Worthing Hospital

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• 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

We looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question as requires improvement with breaches in regulations relating to safe care and treatment, governance and staffing. At this assessment the service was no longer in breach of regulation relating to governance. We have rated the service as good with breaches of regulations in relation to safe care and treatment.

Staff fostered an open and honest culture, using incidents as opportunities to learn and improve care. They went above and beyond to meet the needs of neurodiverse children, helping them access treatment with minimal distress. Staff understood their safeguarding responsibilities and acted to protect children, young people, their families and carers. Leaders maintained effective systems to ensure staffing levels and skill mix kept children and young people safe. They also monitored training completion to maintain staff competence and confidence in delivering safe care. However, the service did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Services for children and young people used learning from PSIRF (Patient Safety Incident Response Framework) to investigate safety events. PSIRF is a national NHS system for the recording and analysis of patient safety events that occur in healthcare.

In the 12 months before inspection 351 children and young people safety events were reported via the electronic reporting system. Bluefin Ward experienced 4 incidents requiring formal investigation during the period from 31 August 2024 to 31 August 2025. The team delivered verbal duty of candour notifications within 2 to 3 days of the children and young people Safety Incident Review Group meetings and issued written notifications within 5 days. Investigations concluded within 6 weeks to 4 months, and the findings highlighted several key areas for improvement. Governance improvements included embedding the National Paediatric Early Warning Score (NPEWS) and Martha’s Rule, Increasing night-shift children and young people nurse staffing in the emergency department and introducing escalation prompt cards. Martha’s Rule gave children and young people, families, and staff the right to request a rapid clinical review by a different team if they believed a child or young person’s condition was deteriorating and their concerns were not addressed. The initiative aimed to improve patient safety by empowering individuals to escalate care, ensuring early recognition of deterioration, and promoting responsiveness within hospitals. In the 12 months before the assessment 1 parent or carer had requested a rapid review under Martha’s Rule.

Training initiatives addressed clinical skills, competency updates, and consistency in documentation. The organisation also shared learning following a safety-related incident elsewhere in the system, resulting in strengthened awareness and joint learning with partner services. Review of additional low-severity events highlighted gaps in clinical monitoring and timely escalation, leading to planned improvements in feedback processes and enhanced point‑of‑care systems by late 2026.

Between September 2024 and August 2025, the service reported 45 health and safety incidents in children and young people’s services, with 8 incidents affecting children and young people. The main children and young people related trend involved children falling while under parent or carer supervision. Of the remaining 37 incidents, 20 involved violence and aggression, including 15 physical assaults against staff.

All staff we spoke with knew how to report incidents and understood duty of candour. They were open and transparent and gave children, young people and families a full explanation if things went wrong. Records showed duty of candour was considered, delivered verbally to children and young people and parents or carers, and was followed up in writing. Staff investigating incidents had the skills and experience to do so. For example, all incidents about mental ill health, were investigated by the children and young people mental health lead for the trust.

Staff received feedback from investigation of incidents, both internal and external to the service. Services for children and young people had a patient safety team who led on learning from patient safety events and complaints. They attended staff handovers and safety huddles and shared feedback and learning from patient safety events. The team also had strong links with the practice development program and developed tailored learning to align with learning from patient safety events. Audit results and action plans were shared with staff on the huddle board. We saw that the most recent National Paediatric Early Warning Score (NPEWS) audit results had been shared with the team and praise given for high compliance. The NPEWS is national standardised approach of tracking the deterioration of children in hospital.

The team used an improvement tracker to implement actions from reviews and shared learning via newsletters, safety huddles, and staff surveys. The tracker captured delays in diagnosis, missed clinical deterioration, and gaps in early recognition of serious illness, supporting monitored actions to prevent recurrence.

There was evidence that teams acted on feedback. For example, following a communication failure that led to a missed theatre slot, teams agreed actions and implemented a revised process to prevent recurrence. The service also clarified referral pathways for children with musculoskeletal concerns after a delayed diagnosis. In response to broader learning, the Mental Health Steering Group launched a programme of improvement to strengthen mental health provision for children and young people.

