• Oxleas FT was forced to close a waiting area for mental health patients after CQC found people waiting for days for admission to a bed
  • The Care Quality Commission threatened the provider with possible enforcement action if it did not address concerns
  • In response the trust has closed the unit, but its chief warns mental health patients will wait longer in ED as a result

A mental health trust has closed its patient waiting area due to a threat from the Care Quality Commission, which its chief has said will mean people waiting longer in A&E.

Oxleas Foundation Trust has been forced to close its pre-admission waiting area in response to a warning from the CQC, which found patients waiting for days in the unit before admission to a bed.

The pre-admission suite, intended as a short term waiting area, was opened in 2017 to try to reduce numbers waiting for a long time in emergency departments in its patch, run by King’s College Hospital Foundation Trust and Lewisham and Greenwich Trust.

In a letter on 21 August, the CQC warned Oxleas it could face enforcement action if it did not address concerns including patients regularly waiting more than 12 hours in the pre-admission area.

According to the letter, published by the trust, between January and July 2019, 151 patients waited for longer than 12 hours, of these 64 patients waited for over 24 hours.

Between March and July, 12 patients waited between three and eight days in the unit.

According to the trust’s board papers the average length of stay in the PAS was below 12 hours until May 2019. However, waits increased after April due to the private sector, which the trust uses for overspill beds, running out of capacity nationally.

Other concerns highlighted in the CQC’s letter, included:

  • A risk patients are unlawfully deprived of their liberty because the exit and entrance to the area was locked;
  • The unit was not comfortable environment for patients waiting hours for admission;
  • The unit did not have suitable facilities for personal hygiene;
  • There was no means of separating male and female patients;
  • The food and drink provided to the patients was very limited;

In response, the trust’s chief executive Matthew Trainer informed the CQC it would close the unit on 27 August as it “cannot sufficiently mitigate the risks around length of stay, or around privacy, dignity and comfort, to the extent to which we can offer you assurances that the PAS would meet the standards that CQC or Oxleas expects”.

However, the trust chief’s letter added: “The [pre admission suite] PAS was opened to address the problem of patients waiting for informal [non-sectioned] admission who were otherwise experiencing very long stays in ED, particularly at Queen Elizabeth Hospital in Woolwich, and at the Princess Royal University Hospital in Bromley.

“The closure of the PAS will lead to patients waiting for longer in these EDs.”

To mitigate this, Mr Trainer said trust, would direct staff booked to work in the PAS unit to work in its liaison and home treatment support teams; and explore whether Queen Elizabeth Hospital, run by Lewisham and Greenwich Trust, has alternative areas for patients awaiting a mental health bed.

Mr Trainer’s letter added: “These short-term actions will be developed into a broader package of measures to remodel our urgent and emergency care service. It is likely that our response will involve the development of a range of new services, some of which will need capital investment and the building of purpose-built environments at Oxleas and in our acute trusts.

”I met the CEO of Lewisham and Greenwich Trust on 15 August and have offered to pay the capital costs of building a dedicated mental health admissions unit on the Queen Elizabeth site, in recognition of the weaknesses in the current model.”

It continued: ”In the past month I have visited the mental health units which support the EDs at Kingston and North Middlesex acute hospitals, and the Lotus Suite psychiatric decision unit at Springfield Hospital to try to learn from good practice elsewhere in London. These visits have reinforced that the PAS is not a suitable environment for informal patients, made clear that our aspirations around 12-hour stay are significantly out of line with what other hospitals have been able to deliver, and have given us ideas about how Oxleas can respond to your concerns by developing a model that is among the very best.” 

As a result of the trust’s decision to close its PAS, the CQC said it would not take any further action.

HSJ Transforming Mental Health Summit

The HSJ Transforming Mental Health Summit, taking place at the Hilton Leeds from 28-29 November 2019, unites 120+ senior figures from across the NHS, local authority and wider mental health service delivery landscape to discuss how to realise the visions of the NHS long-term plan and ensure successful local implementation of national priorities.

Held under the Chatham House Rule, attendees will quiz Paul Farmer and other national figures on general policy direction and co-develop solutions to their local challenges with NHS and local government colleagues from across the country. The summit is free to attend for senior NHS and public sector figures.

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