A review by the Care Quality Commission of the child and adolescent mental health services (CAMHS) provided by The Huntercombe Group has identified a number of concerns and made recommendations to address these.
Teams of inspectors visited hospitals provided by The Huntercombe Group that admit children and young people with mental health problems. The five hospitals are located in Staffordshire, Devon, Berkshire, Worcestershire and Norfolk. Another team of inspectors assessed the corporate management of these hospitals by The Huntercombe Group. The purpose was to find out if serious concerns that had been identified at individual hospitals managed by The Huntercombe Group indicated a wider problem across the group. Our inspection concluded that there have been a number of significant lapses in governance within The Huntercombe Group.
The review has concluded that there are deficiencies in the corporate governance arrangements within The Huntercombe Group that have adversely affected the quality of care and treatment provided by these five hospitals.
CQC has now told the five registered providers of CAMHS services within The Huntercombe Group that they must provide a report setting out how they intend to meet the regulations.
The review took place after two of the child and adolescent mental health inpatient services provided by The Huntercombe Group, at Stafford and Watcombe Hall in Torquay, were rated as Inadequate and placed in special measures. Watcombe Hall closed in July 2017. Huntercombe Hospital, Stafford came out of special measures in May 2017 and is now rated Requires Improvement. The services at Maidenhead and Cotswold Spa are both rated as Good.
Dr Paul Lelliott, Deputy Chief Inspector of Hospitals (and lead for mental health) said:
“During our previous inspections of the individual hospitals, we found a range of concerns including a lack of access to psychological interventions, failures in reporting of safeguarding concerns at some sites, issues around the leadership and culture within services, frequent use of physical restraint and a shortage of registered mental health nurses with relevant experience.
“It was important to establish whether these were isolated problems or whether they were signs of a wider failure in leadership and governance. This is why we conducted this over-arching inspection of the child and adolescent mental health services provided by The Huntercombe Group, looking specifically at whether the services are well led.
“We concluded that a shortage of nurses with expertise in child and adolescent mental healthcare was a fundamental issue that affected these services. A high proportion of posts for qualified mental health nurses were vacant and all five hospitals relied heavily on temporary staff.
“We also identified other problems with the governance of the hospitals. This included a failure to provide staff with specialist training or to ensure that all staff received regular supervision. We also concluded that the organisation did not have an effective process for ensuring that learning from previous adverse events was shared across the five hospitals.
“In the light of these concerns, we have made a number of recommendations for improvements which we expect the hospitals managed by The Huntercombe Group to take forward. We will be monitoring progress to check that improvements are being made - so that the vulnerable young people using these services get safe, high quality care.”
CQC has told the providers that they must take the following steps to improve:
- they must ensure that CAMHS services are staffed by a sufficient number of permanent, trained and qualified registered nurses with experience in CAMHS
- they must provide staff with specialist CAMHS training relevant to their roles and maintain oversight of its delivery
In addition the report has made a number of recommendations including:
- the provider should develop systems in pace to ensure lessons are learnt consistently and in a timely manner across all services
- the provider should review organisational systems and policies, for example, the observation policy, to ensure these are implemented consistently at a ward and individual staff level
- the provider should develop a plan to reduce restrictive practices that limit young people’s access to technology such as mobile phones and tablets
- the provider should review and consider the implementation of processes to improve the consistency and uses of rapid tranquillisation
- the provider should revise their management structures to ensure that all CAMHS services have consistent leadership at regional level
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We have made a number of recommendations for improvements which we expect the hospitals managed by The Huntercombe Group to take forward
Dr Paul Lelliott, Deputy Chief Inspector of Hospitals