Staff were debriefed and received support after a serious incident. The practice development team provided a safe space to discuss and reflect on incidents that had occurred. The ward team met every 8 weeks, and staff could join in person or virtually to maximise attendance.

The evidence showed a good standard. The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service’s referral and admission processes ensured that all essential information about children and young people was received to determine if the children or young person’s needs could safely be met. The service had strong partnership links with specialist providers of care for children and young people. Staff met virtually as teams and discussed treatment plans for children who needed specialist intervention. Essential information was shared safely between the departments. These links were supported by guidelines and standard operating policies (SOP) for staff to follow.

Staff involved all the necessary healthcare and social care services to ensure children and young people had continuity of safe care, both within the service and post-discharge. There was evidence of communication between primary care and the service about children who needed an assessment. The day assessment unit took direct admission from GPs. This prevented sick children and young people needing to attend the emergency department before being assessed and treated.

Staff had access to children and young people records which identified children with additional needs. This included safeguarding, mental health, learning disability or neurodiversity. Tools such as care passports and social stories ensured that additional needs were identified and met by the team. Specialist teams provided expert opinion and care to children and young people and their families. These included safeguarding, Child and Adolescent Mental Health Services (CAMHS), clinical nurse specialist, mental health liaison, social work, learning disability and palliative care.

The team used ward rounds and safety huddles to share information about children and young people. During the assessment, ward rounds were well attended by the multidisciplinary team, and staff used the SBAR tool (a structured method for communicating a children and young people ’s situation, background, assessment, and recommended actions) to share and escalate key clinical information effectively.

The service used a structured, children and young people‑centred approach to support the transition of young people with Type 1 diabetes (Type 1 diabetes is a condition where your body cannot make a hormone called insulin) from children and young people to adult services. Clinicians defined transition as a planned, gradual process addressing health, wellbeing, and independence, and used the NHS‑supported Ready, Steady, Go and Hello framework to prepare young people from early adolescence. Flexible transfer occurred based on readiness and clinical stability. Multidisciplinary transition clinics supported early discussion, education, and continuity of care, with clear handover to adult services and communication with primary care. This approach promoted independence and supported positive long‑term health outcomes.

Ward staff sent discharge summaries electronically to GPs and issued paper copies to children and young people, which helped ensure all clinicians clearly understood the treatment provided and the ongoing care required. However, staff reported that surgeons did not always complete discharge summaries for their children and young people, which led to delays in discharge. As a result, some children and young people left the hospital without receiving their discharge summary, creating gaps in continuity of care.

The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

The hospital’s safeguarding team reviewed all children and young people’s referrals, monitored trends, and noted rising concerns about domestic abuse and online social‑media challenges. The team worked closely with staff on Bluefin Ward to recognise and report safeguarding concerns. There was a daily safeguarding huddle with other hospitals in the trust which discussed high risk safeguarding cases, shared learning and any gaps in support and staffing.

Staff were trained in safeguarding, knew how to make a safeguarding referral, and did that when appropriate. Adult safeguarding training compliance remained high at levels 1 and 2 (96% and 95%) but dropped to 74% at level 3. Children and young people safeguarding showed similar trends, with levels 1 and 2 averaging 96% and 95%, and level 3 at 79%.

The safeguarding policy followed national guidance and was easily accessible on the hospital intranet. The safeguarding team visited the ward area regularly and were well known to the staff.

Most safeguarding referrals related to children’s mental and emotional health, followed by neglect and wider family or environmental concerns. Fewer referrals involved physical harm or sexual abuse. Staff also applied a ‘Think Family’ approach in a significant number of cases, reflecting a focus on whole‑family risk and need.

Staff could give examples of how to protect children and young people from harassment and discrimination, including those with protected characteristics under the Equality Act. Staff of all levels we spoke with during the assessment were knowledgeable about what might indicate there was a safeguarding risk. During safety huddles, board and ward rounds safeguarding risk was discussed and recorded.

