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WANDSWORTH CLINICAL COMMISSIONING GROUP

PROGRESS REPORT TO THE CCG BOARD – 9 JULY 2014

MENTAL HEALTH

1. Purpose

This paper sets out, for Wandsworth Clinical Commissioning Group (CCG) Board members,

the progress in developing and implementing on-going and new initiatives to improve mental

health services in Wandsworth. The report will focus on the last and the forthcoming 12

months and will seek to describe:

Demographics, trends, key health outcome priorities & finance

Performance of current providers (including quality measures)

Key commissioning developments during last 12 months

Mental Health Clinical Reference Group work programme & key priorities for

14/15

The CCG Board is asked to note the above and provide comment on the 14/15 plans.

2. Demographics and Background

Demographics and Need

During 2014/15, Commissioners have worked collaboratively across Health and Social Care

through the Joint Commissioning Unit to develop a Joint Commissioning Plan for Mental

Health. The Joint Commissioning Plan includes a refreshed Needs Analysis compiled by

Public Health and an extract of this is included as Appendix A. Some of the key highlights

noted in the Needs Analysis will form part of a supported presentation to this Report.

Finance

The Wandsworth Clinical Commissioning Group’s budget in 2014/15 for mental health

services is £47M per annum. A breakdown of the budgets are:

Sector of Spend Amount (£000)

South West London and St. Georges Mental Health NHS Trust 39,400

Neighbouring NHS MH Providers (SLAM & CNWL) 1,700

Independent Sector MH Placements 5,200

Other MH Projects (including third sector) 700

3. Performance and Quality (SWLSTG MH Trust)

a. Wandsworth’s largest single provider of Mental Health services is South West

London & St. George’s MH NHS Trust (SWLSTG). The contract is a multi-lateral

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NHS Contract across CCGs in SW London. The Governance and Contract

Management Structure is set out below:

b. Monitoring of the SWLSTG MH Contract is undertaken through a combination of

a Monthly Performance meeting and a Clinical Quality Review Group (CQRG).

Both meetings are lead by Kingston but include key Wandsworth representation.

The monthly Performance Meeting is attended by MH Commissioning Leads

(non-clinical) from Wandsworth CCG and Wandsworth Local Authority. The

Clinical Quality Review Group is attended by a Wandsworth GP Clinical Lead and

the CCG’s Quality Lead. Regular liaison and sharing of papers is undertaken by

the respective leads to ensure that the key links across performance and quality

are maintained.

c. Key performance indicators (KPI), as quality standards, are monitored via the

contract in both these key meetings. The thirty-six key performance indicators

are Red/Amber/Green (RAG) rated across the CCG contracts and for each

individual CCG. Indicators showing a Red performance rating are investigated

within the monthly performance meeting held with SWLSTG and actions

developed as necessary on across CCGs. A Sample of indicators for Month 12

for 2013/14 include:

Indicator Definition YTD Target

YTD Actual

Comments & Actions

Proportion of Service Users followed up within 7 days of discharge from I/P episode

95% 95% Meeting target

Proportion of service users entering an IAPT course of treatment

13% 6.8% Action Plan being developed through local monitoring arrangements

Richmond CCG

– Associate

Commissioner

Merton CCG –

Associate

Commissioner

Sutton CCG –

Associate

Commissioner

Wandsworth CCG

– Associate

Commissioner

Kingston CCG –

Lead Commissioner

Commissioning Support Unit (CSU) – Contract Management Function

Contract

Performance

Meeting

Clinical Quality

Review Group

MENTAL HEALTH BLOCK CONTRACT - SWLSTG

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and CRG lead Psychological Therapies review (see S5).

Proportion of service users who have “recovered” following a course of IAPT treatment.

45% 45% Meeting target. Maintenance of performance considered as part of Action Plan (see above)

Ratio of all informal admissions to the number that are gate-kept by CR/HT service (face to face)

95% 100% Meeting target

Length of wait for first access to CAMHS (days)

60 48 Meeting target.

% of caseload on CPA receiving face to face / phone contact with the month (YTD average)

82% 80% Actions developed through Cluster Performance Management Meeting.

d. South West London and St. George’s performance in relation to their Key

Performance Indicators remains solid. Within the most recent Quarterly and

Monthly reporting 88% of their indicators were Green or Amber. Those indicators

that are showing Red are picked up at the monthly Cluster Performance meetings

and this process is developing well. In Wandsworth, South West London and St.

George’s response to the Foundation Trust performance metrics (see section 4)

continues to be encouraging and the Mental Health Clinical Reference Group

were very pleased with their proactive, collaborative engagement and delivery.

e. The Clinical Quality Review Group measures SWLSTG’s performance in relation

to quality against nationally and locally agreed standards, seeking to ensure that

services commissioned from the Trust deliver the best health outcomes. The key

objectives of the CQRG cover the five National Outcome Framework quality

domains:

i. Preventing people from dying prematurely

ii. Enhancing quality of life for people with long term conditions

iii. Helping people to recover from episode of ill health or following injury

iv. Ensuring people have a positive experience of care

v. Treating and caring for people in a safe environment and protecting them

from avoidable harm

f. The Clinical Quality Review Group work plan includes Serious Incident Reports;

Service User and Carer input; CQUIN monitoring; Quality Account; Integrated

Complaints, Incidents & claims reports; CQC Mental Health Activity report;

Safeguarding; Triangle of Care audit; Cost Improvement Plan; Transformational

Plan. The CQRG also considers reports from the 17 Domains of the SWLSTG

Quality Strategy Monitoring.

g. SWLSTG were in the first wave of the CQC’s Chief Inspector of Hospital

Inspections and this was undertaken in March 2014. The Report was published

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on 12 June 2014. Overall, the CQC found staff caring with good approaches to

patient care. Inspectors found a number of areas of good practice which included

the Behaviour and Communication Support service in Wandsworth. Areas where

improvements were needed included:

i. Ensuring planning and delivery of care always met individual needs

ii. Ensuring suitable storage, recording and monitoring systems for

medication

iii. Continuing to monitor mixed gender wards to ensure full compliance with

national guidance.

The Executive Summary of the Report is attached as Appendix B. The full report can be

accessed at http://www.cqc.org.uk/location/RQY01.

