PERFORMANCE: Low staffing levels and an ‘unacceptable variation’ in the use of restraint at West London Mental Health Trust has caused the Care Quality Commission to call for the trust to make improvements.

During the inspection in June the regulator was most concerned by the forensic and high secure services, which they gave “inadequate” ratings. The forensic services have recently been the subject of an employment tribunal and have seen significant upheaval at senior level over recent years.

Inspectors found that across the trust there was “unacceptable variation in the use of restraint, including a high use of prone restraint”.

Inspectors concluded the trust had a “substantial” problem with staff recruitment and retention, and there were too few employees to “consistently guarantee safety and quality in the forensic services, high secure services and community based mental health teams”.

Broadmoor Hospital

The CQC said staff at Broadmoor Hospital should ‘real concern’ for patients

There was a low morale among staff and “poor engagement” with frontline staff in some of the services.

In the forensic services staff had concerns about a “longstanding culture of bullying linked to race, religion and culture”.

Some patients were being prescribed medication at higher levels than the recommended dose.

The Lakeside Mental Health Unit at the trust was “not considered fit for purpose” because it was “compromising patients’ privacy and dignity”.

In a six month period restraint was used 432 times and in 179 of these incidents patients were restrained in the prone position.

However, inspectors found the low morale problem was not endemic and in many services staff were “very positive” about the trust. They found in most places that “care was delivered by hard working, caring and compassionate staff”, particularly at the high security hospital Broadmoor where staff showed “real concern” for patients.

Chief executive Steve Shrubb, who will be leaving the trust in November and announced his departure shortly after the inspectors visited, said: “The inspection was rigorous and the CQC’s assessment of the trust is very fair. They recognised our staff’s hard work and compassion, many of our services were found to be good, and all of our services were found to be caring and staff should feel rightly proud of this.

“However, we know that we have more work to do and need to deliver improvements if we are to deliver consistently high quality care to every single patient. I apologise to patients and their families if they have received poor care from us.”

Paul Lelliott, deputy chief inspector of hospitals and lead for mental health, said: “The trust is developing a leadership team which has a good insight into the challenges they face. However, we believe that our inspection has identified that the scale and speed of change that is needed is very significant. They must address our findings as a matter of urgency.  We will be working with the trust to agree a plan to assist them in improving their standards of care and treatment.”