Staff knew how to identify adults and children at risk of, or suffering, significant harm. This included working in partnership with other agencies. Teams shared information about children at risk at multi-site and network meetings. Police, social care and health teams had access to a children and young people doctor with enhanced safeguarding knowledge for support and advice. Staff were confident to report safeguarding concerns. Staff followed safe procedures for children visiting the service. Ward access was monitored and controlled using a video entry system. Parts of the ward could only be entered by authorised persons.

Staff received training in de‑escalation, which means techniques to calm situations and reduce distress without using physical intervention. They had clear access to policies and procedures that guided them if any form of restrictive practice was needed. The use of restraint or blanket restrictions was rare. Blanket restrictions are rules or policies that restrict a patient’s rights and liberties, applied uniformly to all patients without individual risk assessments Staff were also trained to understand and apply the Mental Health Act, including temporary powers to keep children and young people safe, in hospital when necessary. Senior mental health clinicians were available to provide advice and support, and specialist staff were involved when children and young people needed higher‑level mental health care or close supervision. After any incident, staff supported children through review and reflection, ensuring decisions were transparent and focused on learning and future safety.

Some children and young people required a specialised full skeletal survey, an X‑ray that examined all the bones in the body to help doctors understand injuries or health concerns. These scans took place in the radiology department and were carried out by staff with additional training and experience in safeguarding children. Carers or play specialists supported the child or young person during the scan by helping to calm and distract them, making the experience as comfortable as possible. Staff worked closely together and showed a strong commitment to keeping children safe and supported throughout their care.

The organisation introduced a trust‑wide safeguarding supervision policy at the end of 2024 to better support staff managing complex safeguarding concerns. Safeguarding supervision gives staff dedicated time to discuss cases, reflect on decisions, and receive guidance to help keep people safe. Trained supervisors provided a mix of one‑to‑one and group support, with oversight through regular reporting. While this was still being embedded in some areas, early evidence showed improved consistency and staff confidence.

The organisation used recognised safeguarding arrangements, including external oversight where appropriate, to manage concerns about staff practice. Senior leaders and human resources worked together to ensure these matters were addressed consistently, transparently, and in line with national safeguarding guidance.

The evidence showed a good standard. The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Staff communicated with children and young people so that they understood their care and treatment, including finding effective ways to communicate with children and young people who had communication difficulties. Communication aides were compliant with NICE Guideline NG204. This recommended tailoring communication to age and developmental stage, using accessible formats, involving children in decisions about their care and supporting parent or carers with clear information. Staff had access to a range of ways to communicate with children and their families depending on their age and ability to communicate. Communication aides included augmentative and alternative communication (AAC) devices such as communication boards, symbol charts, picture exchange systems. Visual support systems included timetables and schedules, emotion cards, social stories and visual cues for routines and procedures.

Staff supported children and young people and families to provide feedback through formal mechanisms, although response rates were low as not many families gave feedback. Families were more likely to share feedback informally, such as verbal comments or a thank‑you card at discharge. Doctors worked collaboratively with parent or carers, and where appropriate children, to make treatment decisions, using decision aids to explain options and risks. Staff communicated clearly and compassionately, taking account of families’ preferences, values, and circumstances.

Staff used a nationally recognised early warning system to identify children at risk of clinical deterioration. Records reviewed during the assessment showed that observations were completed consistently in line with local guidance, supporting early detection and timely escalation of care. The service monitored compliance through regular audit and performance review, which showed overall good completion rates. . Although digital observation recording had been introduced in some areas and was still embedding. Teams routinely reviewed differences in practice through ward meetings, safety huddles, and senior nursing forums. This supported ongoing learning, staff education, and continuous improvement in practice.

Bluefin Ward had high compliance rates with children and young people basic life support training, with most medical staff trained and almost all nurse trained. Compliance rates with advanced children and young people life support among medical staff was low, with no future training booked. All senior nurses were trained in advance life support and the majority of junior nurses had a date to attend training.

Children who needed specialist care were transferred to appropriate specialist centres. Staff actively involved parent or carers in assessing whether a child was improving or deteriorating.

