West London Mental Health NHS Trust ordered to improve restraint and seclusion practices

September 16, 2015
Jim ODwyer

A CQC inspection has resulted in West London Mental Health NHS Trust being required to make "urgent improvements" in relation to the use of restraint and seclusion.

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Following a Care Quality Commission (CQC) Inspection at West London Mental Health NHS Trust, which covers numerous mental health wards and psychiatric intensive care units in and around London including top-security Broadmoor Hospital, the Trust has also been told it must ensure staffing levels are sufficient and morale is improved.

The CQC report highlighted:

  • There were too few staff to consistently guarantee safety and quality in the forensic services, high secure services and community based mental health teams. Across the trust, 25% of staff surveyed said they experienced physical violence from patients and relatives, compared to the national average of 18%.
  • A substantial problem with staff recruitment and retention, coupled with low morale and poor engagement with front-line staff in some services.
  • An 'urgent need' to improve practices in relation to restrictive interventions such as the use of restraint and seclusion, in particular, the "overuse" of face-down restraints on patients. The CQC Inspectors found that restraint was being used mostly on acute, forensic and high secure in-patient wards, including Broadmoor and, in 179 out of 432 cases, patients were restrained in the prone position, also known as face-down restraint, which the government considered banning in 2013.

Dr Paul Lelliott, the Deputy Chief Inspector of Hospitals and lead for mental health, said: "We were concerned at the apparent overuse of physical restraint. Staff must use restraint only as a last resort, and minimise the use of restraint in the prone position."

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