completed and this was not identified until the inspection visit although this was addressed immediately. Incidents had been reported but were assigned to wards rather than the health based places of safety themselves which hindered oversight by managers and potentially, learning.
• In the crisis assessment and treatment teams (CATTs) staff did not always keep appropriate records of patients’ care and treatment. Risk assessment documentation in Hounslow and Hammersmith and Fulham CATTs did not reflect the current patient risk. Some care planning documentation in all the CATTs had not been completed comprehensively to reflect the care that was being provided to patients.
• Medication in the CATTs was not consistently reconciled which meant that medical and nursing staff in the teams did not always liaise with GPs and inpatient wards to ensure that the prescriptions and the medicines received by patients were consistent. As a result there were errors on a few prescription charts.

Updated 21 December 2018

Our rating of this service improved. We rated it as outstanding because:

• Leadership within the service was highly effective. Leaders at all levels were supportive of staff and visible within the service. They supported each other to deliver the best possible service for all patients. Staff were supported to develop their leadership skills through a range of creative training, coaching and mentoring opportunities. This service had greatly improved since its inadequate rating at our first comprehensive inspection in 2015 and this confirmed that leaders had good skills and knowledge.
• There was a strong ethos around patient involvement and it was integral to the way the service was provided. Patients were at the heart of any decision making about the way the service was delivered and in respect of their own care and treatment. We heard examples of changes that had taken place as a direct result of patient feedback.
• Patients were inspired to have hope in their recovery by staff members and recovery and involvement (HOPE) workers. The service was focused on rehabilitation, with patients offered extensive opportunities for vocational training, education and personal development. Staff were committed to this approach. Patients told us that this was important to them and helped them progress through towards discharge.
• The service provided individual care which reflected the holistic needs of patients. This meant that as well as needs relating to physical and mental health being assessed, monitored and reviewed, the patients’ social, cultural and spiritual needs were well met.
• Staff had an excellent understanding of patients’ needs and this enabled them to take positive risks to aid patients’ recovery. For example, one ward escorted all its patients to a leaving party for one patient in the hospital café. The patients concerned said they appreciated the trust put in them and it encouraged them in their recovery.
• The service had safely reduced the use of restrictive practices. De-escalation techniques were used well; rapid tranquillisation of patients had only been required on eight occasions in one year. There were fewer blanket restrictions in place and both patients and staff were better informed about those that were in place and the reasons for them. For example, previously, in the Tony Hillis wing, there had been a ‘one-size fits all’ approach to searches on return from unescorted leave, even though the wing accommodated both medium and low secure wards. Now patients on the low secure wards received searches in keeping with that level of security.
• Patients had access to a full range of physical healthcare professionals at the on-site primary healthcare centre, which included a fully equipped dental surgery. Patients could be seen on the ward if they could not visit the centre so no one was disadvantaged. Patients were supported to make healthy lifestyle choices, such as using the gym facilities and selecting healthy snacks.
• Plans were well underway to move some wards in the least suitable building to a newly refurbished building and to make sure those wards that remained behind also had improved facilities. Repairs and maintenance had not been put on hold in the interim period and were taking place throughout our inspection.

However:

• Although all shifts were covered and recruitment and retention had improved, there were insufficient permanent nursing staff to ensure proper continuity of care for all patients.
• Some records of seclusion were not comprehensive and did not record all the observations which had taken place to show staff were following the Mental Health Act Code of Practice.
• A few patients in the women’s service may not have had all their physical healthcare needs met as on one ward diabetes care plans were not in place for four patients with the condition.

Updated 21 December 2018

Our rating of this service improved. We rated it as good because:

• There were significant improvements in the culture of the service and the responsiveness of leaders which had had a positive impact on staff morale and the quality of the service.
• Staff took account of patients’ individual needs and preferences and treated patients kindly. They took care to make sure patients understood their care and treatment and brought in independent advocates if they had doubts about the patient’s ability to make a decision for themselves.
• The wards were bright and cheerful and, although the ward layouts were not ideal, action had been taken to make the most of the environment and to improve safety.
• Patients received a thorough assessment of their mental and physical health and were monitored for any deterioration. Care plans and risk assessments were in place for all patients.
• Medicines were prescribed appropriately and at the lowest therapeutic dose and prescribers took full account of possible medicine interactions.
• Staff were up-to-date with their mandatory training and were able to access other training opportunities too. They were aware of their responsibilities in relation to the Mental Health Act, the Mental Capacity Act and safeguarding children and adults.
• A range of therapeutic activities was available across the service.
• Families and carers were well-supported by staff and, when appropriate, fully involved in meetings to discuss the patient’s care and treatment.
• Patient information was kept securely, but it was accessible to relevant staff members.
• Ward managers could access timely information about the performance of their ward so they could attend to any emerging issues.
• All the staff we spoke with were committed to ongoing improvement of the quality of the services they provided.