Staff completed nationally recognised risk assessments for each child or young person on admission and reviewed these regularly. Records showed the service had identified and reduced many risks within the children and young people’s areas of the hospital. These risks were graded and reviewed regularly by the leadership team. Environmental risk assessments included high falls, scalds, poisons, trapped fingers, choking, abduction and absconding and sharp objects. Records showed that children had individual risk assessments according to need. This included tissue viability, malnutrition, continence and self-harm. The risk assessments were fully completed, reviewed and up to date.

The evidence showed a good standard. The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Bluefin and Beeding Wards met Health Building Note 23 standards for children and young people and provided appropriate beds, play areas, and family-supportive spaces. The wards were clean and generally uncluttered, with clinical flooring throughout. Clinical flooring is a specialist hospital surface designed to be durable, easy to clean, and safe, helping to reduce the risk of infection and slips. On Bluefin Ward some areas of flooring had visible scuff marks.

Beeding Ward was a special care baby unit with 12 cots for newborn babies who needed extra support after birth. Staff provided short‑term care for babies who did not need intensive treatment, including babies born early or with medical needs. Care included feeding support, oxygen via small tubes, treatment for jaundice, and close monitoring. The team provided care in a safe and nurturing environment, and babies who needed more complex treatment were transferred to specialist hospitals nearby.

The hospital completed fire safety checks for Bluefin Ward and had scheduled the remaining checks for children and young people outpatients. Fire alarm systems and equipment were fully maintained. Electrical equipment was tested regularly, with further checks planned. Water safety checks showed no concerns, and safety devices were in place to control water temperature and prevent scalding. Medical equipment maintenance was reviewed following the introduction of a new system, with progress monitored through senior governance processes.

Bluefin Ward were secure, and only authorised staff could enter the ward using a smart card access system. There was a video access system for children and young people and visitors to use when wanting to enter or exit the Bluefin Ward. This was operated by the staff at the reception desk located on the ward. There was a ward clerk on duty during the day seven days a week and this supported rapid response to letting people in and out of the ward.

Bluefin Ward included assessment, treatment, and cubicle areas, along with staff work spaces. Staff cared for younger and older children in separate areas of the ward, which helped support age‑appropriate care, privacy, and safeguarding. Secure key‑card access-controlled entry to clinical areas and prevented unauthorised access. Staff also had a dedicated room for handovers, confidential calls, and record‑keeping. There was a playroom for younger children with a variety of activities and a play specialist and youth worker on duty during the day. Older children had access to games consoles, a snooker table and age-appropriate activities. There was no outdoor play area for children and young people to access.

All areas had appropriate emergency equipment for children, which staff checked regularly. Bed spaces provided privacy through curtains, blinds, or doors. Safety equipment was up to date and well maintained. Staff had access to specialist equipment, including hoists and adapted cot sides, to support children with additional needs. The ward had introduced an enclosed sensory bed that provided a safe, calming space for neurodiverse children who became distressed or overstimulated in a standard bed, helping them feel more secure.

However, during the assessment, we identified that milk fridges on Beeding and Bluefin Wards, were accessible to parent or carers without restriction, creating a risk of tampering. Staff were notified of the issued and locks were put on both milk fridge’s meaning parent and carers were required to request staff support to access their baby’s milk.

On Bluefin Ward, we also found out‑of‑date baby milk and enteral feed stored in the fridge. Enteral feed is liquid nutrition given directly into the stomach or small intestine via a feeding tube. Staff were informed immediately, and the expired items were removed. Leaders reminded staff of the importance of following their own guidance to routinely monitor and record the expiry dates of milk and enteral feeds. The ward worked in partnership with charities to provide free, nutritious meals to parents and carers while their children were in hospital, helping to reduce financial pressure during a stressful period. A fridge was also available for parents and carers to store food brought from home, and there was a designated area where parents and carers could safely re‑heat food, providing additional flexibility and support.