4. Mental Health service delivery improvements for last 12 months

a. As part of SWLSTG’s Foundation Trust application the Mental Health Clinical

Reference Group (MH CRG) set SWLSTG three key improvement targets in

December 2012. These three targets related to the Reconfiguration of the Tier 2 and

3 Children & Adolescent Mental Health Service (CAMHS) referral management

model, improving patient and care experience and development of the revised model

for residential rehabilitation. The MH CRG continued to monitor progress against

these FT improvement targets during 2013/14. Positive progress had been noted, in

particular:

i. CAMHS reconfiguration - the new Access service commenced on 2

December 2013.

ii. Patient and Carer experience – collaborative working with Voicing Views to

maintain monthly Service User Reference Group. Continued development of

Carers Triangle of Care.

iii. Residential Rehabilitation review – service model approved by Health

Overview and Scrutiny, with implementation underway.

b. For 2014/15, the MH CRG agreed to take the opportunity to set a further suite of

improvement targets in order to assure commissioner support as part of the

Foundation Trust (FT) approval process. These were:

a. Improving timely access to Improving Access to Psychological Therapies

(IAPT) services by reducing waiting times – this is being progressed as part of

the wider Psychological Therapies Review (MH CRG work programme

priority)

b. Expand access to Recovery College for those discharged from Community

Mental Health Teams (CMHT) – access for 3 months after and direct referral

for Primary Care during this period agreed, development of a community

discharge pack and potential for further access beyond 3 months to be

explored further.

c. Improving responsiveness of CMHT – this includes ensuring S75 agreement

with Wandsworth Borough Council KPI’s adhered to, improving embedding of

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recovery goals within care planning, improve responsiveness of duty system

and improve interface with GPs.

d. Improve involvement of carers with care planning process – includes triangle

of care audit, recording of carer status and prioritising engagement with

carers.

e. Alignment with caveat targets set by Wandsworth Borough Council in relation

to a more proactive and preventative approach to Safeguarding on In-Patient

Wards and service user and carer satisfaction improvements.

c. Quality, Innovation, Productivity and Prevention (QIPP) Programme and Cost

Improvement Programme (CIP).

The Mental Health CRG continues to provide leadership to the work of

Commissioners, within the contract negotiation process, to identify efficiencies within

the Mental Health Block contract through Quality, Innovation, Productivity and

Prevention (QIPP) programmes and Provider lead Cost Improvement Plans (CIP).

For 2014/15, as part of QIPP, WCCG Commissioners were required to identify

efficiencies and savings of 4% within the MH Contract with SWLSTG. This equates to

£1.5M. SWLSTG themselves have identified a Cost Improvement Plan to be

delivered through their transformation programme that equates to 2.8%. The

transformation programme includes work on community provision, CAMHS, Acute

Care Pathway and the management structure. The Cost Improvement Plan was

clinically signed off for Wandsworth, other than the programme relating to CMHT

Transformation which was not considered to be clinically safe in relation to local

need. In order to meet this identified shortfall in CIP and achieve the QIPP targets

further efficiency proposals were sought in collaboration with SWLSTG, which were

achievable, could improve or not impact detrimentally on core services.

Within this context, the CCG has worked with the Mental Health Trust and asked

them to manage services in a different more cost effective way in 2014/15,

benchmarked against services for other CCGs. This included a focus on proposals

within its rehabilitation budget, Supported living, Mental Health & Learning Disability

and Arts Therapy budgets. Commissioners and Clinical leads are in the process of

receiving and scrutinising proposals. As a part of this process, Commissioners

sought and received confirmation from SWLSTG that changes to Arts Therapy would

result in delivery of an alternative NICE compliant service providing non-verbal

therapies on a Trust wide basis. Alongside this it was confirmed that there would be

access at Trust-level to a central specialist arts therapy service.

The Mental Health Trust’s proposals were considered by the Mental Health Clinical

Reference Group, including GP clinical leads. As part of this consideration and

additional clarification on the proposals it was noted that the existing stand-alone

service commissioned by WCCG, delivered Art, Music and Dance therapy

interventions. As a result of this the CCG asked that the Mental Health Trust to

confirm that such an alternative method of service delivery would be achievable and

NICE compliant. SW London and St George’s Mental Health NHS Trust has now

confirmed that it has developed plans to ensure that the Trust is NICE compliant for

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the delivery of non-verbal therapies on a Trust wide basis. Furthermore the Trust

confirmed that there would be access at Trust-level to a central specialist arts

therapy service.

Commissioners through the contract negotiation process and lead by the Mental

Health CRG will continue to scrutinise proposals and monitor the effectiveness of the

alternative solutions.

d. Older Adults

Achievements within mental health services for older adults are led by the Older

Adults & Dementia CRG and these were reported to the WCCG Board separately in

February 2014. As part of the MH CRG’s role in oversight of mental health across all

age groups, an update on achievements and key priorities for 2014-15 was

presented to the MH CRG in March 2014.

e. Investment in Working Age Adult MH services

A number of successful bids were achieved through the CCG’s BIG process,

including:

i. Wandsworth Well Family Service. This Project is commissioned

through Family Action and is a re-configured continuation of the

Project originally agreed in 2013/14. Value agreed was £121,000

which includes the requirement for independent evaluation of the

Project Benefits. Project provides direct work within identified

Surgeries & Health centres to provide volunteer mentors, peer

support, key work, workshops and self-help groups.

ii. Big White Wall. The Project value agreed was £128,500 non-

recurrent funding. The investment will be used to extend and build on

existing activity, including providing Support Network places for

Wandsworth residents, with 24/7 support available from trained

counsellors and providing Live Therapy sessions (each equivalent to a

Cognitive Behavioural Therapy or counselling session) for

Wandsworth residents. Live Therapy referral has during 2013/14

been rolled out to accept direct GP referrals. During 2013/14 there

were:

685 people joining the Support Network

836 sessions of Live Therapy delivered.

58% Recovery rate achieved, using IAPT standard measures

iii. Community Network for Family Care: Early Prevention Project.

The project value agreed is £41,600 non-recurrent funding. The

project will fund Year 2 Family Therapy training for the Black Pastors

Network, develop a Year 1 cohort from the Muslim community and

undertake an independent evaluation. This project was prioritised as

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part of the MH CRG’s work stream investigation the representation of

BME communities within MH services.

iv. Perinatal Services Review. As part of the MH CRG review of mental

health services for pregnant women and new mothers funding has

been secured to support additional resource within the existing

commissioned services. Commissioners are in the process of

agreeing service specifications to deliver this.

f. The Project for Improving Access to Psychological Therapies (IAPT) for people

with Long Term Conditions was agreed in 2012/13. The Project value agreed was

£137,800 per annum of recurrent funding. Progress of the Project to date includes:

Recruitment of staff to the LTC arm of the service – two PWPs have been

recruited (started late 2013) and a band 7 CBT therapist seconded into

the service, who commenced in role in January 2014

Links established with CHD disease rehab services across Wandsworth

Links established with all the relevant CRGs for the specific health

conditions i.e. CVD, Diabetes, and COPD, with initial attendance

completed by end of March 2014.

