The Care Quality Commission has published an inspection report on Tees, Esk and Wear Valleys NHS Foundation Trust’s child and adolescent mental health wards, rating it Inadequate.
The 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; are services safe, effective, caring, responsive and well-led?
CQC inspectors returned to conduct a responsive inspection on 20, 21 and 24 June 2019. The inspection was 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 at West Lane Hospital. At the time of the inspection 32 young people were in receipt of care and treatment across the service.
The child and adolescent mental health wards were rated Inadequate overall and for safe, responsive and well-led services, and Requires Improvement for caring and effective services.
The concerns primarily focused on West Lane Hospital, it was not delivering safe care. There were substantial and frequent staff shortages and staff did not adequately assess, monitor or manage risks to patients. When patients demonstrated higher levels of risk, staff did not follow processes and procedures to mitigate these through appropriate observation and engagement.
Trust information showed staffing at West Lane Hospital from 1 January to 31 May 2019 was meeting the trust’s required establishment levels on most days. However, staff raised concerns that staffing was insufficient to support the complex needs of the young people using the service and some staff lacked the necessary skills and competence to meet those needs. Staff also said that the staff levels were not accurately reflected in the roster.
Inspectors found high numbers of interchanging agency staff in West Lane Hospital, not all were familiar with the needs of the young people they were supporting. They also found staff were not always recording observations and engagements with young people, it was unclear whether care and treatment was being provided in line with young people’s needs and ensuring they were safe should an emergency occur.
Inspectors reviewed incidents at West Lane Hospital noted several episodes of patients self-harming, involving ligatures. The risks associated with ligatures had not been well assessed, some ligature risks were present and continued to pose a serious risk. While staff carried alarms, nurse call alarms were not available in each ward or bedroom, on Baysdale Unit, Newberry Centre or Westwood Centre, consequently patients and visitors could not always summon support in an emergency.
Inspectors found gaps in observation records following rapid tranquilisation. Young people were potentially at risk of serious harm because the medication can have side effects and should be monitored until the risk has passed. Inspectors also found a syringe, containing an unknown fluid, left unattended in the clinic room of Westwood Centre, as well as out of date medication. The trust took immediate action to ensure medication was being managed safely.
Staff in West Lane Hospital did not feel supported or valued and morale was very low. There was a divide within the staff team and not all agreed with the treatment plans for the young people or fully understood the care each young person was receiving. Whilst a newly formed leadership team had recorded actions to address issues, some staff felt communication and collaboration with leaders was poor, and they were not visible on the wards. Staff were open about their concerns with inspectors but uncomfortable raising concerns internally, fearing reprisals should they challenge the model of care.
Throughout the visit inspectors raised concerns about how the service ensured it was providing high-quality care and the lack of oversight from management and leadership team. Despite discussions about the quality of the service being communicated to the trust’s board, inspectors were not reassured that the actions were sufficient to fully address the concerns.
A full history of CQC’s findings is available at www.cqc.org.uk/provider/RX3
Dr Paul Lelliott, Deputy Chief Inspector of Hospitals (lead for mental health) said:
“We continue to be deeply concerned about the safety and quality of the care being delivered to young people at West Lane Hospital. We immediately engaged in dialogue with the trust and NHS England about addressing our findings as a priority. We have also taken enforcement action requiring the trust to act on our findings, and because of the seriousness of our findings we are considering further action.
“We have received assurances from the trust and NHS England that progress is being made. However, we will continue to closely monitor the care provided at the hospital and will return shortly to look at whether young people are safe and receiving good quality care.”
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For further information please contact 07754 438750 Mark Humphreys Regional Engagement Officer 01912011675 or mark.humphreys@cqc.org.uk
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