Children and young people needing surgery were placed on a dedicated operating list, separate from adult patients. Theatre staff had completed specialist training to support children during their immediate recovery after surgery. Theatres and recovery areas were equipped with appropriate children and young people’s emergency equipment, and staff were trained to use this safely and effectively.

We visited the Child Development Centre as part of our assessment. The centre provided both community‑based and hospital appointments, where children were seen by a range of specialist teams. These included services such as diabetes, heart and lung care, skin conditions, hearing services, allergies, and cancer care.

Children and young people could also have blood tests carried out in a child‑friendly environment. A multidisciplinary team, including occupational therapists, speech and language therapists, and physiotherapists, worked together to support children’s overall health and development.

The Patient‑Led Assessments of the Care Environment (PLACE) programme is a yearly review of non‑clinical aspects of hospital care, such as cleanliness, food, privacy and accessibility. The latest assessment in 2024 showed good care in supporting privacy and wellbeing and in the organisation of food services, while highlighting the need for improvement in areas including cleanliness, ward food and accessibility for people with disabilities.

The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Leaders had calculated the number and grade of nurses and healthcare assistants required. The trust had recently reviewed the staffing template for nursing on the ward, and this had resulted in an increase in the shift template for both the day and night shift. Records showed the number of nurses and healthcare assistants matched this number on all shifts. The ward leaders could adjust staffing levels daily to take account of case mix.

Records showed that the numbers of trained nurses on duty on Bluefin Ward were calculated to ensure safe staffing to care for children and young people. Sickness absence was identified as a particular challenge affecting staffing stability. Despite these pressures, arrangements were in place to maintain safe care by using bank or agency staff who worked regularly on Bluefin Ward. In the operating theatres, children were supported by registered children’s nurses in the immediate post‑operative period, ensuring close, individualised care.

Recruitment processes met the NHS employment check standards and included identification, enhanced disclosure and barring, qualifications and references. When necessary, Leaders deployed agency and bank nursing staff to maintain safe staffing levels. When agency and bank nursing staff were used, they received an induction and were familiar with the area. Agency staff were rarely used, and regular bank staff are used when needed. Bank staff were required to complete an induction and the nurse in charge of the shift completed a compliance checklist with the temporary staff member at the start of the shift. The completed compliance checklist was uploaded to the temporary staffing portal as evidence of completion.

The on‑call surgical team carried out all planned and emergency operations for children and young people because the hospital had no dedicated paediatric surgeons. When children required specialist procedures, staff referred them to specialist centres.

The children and young people’s service was supported by a team of consultants who provided round‑the‑clock medical cover. Consultants worked closely together and took part in regular supervision, training and clinical governance activities. Records showed arrangements were in place to support continuity of care out of hours, with consultants able to attend the unit within 30 minutes when required, in line with national guidance. The service also supported ongoing learning and quality improvement through audit, review meetings and protected time for professional development.

Staff were up to date with mandatory training that was appropriate for caring for children and young people. Staff told us they were supported to attend training, and this helped ensure they had the skills and knowledge needed to provide safe care. The service promoted a strong safety culture, with staff encouraged to report incidents and near misses and supported to reflect and learn from these to improve practice.

The practice education team supported clinical staff through training, guidance and access to educational resources to promote safe and effective care for children and young people. Newly qualified staff told us they received structured support during their early employment, which helped them develop confidence and clinical skills.

The practice development team provided education and training to support staff working with children, young people and newborn babies across multiple sites. Training helped staff maintain the skills needed to deliver safe and effective care, including life‑support and specialist clinical education. The team also supported nurses to develop advanced and specialist competencies, contributing to high‑quality care for babies and children with more complex needs.

The service provided a range of training and development opportunities to support staff working with children, young people and newborn babies. This included mental health training, simulation‑based learning and initiatives to support staff wellbeing and retention. The service also promoted inclusive care through learning disability and autism training and had plans in place to further develop staff knowledge and skills.

The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The hospital had infection prevention and control arrangements in place to support safe care. Staff were able to access guidance through internal systems, and leaders monitored compliance through regular checks and audits. Where issues were identified, actions were taken to improve practice and maintain high standards of cleanliness and hygiene.

