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Overall, CQC found that the trust was well led, that staff were caring and compassionate, and identified some good and innovative practice, however there were a few areas where improvements were needed that could have an impact on the safety and effectiveness of the services being provided to people.

Inspectors found that ligature points could put people at risk in acute inpatient wards. Although the trust was in the process of taking action to address these issues, there was still more to be done to make these areas safe. The consistency of inpatient care was also sometimes affected by people being asked to move wards without this being based on their clinical needs, for example, to make a bed available for a person of a particular gender.

Some staff working in inpatient services were not confident in using the Mental Capacity Act 1983 and the Deprivation of Liberty Safeguards (DoLS). This led to a risk that people might not be properly involved in decisions about their care. Inspectors were also concerned about the risk of falls for older people, and lessons learned from incidents were not always shared effectively with staff working in wards or teams.

The senior management team at the trust were aware of the improvements that were needed, and were in the progress of addressing them at the time of the inspection. Inspectors saw that people using the services were treated with dignity and respect, and the majority of people spoken to said staff were kind. CQC saw good collaborative working relationships with partner agencies such as social services.

Inspectors identified a number of areas in which the trust must make improvements (alongside other areas where improvements should be made), including ensuring that:

• Staff working in the acute wards are clear about the steps they need to take to reduce the risk of ligature points to patients while building work to reduce these is taking place.
• The policy for managing the risk of falls is updated to consider recent best practice guidance, and this guidance is followed by staff.
• Learning from serious untoward incidents is shared across wards and teams quickly.
• The movement of patients between acute inpatient wards for non-clinical reasons is kept to the minimum. Where it is unavoidable, arrangements must be in place to ensure that a thorough handover takes place to promote continuity of care.
• The action plan for the Psychiatric Intensive Care Unit is kept up to date so that it is clear when targets have been met, and that there are deadlines for outstanding work.

Inspectors also identified a number of areas of good practice across the trust, including:

• A liaison service to health-based places of safety in three local acute hospital accident and emergency departments, rather than in the trust's own premises. These were working well.
• Crisis houses to reduce admissions to acute wards as part of a care pathway to offer the least restrictive option to hospital admissions, which are well received by people who use services.
• Making sure that people using inpatient services receive physical health care as well.
• A stable senior executive team and effective governance arrangements.
• A considerable amount of innovative research. Staff told inspectors how much they valued participating in this work.

Professor Sir Mike Richards, CQC's Chief Inspector of Hospitals, said:

"Camden and Islington NHS Foundation Trust provides vital services to a large number of people in Camden and Islington, which makes it very important that these services are delivered well. We saw that the trust genuinely wanted to put the people who used their services at the centre of their work.

"We found that, while staff were delivering compassionate care and there was innovative practice in some areas, there were some areas of the trust which could present a risk to people using its services. These issues need to be fixed quickly to ensure that people are safe.

"This inspection took place as part of our pilot programme designed to fully test our new methodology, and the trust will receive a rating when we next visit. When we return, we hope to see that the good practice that we have seen has been sustained, and that where we have identified that improvements are needed, these are made quickly.

"We will be working with the trust to agree an action plan to help improve the standards of care and treatment it provides."

CQC found that action had been taken by the trust to meet standards which it was failing to meet at inspections under CQC's old methodology.

Camden and Islington NHS Foundation Trust was one of the first specialist providers of mental health services to be inspected under CQC's new approach to inspections.

An inspection team which included CQC inspectors and analysts, doctors, nurses, social workers, Mental Health Act commissioners, psychologists, patient experts by experience, other specialists and senior managers, visited services run from Highgate Mental Health Centre, St Pancras Hospital, Stacey Street Nursing Home, and a wide range of community services.

The team observed care taking place, talked to staff, patients and carers, and looked at care records. They also held focus groups with different staff groups, attended team meetings, collected patient feedback using comment cards and also consulted local patient and carers' representative groups.

The full reports on the trust and on each core service can be found here.

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