Materials for Guided Self Help collated and ready to implement.

Links made with the Psychiatric Nurse for community wards project as

potential referral pathway

Draft referral guidelines, Care pathway flowchart developed & Referral

pathway for internal IAPT staff guidance complete

Materials for initial Group work at intake of LTC patients drafted

Reinstatement of the Pan- London LTC service Forum to ensure strong

links with other London IAPT/LTC services maintained

Development of information, educational materials and IAPTUS protocols.

5. Mental Health Clinical Reference Group work programme and key priorities for

14/15

a. The MH Clinical Reference Group has been established for two years and has

continued to develop its membership. Key stakeholders represented on the

MHCRG are GP MH Clinical Leads (plus invitations to GP Clinical Leads for

Older Adults, Young People and Substance Misuse), CCG and Local Authority

Commissioners, Service User and Carer representatives, Providers (which now

includes representation from Voluntary Sector providers, as well as NHS MH

Provider) and other key stakeholders such as Black and Minority Ethnic (BME)

Forum.

b. The MH CRG has continued to plan its work programme under the key themes of

Prevention & Promotion of Wellbeing, Quality and specialised/cross cutting

pathways.

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c. Following prioritisation in 2012/13 the MH CRG has continued to make progress

in three key areas for focussed which were:

i. Black and Minority Ethnic (BME) representation in secondary

care (to include young people). Working group has been

established in August 2013 and has met regularly since then (5

meetings to date).

a. Data and evidence bases have been collated across

Prevention & Wellbeing, Early Intervention, Assessment

and Admission & Discharge. Demographic data has

shown that 25% of the population of Wandsworth are from

BME communities and there is a concentration within a

small number of wards linked to deprivation. Local and

national evidence bases have been collated which highlight

particular stigma and limited knowledge of mental health

within the community. It also highlights that BME

communities to access Mental Health services later, are

more likely to enter treatment at the more acute end and

when admitted have longer lengths of stay. Service data

collated also highlighted service models which were

already providing effective, evidence based treatment and

those where further focus would be needed.

ii. The Working Group was keen to progress tangible actions to

address these issues, wherever possible building on the effective

work already underway. It was noted that work will need to An

overarching action plan has now been identified against each of

these themes and includes:

a. Prevention & Wellbeing – investigate potential expansion of

Place2Be and Catch 22 services; investigate Community

Champions programme and Community Network for

Family Care (see 4diii).

b. Early Intervention – develop IAPT & CMHT community

links & Carers CPA involvement.

c. Assessment – build on SWLSTG diversity training & input

of trans-cultural expertise; IAPT cultural sensitivity.

d. Admission and Discharge – Welcome pack development,

Canerows and Plaits Audit Actions, investigate peer be-

friending and CMHT community links.

ii. Psychological therapies. Review Report completed and presented to

MHCRG in March 2014. Action Plan agreed in May 2014 which includes

Short term actions to improve IAPT waiting times and coverage. Provider

currently responding, including:

a. Internal modelling of waiting list with resource to reduce identified

and trajectories proposed

b. Work to recruit to capacity within step 3 and administrative to

tackle backlog commenced in June 2014.

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c. In relation to longer term functioning & improvements, contact

made with Intensive Support Team, NHSE, to undertake

diagnostic analysis on referral mix, capacity, skill, waits and costs

which will allow national benchmarking.

iii. Service User and Carer Experience. MHCRG saw key need to retain

focus on the existing Foundation Trust metric/target, building on current

progress and continuing to improve intelligence through MHCRG key

stakeholders.

iv. Additional MH CRG work programme priorities include understanding

Primary Care Optimal Model, Suicide Prevention, JSNA, Debt

Management, CAMHS and Dual Diagnosis.

v. Input to, and agreement of the MH Joint Commissioning Plan which

was lead through the Joint Commissioning Unit and signed off by the

Health and Wellbeing Board in June 2014. The MH CRG will take a key

role in overseeing the progress against annual commissioning plans.

d. Foundation Trust application.

i. South West London & St. Georges Mental Health NHS Trust continues to

progress in its application to become a Foundation Trust. The MH CRG

has continued to provide recommendations to the WCCG in relation to

commissioner support (convergence). The MH CRG (as detailed above)

as utilised the FT process to lever local service improvements with

SWLSTG. The Provider has responded positively & collaboratively with

the MH CRG.

ii. The current timetable has been impacted by the CQC inspection, with

SWLSTG awaiting outcome and views from a further Quality Summit

before progressing application to the NHS Trust Development

Authority (TDA). The TDA would then decide on whether to move to

the Board to Board process which would consider performance and

external intelligence, before moving onto the final Monitor process

following approval. The timetable for TDA Board Approval is July

2014.

6. Conclusion

The Mental Health Clinical Reference Group continues to build momentum across a wide

range of work streams within Mental Health. The committed contribution & leadership of

the membership, spanning clinicians, commissioners, service users, carers and

providers ensures that the Clinical Reference Group can successfully tackle its

challenging agenda. The clear and agreed work programme has assisted in maintaining

the focus.

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It is accepted that there is still work to do to ensure the work streams deliver against their

ambitions and outcomes improve for the people of Wandsworth and their families facing

mental health problems.

7. Recommendations

The Wandsworth Clinical Commissioning Group Board is asked to:

1. Note progress of the Mental Clinical Reference Group.

2. Note and comment on the agreed Plans and Priorities for the Mental Health

Clinical Reference Group work plan for 2014/15

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APPENDIX A

General Population Characteristics

Data from the 2011 census shows that Wandsworth has a resident population of 307,000, an

increase of 17.9% from 2001(Office for National Statistics 2013). Wandsworth has a higher

proportion of younger people (20-39 years) at 46.3% compared to London (35.7%). The

census also showed that the Black and Asian Minority Ethnic (BAME) population make up

nearly 30% of the all age population. The proportion of the adult population (18-74 years) is

slightly lower at 25.6%. The exact proportions for all ages between ethnicities are 10.7%

(Black), 10.9% (Asian), 5.0% (Mixed) and 2.1% (Other ethnicity)1.The Wandsworth GP

registered population is substantially higher than the resident population, which was 353,385

for the 2011-12 year.

