Torbay Hospital

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

For this key question we looked at the quality statements; kindness, compassion and dignity; treating people as individuals; independence, choice and control; responding to people's immediate needs and workforce wellbeing and enablement. We found staff interacting positively with children and young people. Children and young people had access to specialist equipment and access to activities. and were treated with respect.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Young people were treated with respect. Throughout our visit we observed relaxed and positive conversations between the young people and staff. We also observed ward staff and healthcare security staff supporting a young person experiencing distress with patience and kindness.

Visitors could meet with the young people in private. Parents were able to visit their children either in their bed areas or in a room on the ward. There were no set visiting time for families to visit the ward. A room was available for a family member to stay overnight.

One patient stated, “staff always make time to talk to me and get to know what I like and what I don’t. They have a laugh and a joke, and they try and cheer me up.”

Staff respected patient’s privacy and confidentiality. Staff conducted their multi-disciplinary team meetings in a room which ensured conversations were confidential. Staff tried to ensure treatments happened in places which were separate from the ward areas.

Staff reported there was a growing understanding of young people who were suffering from mental health disorders and they were treated with care and compassion. There was joined up working with colleagues from the mental health trust.

We received feedback from partners who visited the ward from other organisation that staff were kind to the children and young people. They behaved in a way that was caring and compassionate.

We observed staff being caring and compassionate, treating young people with respect and dignity.

Patient records were observed to be kept securely.

Young people were treated as individuals. Young people told us they could personalise their rooms to look homely and most of the young people had decorated their bed spaces with photos and soft toys from home.

The young people had access to mobile technology. They told us they could have their mobile devices and the ward had wireless internet access which they could use. Two young people told us the internet was good enough to watch streaming services.

Staff stated they involved children, young people and those close to them in decisions about their care and treatment. Staff we spoke with were able to tell us the preferences and additional needs of the young people for whom they were caring.

We observed staff communicating and offering choices about treatment options to patients. We observed a medical handover and saw it was clear. Each patient was treated with a personalised approach, recognising their unique experiences, emotions, and individual circumstances. The medical team considered the patients' ability to cope with their situations and discussed individual risks in detail, ensuring a comprehensive understanding of each patient's needs. The discussion also included the recognition of patient and carer voices, emphasising the importance of their voices in the care process. Furthermore, the team considered how the presence and behaviours of one patient might impact others on the ward, demonstrating a holistic and patient-centred approach to care.

There were processes to document patient’s individual needs. One young person said they provided a weekly written summary of what had happened to them during the week and what they had liked and disliked to staff.

However, we had concerns consent was not always considered for the young people in their care. We could not evidence in documentation consent was always obtained from the young person to either agree to the hospital admission or to agree to any treatment plan. Where a young person lacked capacity to consent to any proposed treatment we could not see documented capacity assessments or that the child / young person’s views were taken into account.

Educational and play facilities were provided and further educational support was available to those children that required it.

Friends and family were able to visit at any time. There was a room available for parents to stay when their child / young person was in the high dependency unit. Parents were also supported to stay with children / young persons who were staying in side rooms. Children and young persons we spoke with said they were provided with activities to keep them occupied whilst on the ward. There were 2 play specialists for the Louisa Cary ward who were available Monday to Friday. At weekends, when play specialists were not available, staff used to bring in craft activities for patients. Young people felt able to raise any concerns.

Staff offered a range of activities and equipment to support young people’s well being. The ward had raised funding to purchase specialist equipment tailored to the needs of individuals experiencing mental ill health and/or sensory challenges. To ensure the suitability of the equipment, input was sought from CAMHS patients regarding the most appropriate products. As a result, safety pods, weighted blankets, and noise-cancelling headphones were acquired. Additionally, sensory kits were co-developed with patient involvement and subsequently purchased, further enhancing the support available for these patients.

Young people had access to outside space to a ‘rose garden’ with their carers.

The service provided services which supported access to friends and family and supported patients emotional well-being.

We observed staff supporting young people and ensuring there was a caring environment which enabled and supported independence.

The play team provided activities for the children and young people. All 3 young people we spoke with told us they had been involved in lots of art and craft activities which they had enjoyed. One young person told us they had a private tutor who had come to the ward to support them to continue their education studies which they had enjoyed. Several of the young people were neurodivergent. One of the ward paediatric consultants, who was the mental health lead, had been awarded funding and had purchased sensory items for the young people to use.

Staff told us of how they have used external sources, such as specialist units and local clinical support networks for support and expertise. Providing a case example of a child who was deteriorating and was unresponsive to the standard interventions. Evidence was shown of a comprehensive search for research and expertise that prevented further deterioration.

We saw evidence of the use of a national recognised tool used in the assessment of the deteriorating child / young person and evidence of its use in the child / young person’s notes.

We saw staff interacting positively with the child / young person, and taking the relevant physical observations. We saw staff use appropriate communication with the child / young person.

Staff we spoke with appeared kind, compassionate and committed to providing the best possible care and treatment for the young people, including those experiencing mental distress.

We were told by staff they often felt overwhelmed. Staff stated there had been ”a large increase” in young people experiencing mental health difficulties and in particular those with eating disorder being admitted to the acute trust and this cohort of patients required additional support and supervision. Staff told us they did not feel they had adequate training in dealing with young people with mental health difficulties and this coupled with the lack of registered paediatric and mental health nurses together with the usage of agency staff affected staff wellbeing. Staff we spoke with said caseloads and workloads had become unmanageable.

We were told there had been an improvement in the last 6 months in the level of support being offered to staff in the form of one to one de-briefing sessions and psychological support following physical interventions described as ‘distressing’.

Staff told us incidents of violence and aggression had increased however they felt supported by their team and the security team.

The trust was improving its supervision offering which included supervision once every 6 weeks with a qualified person from the local mental health trust as well as restorative team building sessions facilitated by the trust clinical psychology team.

The trust provided figures for staff turnover rates , together with a summary of reasons for leavers for the period July 2023 to June 2024. Thes show that there has been a reduction in the percentage turn over of staff leavers.