The Care Quality Commission (CQC) has published a report following an inspection of services for children and young people at Dorset County Hospital, run by Dorset County Hospital NHS Foundation Trust in August last year.
A focused inspection was undertaken in response to concerns. Inspectors also concentrated on the pathway for children and young people who are admitted to the paediatric ward (Kingfisher Ward) with mental health conditions, including self-harm. Inspectors also looked at how the service meets the needs of children and young people with mental health conditions, and who also had a learning disability or autism.
As this was a focused inspection, it does not impact the overall rating for the service which remains good.
The hospital remains rated as good, as do its ratings for being effective, caring, responsive and well-led. Safe remains requires improvement.
Catherine Campbell, CQC deputy director of operations in the south, said:
“During our inspection of Dorset County Hospital, we found a team whose focus was on the safety and wellbeing of the young people in their care. This was despite some of the issues we found within the department.
“We found that due to the extensive building work and alterations being made to the emergency department, there was no designated mental health assessment room in place for children and young people. Staff were aware of the challenges caused by this and were taking steps to manage the risks involved. A mental health assessment room area would have provided a safe environment for young people suffering a mental health crisis.
“Some of the treatment records we reviewed didn’t focus on the child’s voice or their wishes. In one young person’s records, the focus was on the impact the child had on others, rather than their own needs and risks to them.
“Following the inspection, we fed back what we found to the trust’s senior leadership team who have begun to take action. In the meantime, we will continue to monitor the service and return at a later date to check what improvements have been put into place.”
Inspectors found:
- There was a lack of clarity regarding who was responsible for overseeing the treatment of children and young people who needed treatment of mental health conditions
- The service provided care and treatment based on national guidance and evidenced-based practice. However, because this was not always clearly recorded there were no assurance that the care and treatment provided was compliant with care pathways based on national guidance
- Senior leaders in the department did not feel empowered to escalate directly to external partners when children and young people no longer had medical needs but had other complex needs that prevented them from being discharged. Instead they had been told to escalate this directly to the trust’s executive team
- Due to the extensive building work and alterations being made to the emergency department, there was no designated area or waiting room for children and young people who attended the department. There was also no designated mental health assessment room which provided a safe environment for people suffering a mental health crisis
- The records reviewed by inspectors suggested that children and young people at Dorset County Hospital did not always have their voices heard or their wishes considered. Their voice was absent in more than half the records reviewed and was limited in the remainder.
However:
- Staff designed a playroom to build good relationships with young people. It included virtual reality and sensory equipment used to distract, socialise, and reduce anxiety
- Staff working on the inpatient ward felt respected, supported and valued.