Indicators of Mental Health Need

Individuals who are unemployed, live in rented accommodation and have low educational

achievements are at greater risk of depression. There is also a well-documented association

between poverty, unemployment, social isolation and the first incidence and prevalence of

schizophrenia. Studies have demonstrated higher rates in deprived inner city areas2.

Although the rate of benefit claimants (jobseekers, incapacity benefits, lone parents and

carers) in Wandsworth is below the London average, the rates vary between wards with

jobseeker’s allowance (JSA) and lone parent claimant rates above the London average in

the most deprived wards in Wandsworth. Also the proportion of men claiming jobseeker’s

allowance is higher than for women, 3.2% compared to 2.0% for April-June 2013. In addition

to the six highest socioeconomically deprived wards of Furzedown (4.2% and 1.7%),

Graveney (3.6%, 1.7%), Latchmere (5.2%, 2.4%), Queenstown (3.6%, 1.5), Roehampton

(4.0%, 2.4%) and Tooting (3.7%, 1.3%), the ward of West Hill (3.7%, 1.4%) also has high

levels of jobseeker’s allowance (JSA) and lone parent claimants. These wards also have the

highest proportions, in the Borough, of people from ethnic minority groups living in them and

will be represented in the JSA and lone parent claimant rates. This indicates the need to

target mental health promotion and other resources at these wards. Figures from November

2013 (latest available) show that more people from Black Asian and Minority Ethnic (BAME)

groups claimed JSA in Wandsworth, despite making up only 30% of the population. Nearly

half (48.1%) of adults claiming JSA were from BAME groups compared to 43.5% from non-

BAME groups (8.4% ethnicity unknown). Of particular note is that adults of Black ethnicity

make up 30% of JSA claimants in Wandsworth”3.

1 NOMIS, 2013

2 Harvey C, Pantelis C, Taylor J et al. (1996). The Camden schizophrenia surveys: II. High prevalence of

schizophrenia in an inner London borough and its relationship to socio-demographic factors. Br J Psychiatry; 168(4):418-426 3 Department of Work and Pensions , 2014

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Prevalence of Mental Illness in Wandsworth

Common mental disorders (CMD) are mental conditions that cause marked emotional

distress and interfere with daily function, but do not usually affect insight or cognition4.

Wandsworth is estimated to have the highest estimated annual prevalence rates of all types

of CMD and rate of people experiencing symptoms of severe mental illness in SW London.

The data is based on prevalence rates from the Adult Psychiatric Morbidity Survey for

England, 2007, adjusted for local mental health need (e.g. unemployment), and using

census 2011 population data. The rate for neurotic disorders was 200 per 1,000 population

in Wandsworth compared to 182 in London. Using rates based on the same survey but on

the current population of Wandsworth it is estimated that around 48,500 people aged 16-74

years and older show symptoms of a CMD in any given week in Wandsworth. According to

the Adult Psychiatric Morbidity Survey for England, 2007, the prevalence of CMDs is higher

amongst females. Calculations from the estimates of prevalence show a split in numbers of

18,000 for males and 30,500 for females. Broken down by individual disorders, the

estimated figures are shown in Table 1 overleaf.

4 McManus S, Meltzer H, Brugha T et al. (2009). Adult Psychiatric Morbidity in England, 2007: Results of a household survey. Leeds: NHS

Information centre for health and social care.

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Table 1: Estimated prevalence of common mental disorders in Wandsworth

Resident population aged 16-74 Rate/ 1000 pop Estimated number of people

Any neurotic disorder 200 48,500

All phobias 24 6,000

Depressive episode 38 9,000

Generalised anxiety disorder 57 14,000

Mixed anxiety depression 94 23,000

Obsessive compulsive disorder 17 4,000

Panic disorder 9 2,000

Source: Based on prevalence rates from the Adult Psychiatric Morbidity Survey for England, 2007, adjusted for local mental health need, and using Census 2011 population data. Adjusted local mental need data from North East Public Health Observatory (2008) Mental Health Brief no 4: Estimating the prevalence of common mental health problems in PCTs in England. Available at: http://www.mentalhealthobservatory.org.uk/mho/briefs

The estimated prevalence of serious mental illnesses, including bipolar, schizophrenia and

other psychoses for those aged 16 –74 in Wandsworth is 13 per 1000 population, amounting

to an estimated 3,200 cases (Based on prevalence rates from the Adult Psychiatric Morbidity

Survey for England, 2007). This is the 8th highest in London (areas corresponding to

previous PCTs) and is much higher than elsewhere in SW London. For example, the

prevalence rate of people experiencing symptoms of severe mental illness in Wandsworth is

2.4 times greater than in Croydon, which has the second highest rate in SW London.

An estimated 2,000 (7.2%) older people (65+ years) in Wandsworth have dementia with the

gender difference being almost two women to every man with dementia.

Prevalence of Mental Illness in Black Asian and Minority Ethnic (BAME) Groups

The Adult Psychiatric Morbidity Survey for England found that there is a higher need for

people of Black and Other ethnicities compared to people of White ethnicity. From the

survey it was estimated nationally that 16.3% of people of Black ethnicity experience a

common mental disorder, 11.3% of South Asians, 19.4% of people in Other ethnic minority

groups and 11.9% for people of White ethnicity. The South Asian group included Indian,

Pakistani and Bangladeshi ethnic groups while Other includes Chinese and Mixed Ethnicity.

Due to a lack of high quality routinely collected data on the prevalence of mental health

disorders in BAME groups, estimates from surveys have to be used. Using national

estimates (as is the case here) at local level can introduce substantial error, unless

adjustments can be made to reflect local factors. The smaller the geographical area

becomes when applying estimated prevalence from national level surveys, the more likely

local factors come into play. No local adjustments have been made to the prevalence rates

by ethnicity. These local factors make the national estimates used less reliable and this must

be taken into consideration when interpreting these estimates.

Links between Mental Health and Physical Health

Many people with long-term physical health conditions or disabilities also have mental health

problems (Naylor et al. 2012). People with long-term conditions and co-morbid mental health

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problems disproportionately live in deprived areas and have access to fewer resources of all

kinds. The interaction between co-morbidities and deprivation makes a significant

contribution to generating and maintaining inequalities. Research evidence consistently

demonstrates that people with long-term conditions are two to three times more likely to

experience mental health problems than the general population. For example:

Depression is two to three times more common in people with a range of cardiovascular diseases5;

People living with diabetes are two to three times more likely to have depression than the general population18;

Mental health problems are around three times more prevalent among people with chronic obstructive pulmonary disease than in the general population6;

Depression is common in people with chronic musculoskeletal disorders. Up to 33 per cent of women and more than 20 per cent of men with all types of arthritis may have co-morbid depression.

