The Care Quality Commission (CQC) has welcomed improvements made at Kent and Medway Adolescent Hospital’s child and adolescent mental health service (CAMHS).
CQC carried out an unannounced focused inspection of the CAMHS wards in July after receiving information of concern about the service. The service has been run by North East London NHS Foundation Trust since it transferred from another provider in April 2020. This was the first inspection under the new provider.
The inspection covered all five domains to look at whether the service was safe, effective, caring, responsive and well-led. As this was a focused inspection, no ratings were produced for these domains, or overall. However, inspectors found a breach of regulation in relation to staffing, which meant the previous rating for effective went down from good to requires improvement.
Jane Ray, CQC’s head of hospital inspection, said:
“When we inspected the child and adolescent mental health wards at Kent and Medway Adolescent Hospital, we found the trust had made real progress in making improvements to the service since taking it on from another provider.
“Young people were now having a much better experience at this service during a difficult time in their lives, and they unanimously told us how supportive staff were. We also saw staff were much better at supporting those with eating disorders, especially during mealtimes as they were now receiving the right training to do so.
“The leadership and the overall culture within the service has improved which was having a real impact on the care being given to young people. For example, there are now less re-occurring incidents, as an improved reporting and managing process was allowing staff to learn from them, and also we saw work was starting on reducing blanket restrictions for things like the use of mobile phones and access to the internet. These are just some of the many improvements that have been made against a backdrop of increased pressure on the service due to an exceptional demand for beds, so leaders and staff deserve to be commended.
“However, we did point out some areas where further improvements are needed, and we will continue to monitor the service to ensure that these are made.”
Inspectors found the following during this inspection:
- Leaders had the skills, knowledge and experience to perform their roles. They had a good understanding of the service and were visible and approachable for patients and staff.
- The ward team included a full range of specialists required to meet the needs of patients. Managers made sure they had staff with the range of skills needed to provide high quality care.
- Staff managed the ward environment safely and were using appropriate techniques to manage environmental risks and keep patients safe from potential harm. Up to date environmental risk assessments and a thorough ligature risk assessment had been completed so that staff knew about the environmental risks and knew how to mitigate them.
- Staff completed a comprehensive risk assessment when patients were first admitted. Risk assessments were updated promptly following any incident that altered the patient’s current risk level. Risk assessments were routinely reviewed by staff on a weekly basis during multi-disciplinary team ward rounds.
- Staff assessed and managed risks to patients and themselves well and followed best practice in anticipating, deescalating and managing challenging behaviour. Staff used restraint and seclusion only after attempts at de-escalation had failed.
- Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.
- Staff provided a range of treatment and care for patients based on national guidance and best practice. They ensured that patients had good access to physical healthcare and supported them to live healthier lives.
- Previously, not all staff were familiar with the correct processes to search people when they returned from leave. This has now improved, so that searches are conducted appropriately, minimising the risk of banned items, such as sharp items or alcohol, being brought onto the ward.
- The service used systems and processes to safely prescribe, administer, record and store medicines. Staff regularly reviewed the effects of medicines on each patient’s mental and physical health.
- Staff maintained good infection prevention control practices.
However:
- There were still many nursing vacancies that needed to be filled, although progress was being made.
- Staff supervision and appraisal compliance rates were low. This meant that staff were not guaranteed to receive the support they needed to carry out the duties they were employed to perform. This was because these activities had been suspended due to competing priorities during the COVID-19 pandemic, but they had recently been re-introduced.
- Some relatives reported that communication with staff was sometimes challenging, and there was not yet a formal mechanism for gathering feedback about the service from families and relatives.
- Staff gave mixed feedback about the culture and how supportive leaders were. They described a very challenging year where they had not always felt well supported.
Particular challenges involved the transfer of the service between providers, a consultation process about the future model of the service that had left staff feeling uncertain, and uncertainty and anxiety caused by the onset of the Covid-19 pandemic. Some staff did report that they felt better supported and able to speak up following the recent leadership changes.
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