Psychiatry-UK

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The provider had appropriate policies in place to keep people safe including a specific policy for children and young people. The policies were detailed, regularly reviewed and easily accessible by staff. The service had a designated safeguarding lead. Staff made appropriate and timely referrals in line with the provider's policy.

The service had enough staff, who knew the young people well and had received basic training to keep them safe from avoidable harm. The number of young people on the caseload of the teams, and of individual members of staff, was not too high to prevent staff from giving each young person the time they needed. There were 40 CAMHS clinicians working for the service. Staff told us the caseload was manageable.

Staff discussed safeguarding at quality and safety committee meetings. Individual safeguarding incidents were discussed at PSIRF panel meetings. Staff completed audits around risk and safety. The service had a new system to record and report safety incidents, risk, and complaints which was user friendly and easy to navigate.

The service offered care and treatment to young people whose needs it could meet safely in line with its referral and admission policy. Staff had a clear and consistent understanding of changing and escalating risk experienced by young people on the waiting list. For example, we saw recorded discussions between one carer and a young person's clinician. The carer reported concerns about a change in the young person's behaviour. Risk information was updated on the young person's care plan to reflect this.

The service had exclusion criteria and policy in place. This ensured they only took young people they could manage safely.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service used young people’s feedback about care and treatment to make improvements. Examples included up to date waiting time information added to the service website and patient portal.

There was a system for recording and acting on significant events. Staff understood their duty to raise concerns and report incidents and near misses. Managers investigated incidents thoroughly, and young people and their families were involved in these investigations. Staff received feedback following the investigation of incidents.

The service encouraged a culture of openness and honesty throughout the organisation.

When a young person was referred to the service, they were triaged through general psychiatry via the non-clinical risk triage by administrative staff. The referral was reviewed by the children and young people's mental health lead. They judged the child's suitability for an online service. This judgement was made at the beginning of the process and was done on a case-by-case basis.

The service's eligibility criteria included children with substance misuse problems, children open to the criminal justice system and children with eating disorders.

The service had a clinical lead who provided support out of hours.

Due to new AI functionality and processes, the service had demonstrated a dramatic reduction in waiting times. Waiting times for a child ADHD assessment was between 1-2 months. The demand for ASD assessments was stable. Ongoing work in this area also indicated further reductions in wait times were projected in 2025.

Staff followed the provider's safeguarding process. They knew how to report a safeguarding concern. Staff could give clear examples of how to protect young people from harassment and discrimination, including those with protected characteristics under the Equality Act.

Staffreferred any concerns to the provider's safeguarding lead, who was closely aligned to CAMHS. The clinical lead oversaw all safeguarding concerns. When a safeguarding concern was reported by staff, it triggered an alert on the provider’s incident management system.

Safeguarding concerns were reviewed on a case by case basis by the team. If they occurred during an online session, staff would end the consultation and contact the safeguarding team. The provider had an emergency protocol in place when a child or young person was at imminent risk including contacting their GP and the emergency services.

Staff received training on how to recognise and report abuse, appropriate for their role. They kept up to date with their safeguarding training. Staff demonstrated they knew how to recognise children at risk of or suffering harm and worked with other agencies to protect them.

The service had implemented a new system to report and manage, monitor all safeguarding concerns. The system had an inbuilt AI safeguarding functionality which alerted staff where there was a potential safeguarding risk.

The provider's safeguarding lead screened the alerts and where risks are indicated, they raised and requested a welfare checks for the child or young person.

Children and young people under the age of 16 were required to have a parent or carer with them during their online assessments and sessions with clinicians. Staff did apply Gillick competencies if a young person aged 16 or older wanted to be on their own.

The provider involved and sought feedback from families. Staff encouraged family and carer involvement in the assessments. They asked families to complete preassessment questionnaires about the child or young person including their past medical histories, and family life. When staff supported looked after children, they involved those with parental responsibilities and requested a medical summary from the GP.

Staff contacted the child's GP for required health information. The services paediatrician reviewed all medical reports such as ECGs. If there was a delay in a response from the GP, the service was able to send out some equipment to the child's home, such as a blood pressure machine.

Staff took part in a CAMHS multi-disciplinary team meetings fortnightly to discuss cases and NICE guidance updates.

The service did not offer any face to face appointments. All assessments were done online.

Young people met with their clinicians online via video calls which were recorded. They were given information about privacy, confidentiality and consent at the beginning of their assessments. Staff told us that some children were difficult to engage as they did not like the online platform or found it overwhelming. In these instances, staff asked parents and carers to help. They would engage the parent then talk to the child about toys or their interests then gradually ask the parents to ‘step back’.

The service had a small office which was used as a correspondence address. We saw that prescription pads were stored in a locked filing cabinet within the office and regular audits were completed.

The office had fire safety signage and notices. Staff knew the fire safety procedures. The service had a designated fire marshal.

Clinicians were required to follow the organisation's home working policy. Requirements for confidentiality included blurring their backgrounds, ensuring a confidential environment and having a secure postal address. Managers audited how staff followed this policy to ensure confidentiality was maintained. Staff advised people that when accessing the provider portal, they should do so safely and privately.

Staff had completed and kept up to date with their mandatory training. The mandatory training programme was comprehensive and met the needs of young people and staff. Managers monitored mandatory training and alerted staff when they needed to update their training.

The provider provided extra training for people required for their roles. For example, the provider offered a leadership training course last year for managers.

The service had enough staff to meet people’s needs. The provider was in process of recruiting more staff to meet the increasing demand for the services.

The clinicians were mainly contract staff. Managers informed us that the organisation was investing in the clinical leadership team to meet the demands for the service.

Managers identified staff learning needs through the appraisal process. Staff had a self review followed by a management review. Staff not receiving NHS supervision via a responsible officer received it through an external programme. Non-clinical staff were supervised in house.

The service had an ongoing recruitment drive and had streamlined the recruitment process for applicants. This meant that staff were onboarded efficiently, turnover was low (November and December 2024 at 2% and January 2025 at 3%) and the service had room to expand with demand.

The service employed Psychiatrists registered with the General Medical Council and were up to date with registration.

We did not look at Infection prevention and control during this assessment. There is no previous rating for the Safe key question so we cannot yet publish a score for this area.

The provider had a medicines management lead who oversaw how medicines were managed. Staff followed the provider’s medicines management policy. Managers conducted audits on medicines management. There was a tracking system in place to monitor prescriptions being sent and received by the relevant people.

The service engaged proactively with young people’s GPs to share information. The service had a shared care agreement with GPs for young people on a particular prescription. Although there were occasions in the past where people could not receive their required medication on time due to miscommunication between the service and the young person’s GP, the service learned lessons from these events.

The service had systems and processes in place to ensure that young people were safely prescribed medicines remotely. The roles and responsibilities of clinicians and prescribers in supporting people with their medicines was clearly defined in line with national guidance and recommendations. Prescribers had regular contact with peers to discuss complex cases. The service offered clinicians opportunities for learning and development.

Medicines were prescribed in line with national guidance and there was robust monitoring in place to ensure that any variation in prescribing was reviewed and justified. Staff encouraged young people’s involvement in their care and treatment, and they could discuss any concerns they had with staff.

The service made good use of technology to remotely monitor the physical health of people before and during treatment with any medicine. Staff escalated concerns around people’s physical health appropriately to the relevant healthcare professionals. They followed up the referral with regular contact with the young person to ensure they were getting good care and treatment.

The provider informed young people and their carers of any issue relating to their prescription including supply shortages via their website.