In Wandsworth in 2011 an estimated 8.2% (19,000) of people aged 16-64 years reported

having a long-term health problem or disability which limited them a little or a lot. In the over

65 years old population, over a half (14,000) of the population had a long-term health

problem or disability. The table overleaf shows the proportion of patients with a particular

long-term condition who have been recorded with depression at some point in their life.

Table 2: Wandsworth registered patients with long-term condition and ever recorded with depression,

July 2012, all ages.

Long-term condition Number Proportion of patient with

long-term condition

Asthma patients with Depression 3,451 10.9%

Cancer patients with Depression 763 12.5%

COPD patients with Depression 616 19.7%

Diabetes patients with Depression 1,506 12.6%

Hypertension patients with Depression 3,540 11.8%

Hypothyroidism patients with Depression 1,244 15.6%

Ischaemic Heart Disease patients with Depression 735 13.9%

Mental Health patients with Depression 932 30.3%

Stroke / TIA patients with Depression 390 14.0% Source: Wandsworth primary care data extract based on EMIS from July 2012.

Links between Mental Health and Drugs, Alcohol and Tobacco

There is a clear association that exists between mental illness and drug and alcohol

dependence. People suffering from mental disorder are more likely to have poor physical

5 Fenton WS, Stover ES (2006). ‘Mood disorders: cardiovascular and diabetes comorbidity’. Current Opinion in

Psychiatry, vol 19, no 4, pp 421–7 6 NICE (2009). Depression in Adults with Chronic Physical Health Problems: Treatment and management.

Clinical Guideline 91. London: National Clinical Guideline Centre. Available at: http://guidanceniceorg/CG91/guidance/pdf/English/downloaddspx (accessed on 22 September 2013

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health. This is due in part to higher rates of health risk behaviours, such as smoking, and

alcohol and substance misuse7.

In Wandsworth an estimated 28.5% of the 16 years and older population engage in

increased or high risk alcohol consumption8. The level of alcohol attributable hospital

admissions for males in Wandsworth is significantly higher than the national average at 1603

per 100,000 (All ages 2010/11). The level of alcohol related recorded crime in Wandsworth

is also significantly higher than the national average at 8.9 per 1,000 population.

Using estimates from the drug misuse section of 2011 to 2012 Crime Survey for England

and Wales, an estimated 23,000 adult (16+ years) residents of Wandsworth had used an

illicit drug in the last year (Home Office 2012). If drug use in Wandsworth reflects the

national trends, cannabis use is the most common where an estimated 17,500 (6.9%) had

used in the last year while 5,500 (2.2%) had used cocaine. Looking at the 16-24 age group,

an estimated 6,500 (19.3%) would have used an illicit drug in the last year, while 2,500

(7.0%) would have engaged in frequent drug use (Frequent use refers to use of any drug

more than once a month in the past year).

Smoking prevalence is greater in people with mental health problems and those that smoke

are more likely to be heavy smokers. The ONS survey of psychiatric morbidity amongst

adults found that 44% of people with common mental health problems were smokers

compared with 27% of people without these problems and were twice as likely to be heavy

smokers9. Stopping smoking can result in significant reductions in dosages of mental health

medications. Increased investment in smoking cessation services for people with mental

health problems is necessary to prevent widening health inequalities in this group.

Links between Mental Health and Debt

While evidence exists of a moderate association between debt and common mental health problems such as depression and anxiety10, there is no conclusive evidence of a causal relationship; and the mechanics of how debt and mental health interact are not well understood. Individuals who have no mental health problems but develop unmanageable debts have a 33% higher risk of developing depression and anxiety-related problems within a 12 month period compared to those who do not experience financial problems11. Fourty-five percent of people who are in debt have mental health problems, compared with only 14% of those who are not in debt12. Debt may also have indirect effects on household psychological wellbeing over time, e.g. resulting in parental depression, conflict-based family relationships, and mental health problems among children. Crucially only 50% of all people with debt problems get advice and without any help around two-thirds with debt problems will

7 Department of Health. (2011). No health without mental health – A cross-government outcomes strategy to

save lives. London: Department of Health 8 Public Health England (2014). Public Health Outcomes Framework http://www.phoutcomes.info/ 9 McManus, 2009 as before

10 Fitch, C., Hamilton, S., Basset, P., & Davey, R. (2009) Debt and Mental Health: What do we know? What should we do? Royal College of

Psychiatrists, Rethink, Money Advice Trust. 11

Skapinakis P, Weich S, et al. (2006) Socio-economic position and common mental disorders. Longitudinal study in the general population in the UK. British Journal of Psychiatry 189 109-117. 12Fitch C, Hamilton S, Bassett P, et al (2011). The relationship between personal debt and mental health: a systematic review. Mental

Health Review Journal 16:153–66.

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not get them resolved within a year13.

Early intervention in the form of a referral between healthcare and debt advice services has demonstrated effectiveness, preventing the debt problem from worsening debtors’ mental health14. A recent economic review, made the case for improved cooperation between

healthcare professionals, debt advisers and creditors (building on the voluntary best practice guidance available), as well as early debt advice intervention in the health and social care system. Investing in debt management services are also suggested to be cost effective with 10% of cost savings accruing to health services. It is estimated that depression and anxiety caused by unsolved debt problems costs the NHS up to £13,800 per person over two years28. But contact with face-to-face advice services and telephone services resulted in a 56% and 47% likelihood respectively of debt becoming manageable and consequently having a positive impact on an individuals’ mental health. In London, it has been identified that the provision of effective and timely debt advice delivered either via telephone or face-to- face, could achieve cost savings of approximately £222 per person15.

Offender Mental Health

Data from Public Health England (PHE 2013) identifies that;

90% of prisoners have substance misuse problems, mental health problems or both

80% of prisoners smoke

9% of the UK prisoner population suffer from severe and enduring mental health illness

10% of prisoners have a learning disability

40% of prisoners declare no contact with primary care prior to detention

Offenders are up to 30 times more likely than the general population to die from suicide in the first month after discharge from prison

There is commonly poor continuity of health care information on admission to prison, on movement between prisons and on release

Offenders and ex-offenders generally experience greater health inequalities and social exclusion than the general population. As the number of people who come into contact with the Criminal Justice Sector increases, there will be an increasing number of ex-offenders in communities.

