The Care Quality Commission (CQC) has published two inspection reports on Tees, Esk and Wear Valleys NHS Foundation Trust’s child and adolescent mental health (CAMHS) wards. The two separate inspections took place on 6 August, and 20 and 21 August and led CQC to impose conditions on the trust’s registration preventing further admissions to West Lane Hospital, leading to its closure.
The CAMHS inpatient service is comprised of five units across West Lane Hospital, West Park Hospital and Roseberry Park. CQC previously inspected the service in June 2018, rating it Good overall and in each key question. It was inspected again in June 2019 prompted by concerns raised about the treatment of young people receiving support, low staffing, a poor culture and a significant number of self-harming incidents. It was rated Inadequate overall.
The August 2019 inspections looked at the care being provided in West Lane Hospital only. Both inspections were unrated. The previous rating of Inadequate remained in place from the June 2019 inspection.
The inspection on 6 August 2019 specifically focused on the key question are services safe? It was prompted by a serious incident were a young person died whilst in receipt of care at the hospital. Inspectors found observations of young people were not always documented and records of which staff supervised the observations were not documented well, making accountability unclear. Inspectors reported that staffing, although improved, was not in line with established agreements and agency staff were overly relied on.
The second inspection, 20 and 21 August 2019, was prompted by whistleblowing information about the care of a person at the service and looked at whether services are safe, effective, caring and well-led. Staff told inspectors they were struggling to maintain a balance between safe care and the least restrictive support, adding the service was ‘traumatised’. Inspectors reported that some incidents were not being documented and it was unclear when episodes of physical restraint occurred. Inspectors found little learning had taken place from reported incidents and again found observation records were poor.
Staff’s knowledge of the risks posed to young people in care, their individual care needs, intervention and positive behavioural plans was inconsistent and partial. Risk management plans often instructed staff to use their discretion on whether to intervene during incidents of self-harming, potentially exposing people to avoidable harm. During the inspection a young person presented items that risked their safety to the inspection team, which had not been identified or managed by staff, additional items of risk were discovered after inspectors raised their concerns with staff.
When speaking about agency staff, young people mostly made negative comments about their experiences. Two people said they felt unsafe. Rotas close to the time of the inspection showed 47% of healthcare assistant shifts were covered by agency staff. However, young people spoke positively about their experiences with permanent members of staff and inspectors saw positive interactions between staff and the people they were supporting.
Feedback about the service from staff was inconsistent, some suggested a divide between staff and management, others felt unable to raise concerns in fear of reprisals, however some staff stated the culture had improved since the previous inspection and the service was actively seeking to improve. Inspectors found that quality audits performed by management were ineffective and failed to identify errors and concerns reported on during the inspection, and there was little evidence of improvement to the service. Inspectors also reported managers could not communicate their plans to address problems in staff morale or the divide in culture at the service going forward.
Jenny Wilkes, Head of Mental Health Inspection, said:
“Leading into these inspections we had deep concerns about the quality of the care being provided at West Lane Hospital - we had previously placed enforcement conditions on the service and were monitoring it’s performance very closely.
“Despite being repeatedly assured that improvements were being made to the service, we were alerted to further concerns and found the care had not improved. People were not safe or being provided with care in line with their needs. Observations were not being recorded well, staff training and knowledge of care for young people with complex needs was poor and incidents were not consistently reported or reviewed well. There was limited experienced managerial oversight of the wards and a culture existed that was not working to the benefit of the people there.
“Ultimately, considering the inspections’ findings, we could not allow the service to continue and took urgent action to prevent further admissions being made to the service, which led to the closure of the hospital. We appreciate action of this nature can cause distress to the people using the service and their families, however our priority is always the safety of people that use services and we will use our enforcement powers to ensure this.
“We continue to work closely with the trust, NHS England and local commissioners to ensure that those affected are receiving the care they need.”
Any action CQC take is subject to appeal by the registered provider.
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For further information please contact 07384902623 / 01912011675 Mark Humphreys Regional Engagement Officer or mark.humphreys@cqc.org.uk
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