Warning notice issued to Newcastle's RVI and Freeman hospitals over mental health care
A warning notice has been issued to a hospital trust after inspectors said care given to people with mental health needs, learning disabilities or autism needed to improve.
The Care Quality Commission (CQC) inspected medicine, surgery and critical care at the Freeman Hospital and the Royal Victoria Infirmary (RVI) in Newcastle, as well as urgent and emergency care and maternity services at the RVI.
This was to look at the quality and safety of care provided to people with a mental health need, a learning disability or autistic people across the services.
It has now issued the Newcastle Hospitals NHS Foundation Trust a warning notice to make "significant and immediate" improvements to the quality of care being provided.
Sarah Dronsfield, CQC deputy director of operations in the north, said: “When we visited The Newcastle upon Tyne Hospitals NHS Foundation Trust, we found staff working hard under pressure, and having kind and caring interactions with people in the services we visited.
"However, 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."
The CQC carried out an unannounced inspection in November and December. It did not re-rate services and the trust remains rated as outstanding overall.
The inspection found:
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. Staff knowledge and awareness of the Mental Capacity Act was inconsistent between different wards and services.
Staff did not maintain complete and appropriate records to evidence adherence to the Mental Health Act.
Multiple examples of gaps in people’s records in relation to mental health, mental capacity and learning disabilities. 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.
Across the trust staff were committed to providing compassionate, caring interactions for people with a mental health need, or a learning disability or autism.
Ms Dronsfield said: “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 them 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."
She added: “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. They’ve taken our feedback on board and have provided details of the immediate steps they’re taking to improve the quality of care.
“We will continue to monitor the trust and will return to check on progress to ensure improvements have been made and embedded, so people receive the safe and effective care they have a right to expect.”
Executive Chief Nurse Maurya Cushlow, said the trust was committed to making improvements.
She said: “Many of our patients have mental health needs, learning disabilities and autism as well as needing physical healthcare, and staff across the trust work hard to support people fully.
“I’m pleased that the CQC found that patients with a mental health need, a learning disability or autism received good care – with good outcomes – and during the inspection patients they told us they felt safe in our care.
“The CQC also found that how we capture and record decisions in the patient record is not always clear. 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.
“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.”
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