Organisations such as the National Offender Management Service (NOMS) and latterly the London Probation Trust aim to help offenders deal with health issues in the following ways:

ensure offenders have access to appropriate health services in custody and the community

ensure suspects and persons detained by the police under mental health provisions are able to access appropriate health & social care professionals at the appropriate time and in the appropriate place

divert offenders with serious mental healthcare needs to appropriate health services

13 LHIN (2013) Keeping well in hard times: Protecting and improving health and wellbeing during an income shortfall: A practical guide for

London Boroughs. LHIN. London. 14

Knapp, M.,McDaid,D.,Evans-Lacko,S.,Fitch,C.,& King,D. (2011).Debt and Mental Health in Mental health promotion and mental illness prevention: the economic case. London: Personal Social Service Research Unit, London School of Economics and Political Science 15 London Debt Strategy Group (2011) Treading water. A report on the work of the London Debt Strategy Group and the changing nature of

debt advice in London. London: Greater London Authority.

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improve health service links to other services working with offenders. Improving the range and standard of health and social care services for offenders and others in contact with the Criminal Justice System, both within prisons and in the community contributes to a reduction in re-offending, by addressing those health needs which may be linked to offending behaviour, such as misuse of drugs and alcohol, or poor mental health.

In January 2013 the Wandsworth Probation Trust Local Delivery Unit (LDU) supervised an annual total of 1,097 cases, of which 458 were on a range of community sentences and 226 were offenders released from prison on licence, with the remainder in custody. Almost half of probation service users report some degree of mental health problems, ranging from depression and anxiety, to obsessive compulsive disorder and schizophrenia.

The number of offenders on Wandsworth Probation Trust caseloads for July 2012 was 899 people- Overwhelmingly male, young, and with significantly larger proportions of Black or Black British heritage communities than is found in the general population.

A recent public health survey of 99 probation users in Wandsworth identified that;

• 40% claimed to have been seen formally by a mental health service

• The rate of self harm is almost 4 times the average for the general population

• 50% of participants stated that their work or other daily activities were limited by emotional problems

The survey also identified that the most common diagnoses were depression and anxiety, with a small but significant number (8) diagnosed with schizophrenia.

The probation needs assessment identified that almost half of probation service users report some degree of mental health problems, ranging from depression and anxiety, to obsessive compulsive disorder and schizophrenia.

It was noted that referral by GPs to the Community Mental Health Team (CMHT) were limited as they tended to focus only on the most serious mental health disorders. As a result engaging specialist mental health services can be problematic and the threshold for accessing the services is set too high.

There was a general feeling that there was inadequate provision of mental health services. The perception was that there was a high level of unmet need16.

Homelessness and Mental Health

In 2012/13 Wandsworth Council made decisions on 1,287 households presenting as

homeless, finding 764 homeless; 59 of these were classed as intentional homeless and a

further 107 homeless but not in priority need. The trends of homelessness in Wandsworth

follow those seen in the UK in general across the same period, with reducing numbers of

statutory homeless until 2010 then increasing homelessness.

During 2013 Wandsworth Public Health conducted a Homeless Health Needs Survey. When

asked whether they had been diagnosed with a mental disorder or condition 61% of

16

Offender Health Needs Assessment, Wandsworth Council, 2013

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respondents said yes; 42% of respondents reported Depression; 14% Schizophrenia and

23% report dual diagnosis with a drug or alcohol problem17. The local data is broadly in line

with the findings from national research, which shows a disproportionate level of mental

health problems among the homeless population. National data clearly identifies that there

are higher levels of mental health needs in homeless populations, with 72% reporting one or

more condition, than seen in the general population 30%18.

Health needs of homeless people are often complicated through having a combination of

problems. Dual diagnosis refers to the simultaneous existence of a mental health diagnosis

and substance misuse – alcohol, drugs, or both. It has been found that 30% of dependent

drinkers and 45% of people dependent on drugs also have a psychiatric disorder19. A review

for Crisis by Rees in 2009 found that most studies estimate between 10-20% of homeless

people would meet the criteria for dual diagnosis (concurrent mental health and drink/drug

dependence). Many more are thought to have low level problems with their mental health

and substance use that don’t meet the formal threshold for a full diagnosis20.

Improving Access to Psychological Therapies (IAPT)

The Improving Access to Psychological Therapies (IAPT) programme provides access to

evidence-based psychological therapies for people who require the help of mental health

services, particularly those presenting with anxiety disorders and depression. The IAPT data

analysed here has been provided by the South West London & St George’s Mental Health

NHS Trust and extracted from their system via a data request. Figure 1 shows the number

of referrals by locality from 2010/11 to 2012/13 (August to July) for those aged 16 years and

older. An August to July year was used in order to obtain three full years of data from the

extract provided. Table 3 shows the actual numbers. There were at least twice as many

female referrals compared to males across all localities over the 3-year period. As Wandle

has the highest number of registered patients this locality had the highest number of

referrals. The number of referrals has increased year-on-year. For 2012/13, there was a

13.2% increase in the number of IAPT referrals compared to 2010/11 for males and an

increase of 5.2% for females.

The data presented are for referrals coded as IAPT (as opposed to non-IAPT and

Employment which appear within the same dataset). Also a small number of referrals are not

included due to gender not being recorded (16 for 2010/11, 8 for 2011/12, 6 for 2012/13).

17

Homeless Health Needs Assessment, Wandsworth Council, 2013 18 London Homeless Link. (2010). The Health and Well-being of People Who Are Homeless; Evidence from a National Audit. 19 Coulthard et al. (2002). Tobacco Drug and Alcohol Use and Mental Health. London. The Stationary Office 20 Rees. et al. (2009). Mental Health in the Adult Single Homeless Population . Public Health Resource Unit

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Figure 1: Number of IAPT referrals by gender and locality, 16+ years, from 2010/11 to 2012/13.

Source: South West London & St George’s Mental Health NHS Trust. 2013a.

Table 3: Number of IAPT referrals by gender and locality, 16+ years, from 2010/11 to 2012/13.

Year Battersea Wandle West Wandsworth No practice recorded Total

Male Female Male Female Male Female Male Female Male Female

2010/11 485 1,131 649 1,342 282 550 46 76 1,462 3,099

2011/12 515 1,144 690 1,283 253 556 72 124 1,530 3,107

2012/13 541 1,104 769 1,413 282 581 63 162 1,655 3,260 Source: South West London & St George’s Mental Health NHS Trust. 2013a.

Table 4 below shows the number of referrals by age group from 2010/11 to 2012/13. The

referral rate per 1,000 population is also shown for 2012/13. The highest referral rate is in

the 25-44 age group at 20.7 referrals per 1,000 population, followed by the 45-64 age group

at 19.8 per 1,000 and the 16-24 age group at 18.5 per 1,000. There is slightly more referrals

shown here (4,921) compared to Table 3 (4,916); this is due five records not having a

gender recorded and therefore being omitted (Table 3).

