Two Newcastle hospitals have been issued with a warning after an inspection by a health watchdog found a number of failures in their mental health care.
The Care Quality Commission (CQC) carried out an unannounced inspection of medicine, surgery, and critical care at the Freeman Hospital and the Royal Victoria Infirmary (RVI) in November and December last year. Inspectors also looked at urgent and emergency care and maternity services at the RVI.
The inspection focused on the quality and safety of care provided to people with a mental health need, a learning disability, or autism across all of these services. Following this inspection, the CQC served the Newcastle upon Tyne Hospitals NHS Foundation Trust with a warning notice which said that the trust needed to make "significant and immediate improvements in the quality of care being provided."
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This included improvements to the 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 that autistic people and those with a learning disability receive care which meets the full range of their needs.
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 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.
However, staff across the trust were praised by the CQC for their compassionate and caring interactions with people who have a mental health need, learning disability or autism, despite pressures faced by the NHS.
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.
“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. 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.”
As this was a focused inspection, the CQC did not re-rate services and the trust remains rated as outstanding overall. Inspectors will be returning to the trust to carry out another inspection of these services in due course to ensure the trust has taken the necessary action to improve.
Following the findings of the report, which will be published on the CQC website on February 24, Newcastle hospital leaders said they will improve how the mental health care needs of patients are being met.
Executive chief nurse, Maurya Cushlow, 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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