The Care Quality Commission (CQC) has taken urgent action to keep young people safe following a focused inspection of the children and adolescent mental health wards at Essex Partnership University NHS Foundation Trust.
The unannounced inspection was prompted by a serious incident and concerning information received about the safety and quality of the service which provides mental health inpatient services to young people and their families. Inspectors visited all three wards of the children and adolescent mental health service; Larkwood ward, Longview ward and Poplar Adolescent Unit.
Due to the serious concerns found on inspection, urgent conditions have been placed on the trust’s registration. The conditions demand that the trust must not admit any new patients without consent from CQC. The trust must also ensure there are adequate staffing levels on all three wards so observations can be carried out safely and patient needs are met.
Following the inspection, the overall service rating went down from outstanding to inadequate. Previously safe was rated as requires improvement, caring was outstanding and well-led was good; the service is now rated as inadequate in all three of these areas.
Stuart Dunn, CQC head of inspection for mental health and community services, said:
“When young people with mental health needs receive care at hospital, all possible steps must be taken to ensure the environment is a safe one for them. Essex Partnership University NHS Foundation Trust was not providing this experience for young people at the children and adolescent mental health wards as some came to harm as a result of their failings.
“Inspectors were concerned enough about what they saw at this inspection to impose urgent conditions on the trust, which is no longer allowed to admit patients without CQC permission.
“Observations were not always carried out safely and patients had been harmed as a result of these poor practices which included patients tying ligatures and self-harming during enhanced observations. These incidents were not always reported or dealt with appropriately.
“Under-staffing was another significant concern made worse by managers not ensuring staff had the appropriate skills and experience to look after the vulnerable patients in their care. Many staff told us they felt overworked and burnt out.
“The use of bank and agency staff was high meaning patients missed out on receiving care from a familiar and trustworthy person. Inspectors saw examples where staff members didn’t understand the needs of patients in their care which resulted in safety incidents occurring. All patients we spoke with told us they felt uncomfortable with unfamiliar staff and it made it hard to build therapeutic relationships.
“In addition, patients often had their activities and holidays cancelled if the service was too short staffed which heavily impacted on their progress and well-being.
“This is why we have imposed urgent conditions on the trust’s registration requiring immediate action to keep patients safe.
“We are monitoring the trust closely and continue to work with system partners to ensure patient safety improves. We will return to check whether sufficient improvements have been made and will take further action if needed.”
Safety incidents were not always reported clearly or in line with trust policy. Inspectors reviewed nine incident forms and lessons learned were not complete in any of them. However, managers debriefed and supported staff and patients fully after any serious incident, including any psychological support if needed.
Staff involved patients in their care plans and discussed these regularly with them on ward rounds to ensure they were aware of any changes or had any feedback. They were open and transparent and gave patients and families a full explanation if things ever went wrong.
Following the inspection, the trust was told to make several improvements, including:
- There must always be enough suitably skilled staff on shift to keep patients safe
- Staffing numbers must be regularly reviewed in order to meet patient need
- The skills and experience of agency staff must be checked and approved before they are placed in post
- The trust must ensure the same staff are placed with patients to ensure a continuation of care and to build positive relationships
- Staff must treat patients with kindness, dignity and respect at all times
- Managers must be proactive in responding to risk and must ensure they are dealt with quickly and appropriately
- Incidents must be recognised and reported appropriately in line with trust policy
- Staff must follow policy and procedures on the use of enhanced support when observing high risk patients in order to minimise the opportunity for patients to self-harm.
Read the inspection report for Child and adolescent mental health wards.
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