Enter and View visit South Hackney Recovery Team CMHT
February 2020
Service South Hackney Recovery Team
Service address Donald Winnicott Centre, Coate Road London, E2 9AG
Provider name East London Foundation Trust (ELFT)
Date/Time of visit 20 February 2020
E&V representative/s Kanariya Yuseinova Emma Cooke Rachel Klem
Healthwatch staff contact Kanariya Yuseinova
Service contact Adesoji Ogungbola 020 7275 1000
About Healthwatch enter and view visits
The Local Government and Public Involvement Act 2007, as amended by the 2012 Health and Social Care Act and directed by Local Healthwatch Regulations 013, imposes a duty on health and social care providers (including the private sector) to allow authorised representatives of Local Healthwatch to enter premises they own or control to observe the services being provided. These are legally binding directions and are often referred to as ‘the right to enter and view’.
Purpose of the visit 1 One in six adults has a common mental disorder such as anxiety and depression
Mental health services are of increasing concern to the public. In Hackney, mental health is consistently raised with us by the public as a key issue. Healthwatch Hackney decided that for 2020, one of our Enter and View priorities would be to review mental health services provision in the borough and report on the care quality.
The purpose of Enter and View is to collect feedback from people who use the services, staff who provide the services, and others with an interest e.g. carers, where possible.
We visited the Community Mental Health Team (CMHT) known as the South Hackney Recovery Team to:
● Get patients’ feedback on the care and support they receive from the CMHT ● Talk to staff members about their experience of working at the CMHT ● Observe the physical environment of the service ● Compile a report highlighting good practice and recommendations for improvement
Our decision to visit was influenced by the following factors: ● Routine comments and feedback from patients to Healthwatch Hackney ● Healthwatch Hackney priority to review mental health service provision within the borough
1 Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2014
Acknowledgements
Healthwatch Hackney would like to thank Team Manager Adesoji Ogungbola and the staff for accommodating our visit, as well as the patients and carers for participating in our interviews. We are also grateful to our volunteer authorised representative for conducting the visit.
Important Information for management/provider
● We asked South Hackney Recovery Team to provide an action plan and response to issues raised in this report’s recommendations. The impact of the Covid pandemic on the service has meant that they have been unable to respond to date.
● Copies of this report will be circulated to the Care Quality Commission, the East London Foundation Trust, City and Hackney Clinical Commissioning Group and Healthwatch England, and will be posted on the Healthwatch Hackney website
Disclaimer
● Observations made in this report relate only to the visit carried out at South London Recovery Team on 20th February 2020which lasted for a total of 3 hours and 15 minutes, and one patient feedback received via email. ● We notified the service five days prior to the visit and sent them leaflets to notify the patients about our arrival. The leaflets were available to patients in the waiting area. ● We did a call-out through our website and social media to anyone who wanted to share their views on these services. ● This report is not representative of all CMHT patients on the day of the visit. It only represents the views of ten patients who were interviewed on the day of our visit, one patient’s feedback received via email, and the members of staff who were able to contribute within the time available.
Recommendations All recommendations are based on patients’ feedback and our observations
Recommendation 1 Improving appointment system. The service should
- make it easier for patients to schedule and reschedule appointments - ensure administration is up to date and provides clear information to patients / eg. a patient received 3 different appointment dates for their first appointment
Recommendation 2 Customer service training for the receptionist and all other support staff
For receptionists to better understand the patients’ needs and the environment provided, receptionists should receive training on how to assist patients with their health visit.
Recommendation 3 Improve signage to access the building
Accessing the waiting area through the two double doors is not clear due to the multiple signs and buttons/intercoms.
Recommendation 4 Improve wheelchair accessibility
Accessibility to the waiting and consultation rooms for wheelchair users and mobility scooters to be reviewed. Wheelchair accessibility should also be reviewed for the lift.
Recommendation 5 Improve the physical environment for patients and visitors
Review processes to ensure the physical environment is regularly checked and ensuring amenities, such as the toilets and water dispenser, are fully stocked for the patients’ and visitors’ needs. In addition, ensure all equipment within the service is in working condition.
Recommendation 6 Better placement of the water dispenser
The water dispenser to be serviced and moved away from the toilet door improve health and safety of patients and visitors. Also ensure that there are cups available at the water dispenser.
Recommendation 7 Provide patients and other visitors with better information
The service should make sure that racks are stocked with up-to date information on: Accessible Information Standard, Dementia, Special Educational Needs, Carers Support, Mental Health support groups, Healthwatch Hackney, Hackney’s Complaints Charter and other relevant information that patients and carers may benefit from. This includes providing more and appropriate reading materials, ensuring that they are free of offensive content.
Recommendation 8 The defibrillator should be moved to an area accessible to the public.
