A lack of mental health beds meant patients at a London hospital continued to be inappropriately admitted to seclusion rooms, in one case for five days, months after the NHS trust running the service assured regulators that the practice had stopped.
Inspectors, who visited St Ann’s hospital in November, found that patients were admitted to seclusion rooms on 30 occasions between 28th August and 17th November. At an inspection six months earlier the CQC had warned Barnet, Enfield and Haringey NHS trust that the practice compromised patient care. At the time, the trust told the regulator the rooms were no longer being used as temporary bed spaces and said it had an action plan to ensure it didn’t happen again.
The rooms, which are unfurnished apart from a mattress and cannot be opened from inside, are meant to be used to nurse patients in isolation for a short period if they are a risk to others.
Matthew Trainer, regional director of CQC in London, said: “We told the trust that their practice regarding seclusion rooms was inappropriate last summer. They assured us they would put this right but when we went back in November we still found problems.
“Their seclusion rooms are just not suitable for use as bedrooms. Even if doors are left open, people in the rooms have severely restricted access to other facilities in the hospital. People should not be spending any longer than necessary there. This is the most serious issue we found in November, but our report sets out other areas where we want to see improvement.”
In 11 cases patients were admitted to the seclusion rooms for over 24 hours. One patient was admitted to seclusion for five days.
The CQC also found that the trust’s section ‘136 suite’ had been used as a bedroom inappropriately on eight occasions since the June inspection. The facility is meant to be used to take patients who have been detained by police under section 136 of the Mental Health Act while they wait to be assessed.
“We found that this was not appropriate to ensure the dignity or protection of people who need to be admitted to psychiatric inpatient care and this practice meant that there was a risk that people would not receive the appropriate care and treatment,” the CQC found.
Inspectors also found that some patients were not aware of whether or not they had been detained under the Mental Health Act or not. This meant patients were at risk of receiving inappropriate care, the CQC said.
Mary Sexton, Director of Nursing, Quality and Governance at Barnet, Enfield and Haringey Mental Health NHS Trust said the trust was “very disappointed” to have received the enforcement notice from CQC.
“As has been reported in the local media, there is significant pressure on our mental health inpatient beds, which reflects the trend across London and the rest of the country. As a result of this pressure there have been instances where seclusion rooms have been used as an absolute last resort for a patient after being unable to locate a bed elsewhere, within the Trust, within London or even nationally. However, this is clearly not good clinical practice and we have ceased the use of seclusion rooms for this purpose,” said Sexton.
“We have recently reconfigured our assessment services for patients referred to the Trust to reduce pressure on the inpatient service, and we are working very closely with our commissioners to address the increased demand the Trust has encountered over recent months so that we can continue to provide our patients and service users with high quality and safe care. ”
In recent months, Community Care has revealed widespread problems with mental health crisis care, particularly issues around accessing inpatient care. In October, we revealed that over 1,700 mental health beds have been closed since April 2011 despite rising demand for care.
In December, we revealed how funding for mental health trusts dropped by 2.3% in real terms since April 2011 as commissioners put pressure on providers to make cost savings.