England's Chief Inspector of Hospitals has rated the specialist community mental health services for children and young people at Birmingham Women’s and Children’s NHS Foundation Trust as Inadequate.
CQC last inspected these services in 2016 and rated them as Requires Improvement. Following that inspection, inspectors told the provider of the actions they must take in order to improve the service.
CQC re-inspected in July 2017 to check whether the required improvements had been made. The trust had only completed three of the eight actions we had told them they must take. We changed our rating of the service to Inadequate overall.
Inspectors identified a number of concerns in relation to infection control, medicines management practice, health and safety, risk assessments, care planning, safeguarding, patient record keeping, staffing, governance and leadership. Patients were at risk of harm because systems and processes were not in place to keep them safe.
The trust’s overall rating of Outstanding has not changed as a result of this inspection.
Dr Paul Lelliott, Deputy Chief Inspector of Hospitals (and lead for mental health) said: "We found that a number of urgent improvements were needed at this service which cares for vulnerable young people and children.
"Staff morale was very low across community services. Staff said they were demoralised by recruitment practice that meant there were vacancies where people had left and had not been replaced. Many were worried that care records were not being managed properly and that something may go wrong. They also expressed their dissatisfaction with ‘agile working arrangements’, the premises from which they worked and a lack of feedback from higher-level management.
"The trust did not have effective oversight to ensure that all staff who worked within the hubs and urgent care were trained to the appropriate levels in children's safeguarding. There were no robust systems in place to ensure that staff handover of care was safe and timely. We saw instances in care records where care coordinators had left the service and necessary handovers had not been carried out.
"Staff did not always adhere to infection control standards. The kitchen area in the health-based place of safety did not comply with national infection control standards.
"However, most patients and carers told us that staff were kind, respectful and professional. Patients and their families spoke positively about the staff and the interventions they received.
"The trust board knows what it must do to bring about sustainable change to its services to ensure people receive the care they should be able to expect. We will continue to monitor the trust closely. This will include further inspections."
Inspectors highlighted areas where the trust must take action to bring services up to the required standards.
Not all patients had an up to date fully completed risk assessment or risk management plan. Where inspectors saw risk assessments in place, they were basic and lacked detailed information.
Overall governance within the integrated community services lacked coordination amongst partners. There were clear issues with data collection, monitoring of waiting lists, allocation of caseloads and staff understanding of standard operational policies and estates management.
Medicine management was poor at the urgent care team base at the South and East hubs. Staff did not store or dispose of medicines correctly and did not routinely undertake medicines audits.
Full details of the ratings, including a ratings grid, are available on the Birmingham Women's and Children's NHS Foundation Trust page.
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We found that a number of urgent improvements were needed at this service which cares for vulnerable young people and children.
Dr Paul Lelliott, Deputy Chief Inspector of Hospitals (and lead for mental health)