Mental health trust slammed over conditions at Broadmoor Hospital

The mental health trust which runs high security Broadmoor Hospital has been attacked for showing a lack of "vitality and vigour" in tackling a series of shortcomings and incidents including patient suicides, in a report by a health watchdog published today.

Inpatients at the West London Mental Health NHS Trust were put at risk due to a failure to properly investigate suicides and learn from other serious incidents, health and social care regulator the Care Quality Commission (CQC) said.

The commission also accused the trust's board of showing insufficient vigour in tackling "serious concerns" relating to issues such as sub-standard buildings, bed shortages, poor physical health care, not enough staff and a lack of training for staff working at the trust.

Rather than be determined to be a leader in the field of mental healthcare, the trust tolerated "mediocre" and in some instances "low standards" of care, the report noted.

The investigation by the commission was provided with 95 reports by the trust into serious incidents - 31 of which related to a patient suicide and five to attempted suicide - in the period between 2005 and 2007.

The commission examined arrangements for investigating such incidents, management or risk and quality of care as well as visiting sites at the trust and interviewing staff, patients and families.

The trust provides high security, inpatient services at Broadmoor Hospital in Crowthorne, Berkshire, as well as community and other inpatient services in Hounslow, Ealing, Hammersmith and Fulham in west London.

The report by the commission painted a picture of a trust where acutely ill patients were at times forced to sleep on sofas because of a lack of beds, wards were faced by staff shortages and some sites had suffered vermin infestations.

The commission said some buildings used by the trust were not a "safe environment" for care of patients.

It said Broadmoor, which was first opened in 1863 and described in a 2003 report by the former regulator as "totally unfit for purpose" and lacking in "basic standards of dignity and privacy", remained so today.

In one example cited in the report the trust told the commission it was not possible to eliminate all the "ligature points" such as bars on windows at Broadmoor, because some of the older buildings at the hospital are listed.

Some of the buildings at St Bernard's Hospital in Ealing, west London, dating back to 1830, were in "urgent" need of upgrading, the commission also noted, with mice and cockroach infestations reported in 2005 and mice in bedrooms and the kitchen the following year.

In 2007 there was an outbreak of legionnaires disease on the site which affected one person who subsequently recovered, the report said.

The CQC also raised problems of overcrowding at some sites with patients likely to be deemed acutely unwell on a "number of occasions" forced to sleep on sofas at its Hammersmith and Fulham unit.

Many services were also affected by staff shortages and absence due to sickness.

Staff shortages were a "persistent" problem at Broadmoor with vacancy levels reaching as high as 22% on some wards and some staff reporting working 15 hours a day on some occasions.

Baroness Young, chairman of the CQC, accused the trust of a "slow and piecemeal" response to the problems.

She said: "Mental health services are inherently risky environments and this trust cares for some of the most seriously unwell patients in the country.

"Given the nature of its services, the organisation should be leading the way in managing risks, yet in some instances they tolerated poor and mediocre practices."

A spokesman for West London Mental Health NHS Trust confirmed that chief executive Simon Crawford had left on Friday to take up a new post at NHS London.

A statement from the trust said it accepted the recommendations in the report.

New chief executive, Peter Cubbon said: "There are lessons to be learnt from the investigation.

"The trust has already made progress in implementing a number of the recommendations and I am totally committed to working with the board to make sure that appropriate action is taken to address all of the outstanding issues.

"Working with our commissioners and NHS London we will ensure that patient safety is a top priority for all at West London Mental Health Trust."

Recently appointed chairman Nigel McCorkell, who joined the trust in January said: "During the past two years changes have been made to the way incidents are reported and investigated at the trust.

"Our priority is to ensure that all incidents are rigorously investigated and that the learning from incidents is appropriately disseminated throughout the organisation.

"The trust recognises the limitations of some of our buildings.

"In terms of Broadmoor Hospital we have submitted to NHS London an outline business case (OBC) for a complete redevelopment of the hospital. We are also working on a strategic outline case for the redevelopment of our St Bernard's site in Ealing and this will go to the trust's board in the autumn.

"In Hammersmith & Fulham we have worked with our PCT and local authority partners to make changes to the way patients are admitted to the wards to ensure the bed pressures highlighted by the report do not reoccur."

A spokesman for English Heritage, which makes recommendations on the listing of buildings, said it had been working with the trust on the "wider issues" of providing care to a modern standard at the site but had not been approached about the specific issue of bars on the windows at Broadmoor.

He said if the trust could demonstrate that people were attempting to take their lives using the bars, then that would present "robust justification" for removal.

He said: "If they can demonstrate that it is happening, if there is an example of that happening and it cannot be managed in any other way, then obviously you would expect that to be robust justification for removal, but nobody has come to us and said that."

A statement from West London Mental Health NHS Trust on the removal of ligature points at Broadmoor Hospital said: "The trust had discussions with English Heritage some time ago about making adjustments to the fabric of the buildings as we felt they were not fit for purpose and posed a risk to patients.

"We have not been able to make all the changes we would like to have made - for example in the case of the bars on the windows we have had to put Perspex between the bars and the windows to reduce risk.

"In terms of the hospital redevelopment we have worked closely with English Heritage in submitting our outline business case to ensure they are in support of our plans."