Participation in clinical research

Local Audits

The Trust continues to participate in both local and trust wide audits, for example Infection control audits, falls, a trust wide documentation audit and emergency equipment. Each division and discipline are encouraged to identify areas for improvement and develop local audit plans to undertake throughout the year and share the learning with staff. Teams were encouraged to focus their audit plan around local and trust wide priorities when identifying audits.

Actions taken in response to local audits

Audit participants are encouraged to share the learning with colleagues in their divisions and across the trust at local quality forums or appropriate meetings.

National Confidential Enquiry (NCE) into Patient Outcome and Death (NCEPOD) - 2018/19

Audit Title Data collection period Survey Requested by NCE Surveys Returned

Suicide 1 April 2019-April 2020 19 14

The Trust is one of the leading mental health Trusts across the country for research, and its performance across key research domains are highlighted below.

Top Five Recruiting Studies

Rank Study Name Local Investigator Recruitment

1 Lifestyle Health and Wellbeing Survey David Osborn 304

2 Attitudes to Voices: A survey exploring the factors associated with clinicians’ perspectives on hearing voices Nicholas Green 80

3 Exploring unusual feelings: a questionnaire study Harriet Martin 75

4 Risk Assessment and Increasing Safety in Dementia – RAISe-Dementia study Sergi Costafreda-Gonzalez 66

5 National Centre for Mental Health (NCMH) Andrew Black 38

Participant Recruitment

As of the 5 March, 956 participants were recruited into 31 research studies

Biomedical Research Centre

The broad strategic aims are detailed below:

o Capacity building

o New treatments,

o Personalised/precision treatment and data science

There has been success with early career researchers who have gained independent funding for midlevel fellowships with the BRC support.

Institute of Mental Health (IoMH)

UCL launched the new Institute of Mental Health (IoMH) in 2019 as a vehicle to centralise research and expertise in mental health. The IoMH aims to be a focal point for UCL’s mental health research community, adding value to current clinical partnerships including C&I and build capacity together.

Professor Anthony David, in his capacity as Director and Sackler Chair of the Institute, joined the R&D Committee in early 2020 and now regularly communicates with members on the latest updates and developments from the IoMH.

As part of the redevelopment of the St Pancras site and building on the strong association with IoMH, a title under consideration is the ‘Institute of Mental Health at C&I’.

Biomedical Research Centre (BRC)

The BRC mental health theme continues its work into new tests, treatments and theories in mental health, neurology, and dementia. An ablation service has been established at Queens Square for the treatment of mental health disorders, with a clinical pathway being set up for severe treatment resistant depression, to include neurosurgical treatment within Camden and Islington Trust.

Theme members led the mental health component of the Genomics England Pharmacogenetic Service that will roll out across the whole of the NHS in 2020. In anticipation of this, a pharmacogenetic testing service has been set up within Camden and Islington for treatment resistant patients with psychosis and depression and those who have experienced treatment limiting adverse drug reactions.

QUALITY AND INNOVATION: THE CQUIN FRAMEWORK

The table below summarises the Trust’s level of achievement against the nationally set targets:

CQUIN targets in 2019/20: Indicator

CCG3a – Alcohol and Tobacco – Screening:

Achieving 80% of inpatients admitted to an inpatient ward for at least one night who are screened for both smoking and alcohol use. Partially Met

Achievement

CCG3b – Alcohol and Tobacco – Tobacco Brief Advice:

90% of identified smokers are given brief advice as outlined in the Alcohol and Tobacco Brief Interventions E-learning programme-including an offer of Nicotine Replacement Therapy (whether this offer had been taken up). Not Met

CCG3c – Alcohol and Tobacco – Alcohol Brief Advice:

90% of patients identified as drinking above low risk levels, given brief advice or offered a specialist referral. Partially Met

CCG2: Improving the uptake of flu vaccinations for frontline clinical staff

Achieving an uptake of flu vaccinations by frontline healthcare workers. Not Met

CCG4: 72hr follow up post discharge

Achieving 80% of adult mental health inpatients receiving a follow-up within 72hrs of discharge from a CCG commissioned service. Partially Met