The defibrillator is currently in the duty doctor’s room, inaccessible to the public for use in an emergency. The equipment is designed to be used without specialist knowledge and training and should be located in an area accessible to everyone.
Key information about the provider
● The South Hackney Recovery Community Mental Health Team (CMHT) provides a specialist service for adults aged 18-65 years who require a period of support to maintain their mental wellbeing. ● The service is run by the East London Foundation Trust (ELFT). ELFT Provides a wide range of community and inpatient services to children, young people, adults of working age and older adults, as well as forensic services to the city of London, Hackney, Newham, Tower Hamlets, Bedfordshire and Luton. ● The CMHT offers a range of interventions or treatments including: ● Joint assessment and care planning ● Talking therapies ● Medication ● Support for family or friends who are helping the service user ● Support to recognise possible early warning signs of distress and developing techniques to manage this and staying well. ● Support finding training, employment, and meaningful activities. ● There are approx. 1,097 service users registered with the service of whom 201 are on the Care Programme Approach (CPA).
Location and transport
● South Hackney Recovery Team CMHT is based at the Donald Winnicott Centre, Coate St, London E2 9AG and shares the entrance with other mental health services. ● The services are open from Monday to Friday 9am-5pm. ● The main entrance is off the main Hackney road, near the 26, 48, and 55 bus stops.
The conversation with the Team Manager
The team
South Hackney recovery team has been fully staffed for the past year and used no agency staff.
The team comprises 35 clinical staff divided into two teams – Recovery Team 1 and Recovery Team 2. The core team consists of 1 operational lead, 2 senior practitioners, 6 social workers, 6 community psychiatric nurses, 2 occupational therapists, 4 support workers, 2 psychologists, 2 assistant psychologists, 2 psycho- social intervention workers, 1 homeless specialist, 2 consultant psychiatrists, 2 staff- grade psychiatrists, 1 employment specialist, 1 carer support worker, 1 benefits advisor.
Each social worker has a caseload of maximum 25 patients per month, and each consultant sees approximately 548 patients per month.
The service also has 8 non-clinical staff comprising administrators and a receptionist.
The full-time receptionist is supported by an apprentice or one of the administrators, so the reception is covered by two people at all times.
Clinical and administration staff receive yearly mandatory training and undertake other annual courses for the various professional disciplines to remain registered with their respective regulatory bodies.
Other services available
Depot clinic – The clinic runs twice a week on Tuesday morning and Wednesday afternoon to provide flexibility for service users of whom there are currently 186.
Open House - This is a fortnightly forum for patients to express their views on their experiences of engaging with the mental health services. Attendance is open to anyone who is known to South Hackney CMHT.
Personal Health Budget (PHB) - This scheme was created to give NHS services users more choice and control over their own health and wellbeing. PHB can be used to purchase a range of services, activities or support that the service users require to achieve their recovery goals.
Duty worker - The CMHT has a “walk-in” clinic every day from 9am–5pm for anyone in need of a prescription or in crisis. The service is run by a different professional every day.
Referrals
Referrals are received mainly by the City and Hackney Adult Mental Health Referral and Assessment service (CHAMHRAS), and directly from inpatient settings including eg the City and Hackney Centre for Mental Health. CHAMHRAS acts as a single point of entry to the services and is responsible for conducting the initial assessment. Referrals to CHAMHRAS can be made by a GP, or by housing or social services. Over the last six months the service has received around 257 referrals.
The service registers around 70 Did Not Attend (DNA – missed appointments) per month.
The service should implement a system to provide patients with timely updates on the waiting list for treatment once assessed by the service.
Treatment
● Once the referral is received by the service, a patient is seen by a professional usually within a month, but this sometimes takes longer. ● Follow-up outpatients are seen routinely by a psychiatrist once every 3-6 months. The patients who are on CPA are seen at least once a month by the care coordinator. ● Patients are discharged from the service back to primary care (GP or other services) with access to an enhanced primary care team, which means the patient will still see a worker once a month.
The service provides interpreters to patients needing them, using the Language Line telephone interpreting service.
Complaints/ Patients’ feedback
Patients’ feedback is collected as part of the Open House Forum. A volunteer from the People Participation Team collects patients’ feedback once a month while they are waiting for their appointment. Patients and carers are also able to share feedback in the form of letters and complaints.
The service is in process of setting up a system whereby feedback questionnaires are sent automatically to the service users’ mobile phones after their appointments.
Carers support
The service does not have an established carers group but provides one-to-one meetings for individual carers.