However:

• Episodes of restraint were not always recorded, so managers could not effectively monitor its use.
• The service found it hard to recruit registered nurses so there were a significant number of vacancies being covered by bank or agency staff.
• There was not equal access to therapeutic activities across all the wards.

Updated 2 June 2020

We rated this service as good because:

The leaders of the service had the vision, capability and drive to ensure that care pathways for women with perinatal mental health continually improved.

•Patients and partner organisations reported that staff were skilled, caring and motivated.

•Partnership work with other agencies was well-developed at both the strategic and operational level. The service led on work with other organisations to improve the care pathway. There were clear operational policies and referral systems and working relationships were positive.

•Staff organised pre-birth planning conferences which were very effective in ensuring that patients with severe and enduring mental health problems and their infants received holistic care and support.

•Staff were fully aware of the diverse cultural background of patients. They worked sensitively with patients and their support network to provide effective support. Patients said their views were always respected.

•The service had a proven track-record of successful and creative work in partnership with experts-by-experience to develop the service.

•The service responded promptly to crisis situations and managed risks effectively. Staff ensured that any safeguarding concerns were acted on.

•Staff reported an open and supportive team culture with many opportunities to learn and develop their skills.

Updated 2 June 2020

Our rating of this service improved. We rated it as good because:

• The service provided safe care. The ward environments were safe and clean. The wards had enough nurses and doctors. Staff assessed and managed risk well. They minimised the use of restrictive practices and usually followed good practice with respect to safeguarding.

• Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice.

• The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.

• Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.

• The service managed beds well so that a bed was always available locally to a person who would benefit from admission and patients were discharged promptly once their condition warranted this.

• The service was well led and the governance processes ensured that ward procedures ran smoothly.

However:

• Improvements were needed to ensure that patients who received rapid tranquilisation had appropriate physical health checks completed afterwards.

• Whilst the service had systems and processes in place to safely prescribe, administer, record and store medicines, further work was needed to ensure staff always followed these.

• Some staff on Askew Ward were not using personal alarms. A few staff on this ward told us they did not feel safe on the ward and managers were investigating their concerns.

• Further work was needed to fully embed the training in safeguarding staff had received into practice.

• Improvements were needed in how staff on Kingfisher Ward reported incidents where the patient had been restrained.

• The current audit programme had not identified issues with medicines, administration of rapid tranquilisation, reporting of restraint and Mental Health Act documentation that we found during the inspection.

• Improvements were needed to ensure that all staff discharged their responsibilities under the Mental Health Act well. For example, staff did not always update records to show that patients had been explained their rights in a timely manner.

Updated 14 July 2022

West London NHS Trust provides a range of community based mental health services for adults of working age throughout the London boroughs of Ealing, Hammersmith and Fulham and Hounslow. Some adults receiving services may be subject to conditions under the Mental Health Act 1983.

We visited a sample of the locality teams in each borough. We inspected a combination of early intervention services and Mental Health Integrated Network Teams (MINT).

The Early Intervention Service (EIS) provides specific support and treatment for patients experiencing a first episode of psychosis. The EIS teams had been established for some years and subsequently expanded their remit to provide a service to people between the ages of 12 and 65 years, over a three-year period.

The MINT teams had recently been set up. The MINT model focuses on supporting people’s mental health, alongside their physical health and social needs, providing joined-up, community-based care tailored for each individual. MINT had been developed to reflect NHS England’s Long Term Plan for Mental Health and the Community Mental Health Framework for Adults and Older Adults. MINT supports adults aged 18+ who need a non-emergency response to a mental health issue. The MINT model expands the traditional community mental health model; under MINT, therapeutic intervention and support is accessible to a much wider range of people than was previously the case.

Our rating of the service stayed the same. We rated the service as requires improvement overall but inadequate for safe because:

