The Care Quality Commission (CQC) has published two reports following an inspection of mental health services for children and young people provided by Sheffield Children’s NHS Foundation Trust.
CQC carried out an inspection of child and adolescent mental health wards (CAMHS) and specialist community mental health services for children and young people in July. This was partly due to receiving concerns about the quality of care being provided in the CAMHS inpatient wards.
Following this inspection, the ratings for the CAMHS inpatient wards remain the same. Good overall and for being effective, caring, responsive to people’s needs and well-led. Safe remains rated as requires improvement.
The specialist community mental health services for children and young people remain rated as requires improvement overall, and for being safe and responsive. The ratings for being effective, caring and well-led improved from requires improvement to good.
The overall rating for Sheffield Children’s NHS Foundation Trust remains rated as good.
Sarah Dronsfield, CQC head of hospital inspections, said:
“During our inspection of mental health services for children and young people at Sheffield Children’s NHS Foundation Trust, we found leaders had a good understanding of the service they were running and were visible and approachable.
“In the child and adolescent mental health wards (CAMHS) staff felt proud to work in the service and told us they were part of a supportive team, who cared for people, as well as each other. It was good to see staff were supported to improve their knowledge and skills and were encouraged to progress their careers.
“However, in CAMHS inpatient wards we did find issues around environmental risks and blanket restrictions. Doors were locked to most communal areas on Emerald and Sapphire Lodges, including the female lounge and quiet rooms. Although staff were happy to unlock the doors when people wanted to go in, they couldn’t freely access these rooms, which they should be able to do to give them more independence.
“In the specialist community mental health services for children and young people, waiting times and caseloads for practitioners remained high. Also, appointments that were cancelled by the service weren’t always re-arranged in a timely way which could put people at risk.
“The trust has started to take action to make the necessary improvements and we will return to check on progress.”
Inspectors found:
In child and adolescent mental health wards (CAMHS):
- Agency staff did not always have access to the electronic records system. This meant that they did not always have access to all relevant information about children and young people.
- The electronic supervision recording tool did not accurately reflect the level of supervision and support staff told us they received. Although figures appeared low, it was acknowledged this was due to the recording system rather than a lack of support for staff. All staff we spoke to felt well supported and accessed supervision both formally and informally on a regular basis
- The most up to date version of the ligature risk assessment for Sapphire Lodge was not available. We were given a risk assessment from 2019 which did not include new rooms that had been added since then. However, we did later receive a copy of the 2022 risk assessment.
However:
- Despite a national staffing crisis and some vacancies within the service, staffing was managed well. Daily safety huddles looked at staffing across the unit and deployed staff to where they were needed most. Lodges were clean. Staff followed infection control policies including those related to Covid-19.
- Since our last inspection, the nasogastric room had been relocated to an empty bedroom. This gave children and young people needing to be fed via a nasogastric tube more privacy and dignity. Despite this, the room was not soundproofed, this meant that other people did at times become distressed due to the noise and anticipation of this procedure.
- Risk assessments were kept up to date and contained key information to manage risk safely. Staff had completed and kept up to date with mandatory training. The environment was in keeping with the needs of young people and was decorated and furnished to suit their needs.
- Feedback from children and young people and their carers was mostly positive. Children and young people felt that staff cared for them and made them feel safe on the lodges. Carers told us that staff involved them in their loved one's care and kept them up to date. Some carers felt that communication could be improved.
In specialist community mental health services for children and young people:
- Children and young people waited a long time to access the service, clinicians had high caseloads which had an impact on their ability to provide safe care.
- The service did not always ensure that children and young people received a physical health check at their initial appointment.
- Staff did not always complete mandatory training.
- The trust did not always ensure that staff were safe in their role as policies, procedures and training in management of violence and aggression, lone working, and incident response were unclear.
- There was not a clear process in place to support young people who were leaving the service and not making a transition to adult services.
- Parents told us that they were concerned about the lack of urgent out of hours provision where their option was limited to attending the accident and emergency department.
However:
- Staff were described as patient and insightful.
- Parents were grateful for flexibility given in appointment arrangements and the variety of settings in which these could take place.
- The Sheffield Treatment and Recovery (STAR) team had expanded their remit to include all mental health presentations which improved access to mental health services for the wider community.
- The risk assessments carried out were comprehensive and also included crisis plans which were shared with all those involved in the care of the child or young person.
- Leaders had the skills, knowledge and experience to perform their roles. They had a good understanding of the services they managed and were visible and approachable.