During our visit we spoke to twenty seven people who use the service. These were people who were inpatients on a number of forensic wards and adult acute mental health wards at St Bernard’s hospital, as well as people living in the community who use some of the community services of the Trust. This included people who use Ealing assessment team and the East and West recovery teams.

Part of our role is to monitor the rights of people who are detained under the Mental Health Act 1983 (and subsequent amendments to this). Our Mental Health Act (MHA) Commissioners have visited St Bernard’s and Ealing Community Services a number of times in during 2011/2012. We looked at information from the MHA Commissioners recent visits. We also looked at information from advocates, Ealing Local Involvement Network (LINks) and written feedback from people who use Ealing community services.

We have also looked at the results of the Department of Health: Survey of NHS Staff 2011/2012 and the CQC Community Mental Health Survey 2012 (CMHS). Whilst the feedback for both of these was gained from across the trust and not at location level we have considered the findings as part of this inspection.

The majority of feedback we received from people who use the service was positive about their experience of being a patient and of being involved in their care. People who were detained under the Mental Health Act said they were informed of their rights and could generally take leave form the ward when they wanted to. Most people commented that their was enough activities to keep them occupied, though we found that these were lacking on the PICU (patient intensive care unit). We also found that privacy and dignity was not always respected in some areas we visited as part of this inspection.

We also found that, across the sites we visited of St Bernard's and Ealing Community Services, the majority of feedback from staff was that they did not feel approriately supported and listened to, which they felt had an impact on the care people received, and could put people who use the service at risk.

Patients supported by community services were interviewed by Ealing LINk representatives to gain their views of the treatment and care provided. The information provided contributed to the overall findings of our inspection.

Patients said they were usually involved in making decisions about their treatment and care and had opportunities to give feedback on their experiences. The majority said they had seen and agreed their care plan and some said they had signed the plan and had been given a copy of it. Patients told us there were activities on offer in the hospital such as using the gym, arts and crafts and watching TV. They said they felt safe in the wards and would talk to staff, advocates or relatives if they had a concern.

Patients told us there were usually sufficient numbers of staff on duty to meet their needs. However, they also told us they did not get their escorted leave as there wasn’t always a member of staff available. One ward was described as “chaotic at times” by patients due to staffing issues. They said “staff do their best, there isn’t enough of them” and “there is an over reliance on bank and agency staff”.

Patient comments across the services included “the nurses and doctors are really very good”, “staff are generally lovely” and “the nurses are ok”.

The visits to St Bernard’s Hospital and Ealing Community Services took place over two days. During the inspection we visited 12 wards and three community services. We also attended three service user groups where there were approximately 30 people who use the service and/or their representatives. We received comment cards from 18 people who attended the community services during our visits. We also received feedback from some of the independent advocacy services and from a carers network group.

During the inspection we spoke with a minimum of 37 people who use the service and a minimum of 56 staff from various disciplines.

The majority of feedback we received from people who use the service was positive and showed people valued the service they received. Comments we received from some people were: “the service I have been receiving here has been excellent. Staff are friendly. It has done wonders for me”, “good help. They are very nice people”, “the staff are working miracles” and “the service here is excellent.”

We found that people felt respected and involved in their care and treatment. Risks to people were identified and plans were in place to minimise risks to themselves and others. Similarly, staff knew how to respond to safeguarding issues that they came across as part of their work to protect people from abuse.

The provider took information about complaints seriously, though information of how to make a complaint was not always readily available to people.