• The main concerns identified during the inspection were in relation to the MINT service.
• The service had significant staffing issues across the teams. Overall vacancy rates in the MINT teams ranged from 25% to 35%. Staff told us that high vacancies and turnover rates made it difficult to provide a consistent, high quality service. In line with the new MINT model not all patients had or needed a care co-ordinator which may result in a risk of patients not having their needs met due to the high level of demand in the service. In one team a member of staff had left, and the patients who required a care co-ordinator had not been reallocated which meant they might not be appropriately supported. Patients told us they had experienced changes in their care co-ordinator.
• Risk assessments for some patients were brief and did not always explain how a risk was mitigated. There were examples of where new risks had been identified, for example a deterioration in their mental health, but these had not been followed up in a timely manner.
• The MINT did not meet trust target times for seeing patients from referral to assessment and assessment to treatment. Delays to patients accessing treatment were significant. Staff told us that these delays were due to increased demand which was 40% higher than anticipated and staff vacancies. Data produced by the trust was unreliable so it was not always possible to identify how many patients were waiting for specific treatments and how long this was taking.
• Staff in most teams did not follow clear personal safety protocols, including for lone working. There were multiple systems in use for lone working; this meant that the process could be confusing and that staff may record visits on systems that were not being monitored.
• Staff within the MINT teams were currently using two electronic patient record systems. In some cases, staff had to make duplicate entries on both systems which was time consuming, over-complicated and caused frustration for staff. At the time of the inspection the quality of data produced by the MINT teams did not facilitate sufficient oversight of outcomes and performance.
• Some clinical premises we visited were not well maintained and one did not have panic alarms fitted.
• Supervision rates for March 2022 in the MINT ranged from 17% to 33%. The supervision rates were better in the EI teams, however, there were still months when rates of supervision were low. There was the potential for staff to feel unsupported as a result.
• Some staff training modules also had a low compliance rate. This reflects the trust’s decision to suspend courses which could only be offered through face to face teaching during the last two years of the Covid-19 pandemic, which led to a backlog of compliance. The trust told us that this issue is now being addressed. The courses with the lowest compliance rates were breakaway training, promoting safe and therapeutic services (PSTS). For example, the compliance rate was 43% for all staff for breakaway training. Therefore, there was a risk that staff may not be appropriately trained and may not respond appropriately to incidents.

However:

• The EIS teams which were longer-established were providing a good level of care and were meeting the needs of their patients. Their prompt response to referrals had been confirmed by the National Clinical Audit of Psychosis (NCAP).
• Staff provided a range of treatments that were informed by best-practice guidance and suitable to the needs of the patients. The service provided care and treatment including medication, psychological therapies, psycho-social education and signposting to social opportunities or specialist groups. Compared to the remit of the former recovery teams, the range of needs the MINT teams worked with was very broad.
• The teams included or had access to the full range of specialists including peer support workers who met the needs of the patients. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation. The trust part-funded some local third sector organisations so people could receive support tailored to their specific needs.
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
• Overall, feedback from patients was very positive about the care and treatment they received from staff. Patients said that staff were kind and caring and they felt involved in their care.
• Although areas of concern were identified during the inspection, senior managers were already aware of these issues which had been identified through the governance processes within the trust and were working to make the necessary improvements.

There are nine MINTs across the London boroughs of Ealing, Hammersmith & Fulham and Hounslow. Each MINT is aligned to one to three primary care networks, which are made up of a cluster of general practitioner surgeries. At the time of inspection there were nine MINTs, three teams per borough.

CQC previously inspected this core service pre-MINT in September 2018 and issued an overall rating of requires improvement. During this inspection we rated this core service as requires improvement overall and requires improvement for the safe and responsive domains.

This inspection was short notice announced (staff knew we were coming) to ensure that everyone we needed to talk to was available.

The CQC inspection team that inspected the service included four CQC inspectors, two inspection managers, one specialist advisor who was a registered mental health nurse and one expert by experience who contacted patients and carers on the telephone. Before the inspection visit, we reviewed information that we held about these services and information requested from the trust. During the inspection visit, the inspection team:

• visited six services and looked at the quality of the environment
• spoke with eight patients and six carers
• spoke with six team managers
• spoke with 44 other staff members including consultant psychiatrists, registered mental health nurses, clinical psychologists, counselling psychologists, mental health associates, occupational therapists and social workers
• attended and observed seven meetings, which included a zoning meeting, triage meeting and a meeting with local primary care leaders
• reviewed 24 care and treatment records
• reviewed medicines management
• looked at a range of policies, procedures and other documents relating to the running of the service

You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

What people who use the service say

Overall, feedback from patients was very positive about the care and treatment they received from staff. Patients said that staff were kind and caring and that they felt involved in their care. Most patients we spoke to had received services from the trust for a number of years. They felt that there had been a huge improvement since the MINT transformation. The only issue occurred during the transition from the old system to MINT. Most patients told us they were not informed of the change and did not immediately understand the new model. Patients told us that now everything was very clear and positive with effective interventions and good quality of care. However, some patients also fed back that there had been multiple changes to their care-coordinator.

Feedback from carers was positive about the care and treatment family members received. Relatives told us that staff were supportive and they kept them involved in their loved one’s care.