The infection prevention and control team carried out regular audits of the ward environment. These showed that hygiene and cleanliness improved over time as actions were taken to address issues identified. Improvements were seen in areas such as hand hygiene facilities, availability of protective equipment and equipment cleaning. Some areas, including storage and the use of sharps bins, continued to require ongoing oversight to ensure standards were consistently maintained.

Staff ensured equipment was cleaned in between patient use. During the assessment ‘I am clean’ stickers were visible and in date. All ward areas were clean, had required furnishings and were generally well-maintained. Cleaning records were up to date and showed the ward areas were cleaned regularly. Waste was separated into general and contaminated waste and stored and disposed of safely. Contaminated linen was bagged clearly and stored safely before being laundered.

Staff followed infection prevention and control guidance, including good hand hygiene practices. Personal protective equipment was readily available in clinical areas, and staff were reminded to clean their hands at appropriate times. During the assessment, we observed staff cleaning their hands correctly in every area we visited. Staff were bare below the elbows in clinical areas. Clinical areas were well stocked with hand gel for staff and visitors. Posters prompted staff and visitors to the ward to clean their hands regularly. Toys in the playroom and ward were cleaned regularly.

The infection prevention and control team monitored hand hygiene practices on the ward and acted where improvements were needed. Over time, standards improved as staff received additional reminders and support to follow good hand hygiene practices consistently. Staff cared for children at risk of infection in appropriate isolation areas, with clear guidance for staff and visitors on required precautions. All reusable equipment such as blood pressure machines were cleaned between use and disposable equipment was disposed of safely.

Chemicals hazardous to health (COSHH) were stored securely and only accessible to those permitted to use them. COSHH records were managed centrally, and all findings were escalated through Infection Prevention and Control (IPC) governance to ensure sustained standards.

The evidence showed some shortfalls. The service did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

Processes were in place for the secure storage of medicines including controlled drugs and medical gases. However, across the services for children and young people where medicines manufacturers recommended a revised "in use expiry date", we identified variation in the use of revised expiry dates when a medicine was opened. This meant that some medicines had opened dates whilst others had expiry dates. This could be confusing for staff.

Except for one fridge, room and fridge temperature records showed medicines were kept within their recommended temperature ranges. Emergency medicines boxes prepared centrally across the trust were available, tamper evident and in date. The content and presentation of locally produced emergency "psychotic episode" boxes varied between the children's wards on the St Richards and Worthing sites. The lack of standardisation of these boxes meant that staff may not be familiar with their contents.

Over-labelled medicines were available for staff to supply against emergency department and discharge prescriptions. However, the quality of the over labelling of the medicines in the TTO (To Take Out) cupboards were variable, including appropriate over labelling or incomplete labelling. Therefore, there was a risk that children and young people on discharge may receive medicines with incomplete labelling and directions. Following the assessment, the service took immediate action in response to the findings and developed a pharmacy‑led standard operating procedure to prevent recurrence of the issue identified by the assessment team. Staff told us that delays in discharging patients were sometimes caused by the pharmacy sending take-home medications to the ward late.

Trust guidance was available to support the record keeping of controlled drugs and controlled stationary. The controlled drugs registers we reviewed showed staff were following trust guidance. However, when we reviewed the controlled stationary records whilst guidance and processes had been produced, staff told us these were not consistently followed.

Guidelines to support the prescribing and administration of medicines were available via the trust intranet. If access to the internet was lost, paper copies were also available. However, a few of these documents lacked version details or were more than 5 years old, without evidence to demonstrate they were the current version. Therefore, we were not assured that staff would always access the current version.

Staff explained the clinical pharmacy service provided to Bluefin and Beeding Ward included a pharmacist reviewing children and young people prescribed medicines. Staff on the children’s ward described how the children and young people profile on the ward had changed their confidence and understanding of medicines used to treat mental health conditions, especially anti-psychotics and medicines to reduce anxiety, had improved.