Table 4: IAPT referrals by age group, number and referral (2012/13) rate per 1,000 population.

Age Group 2010/11 2011/12 2012/13

Number Rate

16-24 294 381 553 18.5

25-44 2,981 2,972 3,087 20.7

45-64 1,090 1,089 1,139 19.8

65+ 212 203 142 5.2

Total 4,577 4,645 4,921 18.6 Source: South West London & St George’s Mental Health NHS Trust. 2013a.

0

200

400

600

800

1,000

1,200

1,400

1,600

Male Female Male Female Male Female

Battersea Wandle West Wandsworth

2010/11 2011/12 2012/13

Nu

mb

er o

f

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Table 5 shows the number of referrals by referral source across all of Wandsworth for those

aged 16 years and older. Each year the proportion of self-referrals has increased, from

56.7% in 2010/11 to 70.3% in 2012/13. The proportion of GP referrals has dropped to a

quarter (26.5%) of all referrals over the same period.

Table 5: Number of referrals by referral source, 16+ years, from 2010/11 to 2012/13.

Referral Source 2010/11 2011/12 2012/13

N % N % N %

Self 2,597 56.7% 2,830 60.9% 3,458 70.3%

General Medical Practitioner 1,907 41.7% 1,605 34.6% 1,306 26.5%

Other Sources 73 1.6% 210 4.5% 157 3.2%

Total 4,577 4,645 4,921

Source: South West London & St George’s Mental Health NHS Trust. 2013a.

The recovery rate as reported by the MH trust for Wandsworth IAPT patients, set out in

figure 2 below, has remained between forty and fifty percent since 2010.

Figure 2: Recovery rate for patients referred through IAPT, 16+ years, from 2010/11 to 2012/13.

Source: South West London & St George’s Mental Health NHS Trust. 2013a.

GP Severe Mental Illness (SMI) Registers

During 2011-12 Wandsworth GPs recorded 3,156 people on the mental health register. This

data covers serious mental illnesses, including bipolar, schizophrenia and other Psychoses

(The Information Centre 2013). This figure translates to a rate of 8.9 people per 1,000 GP

registered population in Wandsworth, an increase from 2009 when the figure was 8.2. The

number of people on the SMI register is similar to that estimated (3,200 - Based on

prevalence rates from the Adult Psychiatric Morbidity Survey for England, 2007), however

the trend across other areas in South West London is that over two times the number is

usually seen on the register compared to the number estimated. This could be due to:

Variation in SMI register inclusion criteria between PCTs (under-inclusion of patients in Wandsworth and over-inclusion in other PCTs)

The estimated numbers of people experiencing symptoms may not be a true

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reflection of the mental health need in the different boroughs

Undiagnosed SMI in Wandsworth.

Community Mental Health Services

In the year to June 2013, there were 2,332 referrals for Wandsworth CCG patients aged 18-

74 years, 2,075 of these to Community Mental Health Teams (CMHTs) based in

Wandsworth (Table 6). This data has been provided by the South West London & St

George’s Mental Health NHS Trust and extracted from their system via a data request.

Looking at Wandsworth teams only, the highest numbers of referrals were to the Central

Wandsworth & West Battersea CMHT (680) and the lowest to the Battersea Junction CMHT

(312). Compared to the previous year (2011/12 July-June) the number of referrals has

remained constant for the Battersea Junction and Putney & Roehampton CMHTs, while

there was an increase for the teams of Balham, Tooting & Furzedown (18.7%) and Central

Wandsworth & West Battersea (17.9%). From 2010/11 to 2011/12 there was a decrease in

referrals across all teams (539, 20.8%), with largest for the Putney & Roehampton CMHT.

Referrals for the 2010/11 year were coded for Putney, Roehampton and Putney &

Roehampton. They have been grouped for this analysis.

Table 6: Adult, 18-74 years, accepted referrals to a Community Mental Health Team, Wandsworth CCG

population.

CMHT 2010/11 2011/12 2012/13

Balham, Tooting & Furzedown CMHT 578 481 571

Battersea Junction CMHT 312 298 312

Central Wandsworth & West Battersea CMHT 641 577 680

Putney & Roehampton CMHT 869 507 512

CMHT outside Wandsworth but CCG patient 188 186 256

Total 2,588 2,049 2,332 Source: South West London & St George’s Mental Health NHS Trust 2013b.

For older people, 75+ years, the number of referrals has remained constant for the last two

years with 845 referrals for 2012/13 and 816 referrals for 2011/12 (Table 8). From 2010-11

to 2011/12 there was an increase of 228 (38.8%) referrals for older people. A number of

referrals to older people services had an age recorded that was under 75 years (e.g. 153 for

2012/13); these have been omitted from the analysis when calculating referral rates but are

listed in the table below.

Table 7: Older people (75+ years) accepted referrals to a Community Mental Health Team, Wandsworth

CCG population.

CMHT 2010/11 2011/12 2012/13

Wandsworth Older People Liaison Service

80 77

Wandsworth Older People’s CMHT 367 547 720

Wandsworth West Older People’s Team 179 160 Team outside Wandsworth but CCG patient 42 29 48

Total 588 816 845

Referrals aged under 75 years 127 177 153 Source: South West London & St George’s Mental Health NHS Trust 2013b.

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Inpatient Services

During 2012-13 there were 663 hospital admissions related to mental disorder in

Wandsworth. Again the data has been provided by the South West London & St George’s

Mental Health NHS Trust and extracted from their system via a data request. Table 8 shows

the breakdown by ward. Using data for patients that were admitted and discharged during

the year 2012-13 (July-June), the average length of stay across all wards was 32 days. By

ward, the shortest average length of stay was at the Assessment Suite, at 14 days and the

longest was for Jasmine and Laurel wards at 40 days (exlcuding the grouped wards). In

2011-12 there were 562 admissions, which was 15.2% less admissions compared to 2012-

13. In 2010-11 there 717 admissions which was 8.2% higher than the number for 2012-13.

Table 8: Hospital admissions for adults, 18-74 years, related to mental ill-health in Wandsworth, 2012/13.

Ward Admissions Admissions with Discharges (at time of extract)

Occupied Bed Days (excludes

leave)

Average Length of

Stay

Assessment Suite (MHA Section)

131 129 1,858 14

Jasmine (Rose) 34 33 1,308 40

Laurel 124 115 4,657 40

Rose (Vine) 87 85 3,121 37

Ward Two (Old Bluebell) 181 173 4,983 29

Other wards 106 89 3,745 42

Total 663 624 19,672 32

Source: South West London & St George’s Mental Health NHS Trust 2013b.

