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NHS trust warned ‘significant and immediate’ improvements needed in mental health services

The Care Quality Commission (CQC) has issued the Freeman Hospital and the Royal Victoria Infirmary with a warning notice after inspectors found failings in the hospital’s assessment and management of mental health risks, as well as issues complying with mental health legislation.

28/02/23

NHS trust warned ‘significant and immediate’ improvements needed in mental health services

Inspectors have served Newcastle upon Tyne Hospitals NHS Foundation Trust with a warning after an unannounced focused inspection found issues with poor mental health care.

Looking at urgent and emergency care and maternity services at the Freeman Hospital and the Royal Victoria Infirmary (RVI) last November and December, inspectors examined the quality and safety of care provided to people with a mental health need, a learning disability or autistic people across all of these services.

Following the inspection, CQC warned that the trust needed to make significant and immediate improvements in the quality of care being provided, including its assessment and management of mental health risks, as well as compliance with the Mental Capacity Act and Mental Health Act. The warning notice also requires the trust to ensure people with a learning disability and autistic people receive care which meets the full range of their needs.

As this was a focused inspection which did not include all of the key lines of enquiry for each key question in each core service, CQC did not re-rate services following this inspection and the trust remains rated as outstanding overall, however inspectors will be returning to the trust to carry out an inspection of these services in due course to ensure the trust has taken the necessary action to improve.

The inspection found that the trust did not have effective systems and processes to ensure people consented to their treatment, or ensure staff adhered to the requirements of the Mental Capacity Act.

In all services staff had not undertaken and recorded assessments of mental capacity and decisions made in people’s best interest for people subject to the Deprivation of Liberty Safeguards. Staff knowledge and awareness of the Mental Capacity Act was also ‘inconsistent’ between different wards and services.

Inspectors said that staff did not maintain complete and appropriate records to evidence adherence to the Mental Health Act. The records of people detained under the Mental Health Act did not consistently include copies of detention papers, or proof of authorised leave under Section 17 of the Act, or papers required to authorise medication and treatment under the Act.

There were also multiple examples of gaps in people’s records in relation to mental health, mental capacity and learning disabilities. This included details of additional needs and reasonable adjustments, applications for Deprivation of Liberty Safeguards, mental capacity assessments and best interest decision, and forms to evidence compliance with the requirements of the Mental Health Act. The inspection team was supported by trust staff to review people’s records and our inspection showed staff repeatedly struggled to find the evidence required.

Inspectors did find, however, that staff across the trust were committed to providing compassionate, caring interactions for people with a mental health need, or a learning disability or autism.

Sarah Dronsfield, CQC Deputy Director of Operations in the North, said that staff were working hard under pressure, and having kind and caring interactions with people, but that the trust didn’t have effective systems and processes in place to ensure people with a mental health need, a learning disability or autistic people received care that met their needs.

“Across all services we found staff hadn’t carried out and recorded assessments for people who presented with a mental health need. For example, in the trust’s emergency department, we found staff hadn’t completed mental capacity assessments or recorded decisions made about people who had presented with a mental health need, and at times they were prevented from leaving the department. The trust must make improvements to ensure staff provide care that is respectful of people’s individual rights to keep them safe and ensure they receive the appropriate care relevant to their needs.

“Additionally, the trust needs to improve the quality and experience of people with additional needs or where reasonable adjustments are required due to people’s learning disabilities. We found staff were strongly focused on providing care to meet physical health needs rather than a holistic approach to care that met all of their needs.

“Following this inspection, we wrote to the trust to share our concerns and we’ve asked the leadership team to take immediate action to improve the quality and safety of services.”

Responding to the report, NHS leaders pledged to continue to improve how the mental health care needs of patients are being met across Newcastle Hospitals.

“This inspection has provided us with the opportunity to review our policies, processes, and training so we can better support and prepare staff to meet the healthcare needs of our patients,” Maurya Cushlow, Executive Chief Nurse at the trust said.

“Delivering the best possible care to all our patients remains our top priority, and I want to thank staff for their incredible hard work. We are committed to making trust-wide improvements until we – and the CQC – are confident that we meet and demonstrate the required standards.”

CQC says it will continue to monitor the trust and will return to check on progress to ensure improvements have been made and embedded.

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