The Care Quality Commission (CQC) has rated Hertfordshire Partnership University NHS Foundation Trust’s child and adolescent mental health wards inadequate, following an inspection undertaken in November and December. CQC found a significant deterioration in the quality of the service which was previously rated outstanding in March 2019.
The inspection of the service at Forest House in Radlett, was prompted by information indicating the quality and safety of patient care had deteriorated. The inspection substantiated these concerns.
Following the inspection, CQC served the trust a warning notice informing it where it needs to focus their improvements where they are most needed.
The ratings for how safe the service drops from good to inadequate, and how well-led the service is drops from outstanding to inadequate. How effective and responsive the service is drops from good to requires improvement and how caring the service is drops from outstanding to requires improvement.
The inspection was not wide-ranging enough to update any overall trust ratings, so the trust remains outstanding overall.
Craig Howarth, CQC head of inspection for mental health and community services, said:
“Our inspection found children and young people were not receiving standards of care they have a right to expect at Forest House as leadership in this service had significantly deteriorated since our previous inspection. This was having a knock-on effect in all areas of care being provided, and it is one of the reasons we have served the trust with a warning notice.
“While it was encouraging to see refurbishments taking place on the unit, the trust was doing little to manage the impact this disruption had on people using the service, especially when consistency and routine is important. It meant therapists didn’t always have rooms available to conduct therapy sessions.
“It was very concerning that there weren’t effective systems in place to ensure young people were given routine medication safely, or even when medication was administered for the purpose of rapid tranquilisation, putting them at risk.
“It was also worrying some patients told us they felt unsafe, and others told us they felt dissatisfied with the care they received. This was in part because there weren’t enough staff to meet their needs or ensure their safety. There weren’t always enough suitably trained, competent, skilled and experienced staff to deliver safe care and treatment and develop meaningful therapeutic relationships with the young people. Leaders need better oversight of this.
“The trust must take immediate action to address the shortcomings we identified and meet its legal obligations, and we have served it a warning notice detailing these areas. “We continue to monitor the service and the trust has already shared its plans to make significant improvements to the service with us. We will inspect it again to assess whether improvements are made. If we find patients are at immediate risk of harm, we will not hesitate to take further action to ensure their safety.”
CQC’s inspection of Hertfordshire Partnership University NHS Foundation Trust’s child and adolescent mental health wards found the quality and safety of patient care had significantly deteriorated, compared to previous inspections.
Inspectors found people’s needs were not consistently met because the service had a high number of staff vacancies. Similarly, patients did not have adequate access to a clinical psychologist, slowing their recovery.
Inspectors also found policies and systems to manage people’s medication, support their physical health and enforce the unit’s mobile phone policy were not always followed. Not enforcing the unit’s mobile phone policy meant young people could access potentially upsetting material.
Combined with more patients needing the service and the impact of an ongoing refurbishment, these issues impacted staff morale – which undermined healthcare professionals’ ability to provide good patient care.
If senior leaders had better oversight of the service, steps could have been taken to address these issues at the earliest possible opportunity.
However, inspectors found most staff treated patients with kindness and compassion. Staff also managed ligature risks well and developed patient care plans that were holistic and person-centred.
Inspectors also welcomed the trust’s work to maintain the unit while a reduction of provision in the region has led to fewer places where children and young people needing in-patient mental health care can receive support.
Hertfordshire Partnership University NHS Foundation Trust must take action to comply with CQC’s warning notice, including:
- Ensuring people receive psychological interventions to support their recovery
- Using effective systems to ensure staff administer and record medicines correctly, and to ensure good managerial oversight of the service
- Completing physical health checks for young people following rapid tranquilisation
- Ensuring there are suitably trained, competent, skilled and experienced staff to deliver safe care and treatment.
The trust must also take several other steps to ensure the quality and safety of its patient care, including:
- Ensuring patient risk management plans are updated and documented appropriately
- Enforcing the unit’s mobile phone policy to ensure the safety and wellbeing of all young people on the unit
- Investigating complaints within set timeframes.
Full details of the inspection are given in the report published on our website.
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