Ellern Mede Barnet

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Our overall rating of safe at Ellern Mede Barnet has improved and is now good. We assessed 7 quality statements. Leaders understood and embodied the culture and values of the workforce and the organisation. Leaders had the skills, knowledge and experience to perform their roles, had a good understanding of the services they managed, and were visible in the service and approachable for patients and staff. Staff said they felt respected, supported and valued. The service had an open and transparent culture where people could speak up and be heard. Improvements had been made to the governance arrangements within the service. There was now good oversight of actions from audits, medicines management, staff training and the therapeutic support on offer to patients. There were clear performance and risk management systems based around delivering safe and good quality care and treatment. The service worked well with system partners and knew which areas of the service required improvement.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff spoke with pride about the service and felt empowered to deliver high quality care and support to patients and carers. Staff said they felt respected, supported and valued. They said the service promoted equality and diversity and provided opportunities for career development. They could raise concerns without fear of retribution and that any concerns they raised were acknowledged and taken seriously by senior managers. Staff knew and understood the provider’s strategy, vision and values and how they were applied in the work of their team. All staff reported that the model of care and future strategy of the service was under review following a peer review by NHS England. The hospital had mandatory training on the hospital values, and 100% of staff had completed this. Values were also shared with staff on their induction to the service. Staff spoke about the importance of team working to provide the best outcomes for their patients.

There was an effective process to identify, understand, monitor and address current and future risks including risks to patient safety. The service had a risk register which was reviewed and updated at each clinical governance meeting. Risk management was embedded throughout the service and recognised as a collective responsibility of all the staff. Staff discussed risk at each handover meeting to ensure that patients were safe. Staff had access to the information they needed to provide safe and effective care and used that information to good effect. The leadership team were aware of areas where improvements could be made and were committed to improving care and treatment for patients. There was a strong focus on reducing restrictive practices such as restraints and one to one observations. All restrictive practices were regularly reviewed to check they were still proportionate and necessary.

The leadership team within the service promoted and prioritised safe, high quality, compassionate care. Staff we spoke with said they felt supported to do their job and described staff morale as good. Overall, they described good team working. Leaders we spoke with demonstrated that they had the experience, capability and understanding to deliver the service’s vision, and manage risks. They were aware of the key challenges, priorities and risks and were open in sharing them. Leaders reported that they could access appropriate support and development in their role.

Leaders were visible in the service, approachable and accessible for patients and staff. Staff reported they could raise any concerns they had with them. The medical director and the clinical operations director visited the wards regularly and met with patients and staff. The hospital manager and provider kept up to date on any current national guidance and maintained their own professional development by attending regular training. Patients, parents/carers could contact the hospital manager directly to share any feedback with them.

Staff and leaders spoke with openness, and transparency. They were aware of the Freedom to Speak Up Guardian for the organisation and how they could raise concerns.

The service had a whistleblowing policy and had a Freedom to Speak Up Guardian. Staff reported they were aware of these procedures. There were posters in staff areas and reception informing them of the key information. Staff understood their responsibilities around the duty of candour. They were open and transparent and gave patients and families a full explanation if and when things went wrong.

Leaders valued, understood and respected different cultures across the workforce. The service enabled open communication with staff and people taking account of their protected characteristics. Staff could seek guidance through team meetings and one to one supervision. Staff said that workforce morale was fair at the time of the inspection.

There were policies and procedures in place focused on equality and diversity. This meant staff had guidance to use if needed. Staff had training in equality and diversity.

Leaders were aware of the impact of the occupational therapist vacancy and sickness absence within the activity coordinator team and the impact on the number of therapeutic activities on offer. To mitigate this, the provider now required all care staff to complete the children and young people mental health certificate. Dialectical Behaviour Therapy (DBT) training was on offer and activity schedules were discussed with patients at the weekly community meeting. Senior managers were aware of areas where improvements could be made and were committed to improving care and treatment for patients. Staff told us about the complexities of patients having an eating disorder and autism. Staff spoke about the extensive training they had undertaken to ensure they had the right skills and knowledge to support patients in a person-centred manner. The provider’s autism lead visited the service weekly to offer support to patients and staff.

At our last inspection we required the provider to make improvements to their governance arrangements. At this assessment we found improvements. Staff vacancies had reduced, and ongoing recruitment was taking place to fill the remaining psychologist vacancy. Staff recorded all medicines administered on the electronic medicines administration records (eMARs) in line with the provider policy. Arrangements had been strengthened to ensure that observation records were completed correctly, and physical health observations were carried out following rapid tranquilisation. The adult consultant psychiatrists had completed their mandatory training. With the reduction of agency staff, there was better skill mix on the ward and all staff had been trained to use bespoke restraint techniques for people with low body weight and challenging behaviour. Findings from audits were followed through and monitored at the clinical governance meetings. Team meetings followed a set agenda where lessons learnt were discussed. Governance and performance monitoring arrangements had been strengthened since the last inspection. The service had recently introduced a provider risk management meeting which focused on exception reporting within each service. The service had a reducing restrictive practice strategy and were working with the patient inclusion lead and an expert by experience to review restrictive practices used at the service. Patients were cared for in a clean environment. Some ligature risks and blind spots had not been identified but were addressed during the assessment. Environmental risks were adequately mitigated using routine environmental observations. There were sufficient staff on duty to meet the assessed needs of patients safely and additional staff could be rostered if needed. Staff were trained, supervised and appraised appropriately. Staff ensured patient outcomes and clinical effectiveness.

Patients had regular contact with the service’s independent advocate and their care coordinator.

Staff and leaders told us they worked well with other health care professionals, commissioners and the North Central and London Integrated Care Board and shared information as required. The staff team worked collaboratively with local community mental health teams to ensure that patients had the right care and support to meet their needs when they were discharged. Where required the staff team had provided training to community teams so that they were better equipped to support people with autism and eating disorders.

Feedback we reviewed showed that staff and leaders were open and transparent and worked well with system partners. We reviewed feedback received by the service from commissioners. One commissioner reported ‘Thank you so much for all of your support and time during the admission. It has been a pleasure to work closely with you and have always appreciated your transparency and openness’. Another said ‘I just wanted to express my thanks to you and the rest of the team for the support you have given patient and their family over the past 18months’

Effective systems were in place to foster good working relationships with community health care teams. Case managers attended Care Programme Approach meetings, staff met with commissioners to review patients and held regular quality reviews were held with the provider collaborative. Learning from incidents and new ways of working were shared across the provider organisation through the online training portal.

Leaders told us that improvement plans were in place in response to the last CQC inspection and NHS England peer review. These were being monitored and reviewed at the service clinical governance meeting. There were clear processes in place to ensure that learning happened when things went wrong, as well as from examples of good practice. Reflective practice sessions were held with staff, and debrief sessions were held when needed. Learning was shared with the staff team at regular handover, team meetings and multidisciplinary team meetings.

The hospital had been participating in regular QNIC reviews. This was a quality standard programme of peer reviewers measuring the service against the standards. Leaders encouraged staff to speak up with ideas for improvement and innovation, for example staff told us about using a trauma informed care approach when working with patients. The provider updated policies and procedures to meet best practice standards and guidance, for example the autism lead for the provider had updated the autism policy in line with guidance issued by NHS England National framework and operational guidance for autism assessment services. The multidisciplinary team held regular clinical case studies. These reviews allowed the clinical team to carry out an in-depth review of the patient, make changes to care and treatment, review effectiveness and to also share any learning.