The data exlcudes older people admissions and admissions to the psychiatric intensive care

units (PICUs). Patients are transferred in and out of the PICUs from the acute wards and

therefore admissions to the PICUs are excluded from this data to avoid double counting of

admissions. The category of admission ward include: addictions, adult acute, deaf services,

eating disorders, forensic services, learning disbilities, OCD/BDD, rehabilitation and Other.

The number of admissions for older people have been decreasing each year since 2010/11,

from 45, to 26 during 2011/12 and 23 in 2012/13. However, a further number, under the

category of older people, were aged under 75 years; they were 32 in 2010-11, 14 from

2011/12 and 8 admissions for 2012-13.

Between 2009/10 and 2011/12 the directly standardised hospital admission rate (313 per

100,000) for mental health in Wandsworth was significantly worse than the England

average21. Furthermore, in-year (2010/11) bed days for mental health rate, at 379 per 1,000

population was significantly higher than the national average.

Suicide Prevention

The likelihood of a person taking their own life depends on several factors. These include:

Gender – males are more likely to take their own life than females

Age- people aged 35-49 now have the highest suicide rate

Mental Illness

21 North East Public Health Observatory. (2013). Community Mental Health Profiles 2013.

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Physically disabling or painful illnesses including chronic pain

Alcohol and drug misuse

Stressful life events can also play a part. These include:

The loss of a job

Debt

Living alone, becoming socially excluded or isolated

Bereavement

Family breakdown and conflict including divorce

Imprisonment

For many people, it is the combination of factors which is important rather than one single

factor. Stigma, prejudice, harassment and bullying can all contribute to increasing an

individual’s vulnerability to suicide22.

The latest Public Health Outcomes Framework data 2010-12 identifies that Wandsworth

mortality from suicide and undetermined injury in all ages (8.0 per 100,000) is higher than

the London average (7.5) but below England average (8.5). As a result, the Wandsworth rate

is the 4th highest in South London and the 11th highest in London.

While overall mortality from suicide and undetermined injury in Wandsworth is similar to the

national and London averages, there will be variation within the borough. Suicide rates have

been found to be higher for those living in areas of highest socioeconomic deprivation

compared to those living in areas of lowest socioeconomic deprivation36,23. Recent research

particularly indicates a strong relationship between unemployment and a higher rate for

suicide24. The highest rates of unemployment in Wandsworth are seen in Furzedown,

Graveney, Latchmere, Queenstown, Roehampton, Tooting and West Hill. Suicide prevention

work should continue to be targeted at residents in these areas of the borough.

Service Utilisation Black Asian and Minority Ethnic Groups

According to Census 2011 figures the adult (18-74 years) Black, Asian and Minority Ethnic

(BAME) population account for a quarter (25.6%) of the resident population of

Wandsworth25. BAME adult referrals to the CMHTs of Wandsworth, over a 3-year period,

from 2010-11 to 2012-13, account for nearly a third (32.1%) of all referrals, showing a higher

representation in community mental health referrals compared to the population distribution.

One in nine (11.6%) of CMHT referrals did not have an ethnicity recorded which could alter

the above result either way. In particular adults of black ethnicity make up a higher

proportion of referrals, at 15.1%, compared to this population representation 9.3% of the

adult Wandsworth at the last census in 2011. Adults of Black ethnicity account for an even

higher proportion of hospital admissions due to mental disorder - nearly a quarter (23.7%)

22

Department Of Health, 2012 23 McLean J, Maxwell M, Platt S et al. (2008). A systematic international literature review of review-level data on suicide risk factors and

primary evidence of protective factors against suicide. Edinburgh: Scottish Government Social Research.

24 Barr B, Taylor-Robinson D, Scott-Samuel A et al. (2012). Suicides associated with the 2008-10 economic recession in England: time trend

analysis. BMJ 2012;345:e5142. 25

Office for National Statistics 2013

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over three years (2010-11 to 2012-13). Admissions for adults from all ethnic minority groups

account for two-fifths (38.9%) of admissions.

The BAME population of all ages account for 19.1% psychological therapy services

provided26. The all age resident BME population of Wandsworth make up 28.6% of the total

resident population.

26

SWLStG Mental Health Trust 2013

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APPENDIX B

CARE QUALITY COMMISSION

Summary of findings

Overall summary

Springfield University Hospital is part of South West

London and St George's Mental Health NHS Trust. It

provides a range of mental health inpatient and

outpatient services including, acute, rehabilitation, older

people, eating disorder and forensic services. The trust is

responsible for providing all the community and

hospital-based psychiatric services to the London

Boroughs of Kingston, Merton, Richmond, Sutton and

Wandsworth.

We found that the services at Springfield University

Hospital were safe, the wards were clean and staff were

aware of risks. There were ways to report and learn from

incidents, but improvements were needed in assessing

and managing risks to people's safety.

Staff interacted with people who used the service in a

caring and compassionate way. People and their relatives

were involved in planning their own care, although

records did not always reflect this. People were engaged

in activities they felt were meaningful and therapeutic.

Ward staff listened to people’s feedback and involved

them in making positive changes.

The Mental Health Act responsibilities were being

discharged appropriately. Some actions from previous

Mental Health Act monitoring visits had not been fully

resolved.

We saw good examples of learning from audits and

incidents being shared, and changes to practice being

made as a result.

All staff we spoke to on the ward told us they received

training for safeguarding children and vulnerable adults

as part of their annual mandatory training. They also said

they would be confident in reporting safeguarding –

either internally or to the local authority.

Staff told us they felt supported by the management on

the ward and their immediate managers. Some staff told

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us they did not always feel involved in conversations

about their roles, particularly when organisational

changes were taking place.

We found that the recording of rapid tranquilisation on

some wards was not being done well. We saw routes of

administration being recorded incorrectly, doses of

medicines being recorded in progress notes but not on

medicines administration records, and patients who were

administered these medicines did not have a reason for

the use in their progress notes.

Extract from:

South West London and St George's Mental Health

NHS Trust

Springfield University Hospital

Quality Report

61 Glenburnie Road

London

SW17 7DJ

Tel: 020 8682 6000

Website: www.swlstg-tr.nhs.uk/ Date of inspection visit: 18- 21 March 2014

Date of publication: May 2014

http://www.cqc.org.uk/location/RQY01