Patients at a London mental health trust have been put at risk because of failures by the trust’s leadership, according to a report by the care and health services inspectorate.
The Care Quality Commission (CQC) says West London Mental Health NHS Trust failed to investigate suicides properly or learn from serious incidents involving patients.
The report, triggered by concerns about the trust’s response to patient suicides, concludes that its arrangements for investigating and learning from serious incidents were “seriously flawed” and that the trust “tolerated mediocre and, in some instances, low standards of care”.
The CQC said the trust repeatedly failed to learn lessons over a number of years and that its board “lacked vitality and vigour”.
The report looks at the high-security services at Broadmoor Hospital in Berkshire, as well as community and inpatient services in west London, and also highlights problems with sub-standard buildings, poor physical healthcare, a lack of beds, a shortage of staff and poor training.
Barbara Young, the CQC’s chairman, said: “Patients were considered to be at greater risk of harming themselves or others, because the trust’s systems to manage risk were seriously flawed.”
The report came two days after the publication of the Mental Health Act Commission’s final report into inpatient care in England, which found serious concerns about safety, care quality, and patients’ human rights.
Paul Farmer, chief executive of the mental health charity Mind, said the failures at the trust were “symptomatic of failings across the country in the way that mental health inpatients are treated”.
He added: “Delays, bureaucracy and failure to learn from past mistakes are putting patients’ lives at risk. There can be no excuse for these serious failings.
“Although there are some excellent inpatient wards, in many areas poor practice has become entrenched, and conditions that should be considered unacceptable have become the norm.”
21 July 2009