CCG5a: Mental Health Data Quality: MHSDS Data Quality Maturity Index

The MHSDS DQMI score is an overall assessment of data quality for each provider, based on a list of key MHSDS data items. The MHSDS DQMI score is defined as the mean of all the data item scores for percentage valid & complete, multiplied by a coverage score for the MHSDS. The full definition and DQMI data reports can be found at: Met

CCG5b: Mental Health Data Quality: Interventions

Achieving 70% of referrals where the second attended contact takes place between Q3-4 with at least one intervention (SNOMED CT procedure code) recorded between the referral start date and the end of the reporting period. Not Met

CCG6: Use of Anxiety Disorder Specific Measures in IAPT

Achieving 65% of referrals with a specific anxiety disorder problem descriptor finishing a course of treatment having paired scores recorded on the specified Anxiety Disorder Specific Measure (ADSM). Partially Met

CARE QUALITY COMMISSION (CQC)

Registration:

CQC registers Camden and Islington NHS Foundation Trust services to carry out the following legally regulated activities.

Treatment of disease, disorder or injury

St Pancras Hospital

Highgate Mental Health Centre

Assessment or medical treatment for persons detained under the 1983 Act Registered services

St Pancras Hospital

Highgate Mental Health Centre

Diagnostic and screening procedures

Highgate Mental Health Centre

St Pancras Hospital

Participation in reviews and investigations

CQC inspections

In October and November of 2019, CQC inspected the following core services ad part of the ongoing monitoring of the quality and safety of healthcare services. The following core service were inspected:

• Acute Wards for adults of working age and psychiatric care units

• Long Stay Rehabilitation Mental Health Wards for working age adults

• Mental Health Crisis Services and Health Based Places of Safety

• The Trust also had a well-led inspection.

Results for this inspection

What the CQC said about our services

Across the organisation, the CQC found:

• Patients were treated with compassion and kindness across all services with respect for their privacy and dignity

• ‘Evidence of some outstanding care’ supported by a flourishing and wellembedded QI programme

• Establishment of the Primary Care Mental Health Networks ensuring joined-up care

• Positive engagement with patients, carers and staff including a wide range of coproduction work • A strategy to improve staff health and wellbeing

• A ‘capable and experienced leadership team’ who are open about the challenges they face

• Effective partnerships with other stakeholders across north London, including the formal alliance with Barnet, Enfield and

Haringey Mental Health NHS Trust (BEH),

‘which was progressing well’

We still face challenges including high demand for acute beds; caseloads that are too high in community-based mental health; and delays to both Mental Health Act assessments and serious incident investigations. The CQC also identified the need for more work to strengthen support networks to meet the needs of staff and patients with protected characteristics

Mental Health Act Monitoring Visits

Our inpatient wards receive an unannounced visit from the CQC every 18 months as part of its regular cycle of MHA monitoring visits. In 2019-20 the following six wards have received a visit so far:

Domain Area

Care Plans S132 Rights S17Leave of absence Consent to Treatment General Healthcare

Emerald Dunkley Coral Amber Jade Pearl

Statutory requirements met Improvement required

The top three concerns raised by the CQC are:

• Consent to treatment: when seeking the patient’s consent prior to first admission and assessing the patient’s capacity to consent to treatment, the nature of the decision for which the patient’s capacity was being assessed was not recorded and/or the evidence for the conclusion of the capacity assessment (when the patient was found to lack capacity) was not available (Breach of

paragraph 24.41 of the Code of Practice to the Mental Health Act and Section 5 of the

Mental Capacity Act); and

• Care plans: patients’ views were not adequately reflected, and copies were not always shared with patients (Breach of Chapter 1 of the Code of Practice to the Mental Health Act); and

• Section 17 Leave: trust form not fit for purpose.

It is noted that, in 2019/20, no concerns were raised by the CQC re Section 132 rights (evidence of attempts made to explain their rights to patients not being found), which is a considerable achievement (and had not happened since records began in 2015).

The CQC findings are corroborated by internal assurance sources. C&I introduced MHA key performance indicators (KPIs) for all divisions in July 2017 to reinforce accountability of operations and make non-compliance issues more visible. Those KPIs will be reviewed in 2020/21.