Observations The following observations were made during the visit:
Physical environment/ Cleanliness/hygiene
● We felt that the reception area was messy and untidy. ● The water dispenser was available in the waiting area but situated right next to the toilet door, making it tight for space. The cup holder was empty and there was a leak coming from the dispenser. Water cups were kept at the reception desk. ● The seats and floors were clean, however some patients suggested better and more comfortable chairs. ● There was good bright lighting. ● There was some artwork on the walls done by patients. ● A fish tank and TV were available in the waiting area. ● There was one patient toilet in the waiting area which wasn’t dementia friendly or accessible due to the lack of grab rails. The toilet wasn’t very clean and there was dirty paper on the floor. There was a baby changing facility available with a safety strap. ● The ‘You said…We did’ notice board was available and said there had been better continuity with doctors and more welcoming reception staff. ● There was a lack of reading materials in the waiting area - only one copy of Viz and an Evening Standard. Viz is an adult magazine and could be deemed as offensive for some visitors because of its sexual content. ● The notice boards were messy and overcrowded, and several notices were out of date. Other boards, such as the CQC rating board, were last updated in 2016 and 2018. Flyers about training sessions and feedback events were out of date by nearly 9 months. There were also many leaflets on the bulletin board but again overcrowded making it look unorganized.
Patient-centred care/dignity/safety
● Patients noted a deterioration in their mental health as one appointment every few months is not enough. CMHT patients stated they need more support while on the waiting list for psychotherapy treatments elsewhere. ● Key fobs were given to many workers who came in to do construction work, but we noticed that their names were not recorded, and they were not asked about their business there. ● Fire alarm sensors were available with a fire alarm button at the entrance. The fire exit map was also available there. There was a security system in place and fob locks were necessary to enter all doors. There was no information about the fire or panic alarm system. ● Fire extinguishers are available on the 1st and 2nd floors but not visible in the waiting area. A first aid kit was available in the office and on the 1st and 2nd floor kitchens, but again not visible in the waiting area. ● The reception desk has two levels making it suitable for wheelchair users. There is a glass screen separating the receptionists from the patients, but some information can still be overheard. ● The bars on the outside of the did not create a welcoming atmosphere. ● A defibrillator is available in the duty doctor’s room
Communication with patients/ Information
● There is a hearing loop available at the reception. ● One patient reported receiving 3 separate appointment letters from CMHT in quick succession changing her appointment. ● We observed that the receptionists were warm and friendly with the patients and their colleagues and had a very non-judgmental and positive approach. ● Members of staff were engaging, approachable and friendly with patients even if they weren’t due to see them on that day, and this had a very positive effect on many patients as they waited for their appointments. The patients really appreciated seeing familiar faces, being asked how they were and remembered, which all added a personal touch. ● There was a ‘Tell us how we did’ poster but it was covered by the health monitor instruction sheet. No information was available on how to directly complain, but there was an Open House Forum leaflet on the bulletin board giving dates to come and share patients’ experiences. ● Mental health services and carers group materials were available on the bulletin board. ● A conversation was overheard between a patient and receptionists: ‘Did you know there is a puddle coming from the water dispenser? Someone could slip’. The receptionists cleaned the puddle immediately.
Access issues (physical or accessible information)
● The two lots of electronic double doors giving access were confusing because it wasn’t clear whether you could open the second set of doors yourself by pressing the open button, or by using the intercom to have the receptionist open the doors for you. It was possible to get stuck between the two sets of doors when leaving because the ‘Open Door’ button was not in working order. The first set of doors could be manually opened but all the signs on the door suggested they were automatic use only. ● There was no accessibility information for patients with learning disabilities or visual and hearing impairments. The lift is too small for wheelchairs. The lower reception desk for wheelchair users has only a small surface area which seemed cluttered with ‘depot notice’ signs. There is not much space available in the waiting area for wheelchair users to be seated although enough for them to move around. However, the toilets are a bit small for wheelchairs.
Appointments system
● The turnover of junior doctors on rotation means that some patients rarely see the same doctor regularly. This can be challenging for patients with mental health issues; they have to repeat their story again and again and feel as though their treatment is very impersonal.
Patient feedback
Patient 1 The patient has been involved with the service for over 9 years. She was waiting for her appointment for talking therapy.
The patient needed an interpreter and was happy that the service could arrange the same interpreter for every appointment. She has a key worker assigned to her and finds him very helpful and supportive.
“Everyone here is very nice, kind and supportive.”
The patient said the talking therapies were very good because the therapist makes her feel comfortable and is very supportive and motivational. They talk about her mental health and wellbeing.
Two years ago, she was admitted to hospital because she stopped taking her medication. Her doctor decided that it would be better for her to receive depot injections which caused tremors, sleeplessness, distraction, and self-isolation.
She told the doctors of her symptoms, but they said she still had to finish her injection rounds. The patient was not happy with that.
The patient told her key worker who then spoke to the doctor, and she went back on her medication. Her tremors are continuing but are not as severe.
The patient receives text message reminders for her appointments, which she finds helpful.
Her doctor is good and helps her a lot. The patient feels that seeing her doctor every three months for 10 minutes is not often enough or long enough. The staff arrange the appointments in advance, and according to the patient’s availability.
The patient said that her key worker is great, and she trusts him a lot. He is her first point of contact if she is struggling with something.
The patient attends the Open House group meetings. Everyone there is very kind and helps her socialise.
Patient 2 The patient was waiting to see a duty worker to request medication to help her sleep.
She has been involved with the services for over 10 years and sees the same doctor every three months. He is great and very supportive and understanding. They book the appointments in advance, and according to the patient’s availability. If she needs to see the doctor in between her appointments, she calls the office and leaves a message, then the doctor calls her back, which she finds very helpful.
The patient attends a bipolar therapy group which she finds to be excellent.
The patient thinks doctors should take their time to find the best medication for patients, and perhaps arrange more group therapies rather than prescribing medicines.
She thinks the professionals are very kind and supportive, except for the reception staff. They used to be much more professional. They are often speaking with each other or on their phones. She sometimes must wait outside until they open the door. Sometimes she has to call the group leader, to come and open the door which she says is frustrating. The patient does not think the receptionists have any mental health awareness or know how to deal with such patients.
The patient commented on the bars on the windows. She also said they need better chairs and at least one more toilet for patients.
In November, the patient was told that a care coordinator would be appointed for her, but she only heard from them after three months. The care coordinator did not check her notes, and incorrectly stated her employment status since being diagnosed.
During the interview, a member of staff known to the patient walked into the service and approached her in a warm and welcoming manner, calling her by her first name.
The staff member suggested passing the patient’s message to her regular doctor (although it was not part of her job) and suggested the patient comes back in the afternoon to receive her prescription. The patient left the service visibly satisfied.
Patient 3 The patient has used the service for over two years. She had an appointment with the employment support worker.
She said that apart from the psychiatrist, she also uses the services of the employment support worker and the benefits coordinator.
The patient sees a psychiatrist every three months but missed the last appointment in January, so she now must wait until March for another one. She was told she will not see her regular doctor but was not given a reason. However, the patient did not mind the change.
The patient said she feels listened to and well looked after by the professionals. She finds the building accessible and reception staff friendly. She feels safe at the premises and said that “everyone here is very kind and helpful”
Patient 4 The patient was referred by the hospital a few months ago and started seeing a psychiatrist once a week. She has been through eight of her twenty sessions but feels she will need more than twenty. The doctor told her they can arrange more consultations if she still feels this way when she finishes her sessions.
The patient is always seen on time and never felt rushed. The psychiatrist is very supportive.
The patient’s comment about the mental health services was “they should stop taking people into hospital for no reason. I wasn’t ill when I was admitted, I was just lost”.
Patient 5 The patient feels this is a fairly good service, but it can also be difficult. There is some misunderstanding with the doctors because the patient often feels misinterpreted. The time during the appointment is balanced so the doctors can get enough of an idea about what to do to help the patient, but it is difficult because they can’t relate to the patient. He says that the service tries to see patients as quickly as possible.
The patient is happy with the care continuity.
He feels comfortable and listened to. The appointments are usually about 30 minutes and he does not feel rushed. He added “There is always room for improvement” but on the whole it works well.
Patient 6 The patient waited a month for her first appointment having been referred by her GP at the Richmond Practice.
She received three letters with three different appointment times. The letters overlapped and the patient received them in the wrong order. This caused her difficulties getting time off work and caused further stress and anxiety. Called DWC to confirm which one was right. Found it easy to get through and confirmation was fine.
Patient 7 The patient was new to the area and this was their first appointment after being referred by their GP at the Richmond Practice. The waiting time for this appointment was about three weeks.
Patient 8 The patient says that the Donald Winnicott Centre does not call back even if you call several times. She made 8/9 calls this month to try and change her appointment but still did not received a call back.
Patient 9 The patient was distressed about the impersonal approach of seeing a different doctor nearly every appointment. She attends appointments once every three or four months while waiting for Mentalisation-Based Therapy (MBT) at Vivien Cohen House.
She found the mindfulness classes very helpful. While she was waiting, the leader of the classes came through reception and remembered the patient and her details. The patient was visibly moved by this and used it as an example of the difference it makes when a professional knows you and can remember you.
Patient 10 The patient finds the services generally good, apart from finding the reception staff rude on many occasions and adding that they “seemed not to care or appeared to not really enjoy their role”. “My consultant was also sometimes difficult to talk to. It was not easy expressing my thoughts and feelings and often time I felt rushed. I have a new consultant now after 7 years. I have met him once but had a negative history with him during my time at Homerton; however, we seemed to get on better at the DWC, time will tell how it goes”.
The patient found the premises an adequate size for its purpose and well kept.
Gender Male 7 Female 3