Alder Hey Children's NHS Foundation Trust

Updated 8 July 2020

Not used

Updated 8 July 2020

Our rating of the trust stayed the same. We rated it as good because:

• We rated effective, responsive and well-led as good. We rated caring as outstanding and safe as requires improvement.
• We rated all seven services we inspected as good. This included improvements in the overall rating in three core services. In rating the trust, we took into account the current ratings of the five services not inspected this time.
• Across the trust we found that children had good outcomes because they received effective care and treatment that met their needs.
• We found that children’s’ needs were met through the way services were organised and delivered.

• We saw evidence that people were truly respected and valued as individuals and were empowered as partners in their care.
• We noted improvement in the leadership and culture, which were used to drive and improve the delivery of high-quality person-centred care.

However:

• Although we found the trust’s services largely performed well, it did not meet some legal requirements relating to the safe domain, meaning we could not give it a rating higher than requires improvement in this domain.
• We found some risks which had not been identified by the trust’s internal governance structure. We escalated this to the trust at the time of the inspection, who took appropriate action.

Updated 25 June 2025

This inspection took place on the 25 to 27 March 2025.

The inspection covered specialist community mental health services, ASD ADHD Services for children and young people.

We inspected the service following a major incident. Although we did not have specific information of concern regarding the specialist community mental health services for children and young people we visited the service to ensure they were operating safely and to enable the Trust to provide assurance about the quality of care being provided

Alder Hey Children’s NHS Foundation Trust provides specialist community mental health services, ASD ADHD Services for children and young people up to the age of 18. The service covers the populations of both Liverpool and Sefton. The service provision included Children young people community mental health services, ADHD and ASD services, Mental Health Support Teams, Eating Disorder community team and a Crisis Care service. Services worked with each other but were primarily structured by locality to reflect previous commissioning arrangements. The Crisis Care service was based in Liverpool but provides a service across both Liverpool and Sefton.

The ADHD and ASD service provide assessment and diagnosis for Attention Deficit Hyperactivity Disorder and Autism. They commence treatment and prescribing for ADHD. During this inspection we visited the ADHD and ASD service in both Liverpool and Sefton localities. We also visited the ADHD and ASD post-diagnosis support team that was only commissioned in the Sefton area. The service supported children or young people and their parents and family to understand the diagnosis and the needs of the child or young person and helped develop personalised strategies areas such as behaviour management.

Child and Adolescent Mental Health Teams provide support and treatment for children and young people experiencing emotional, behavioural or mental health difficulties. They offer a range of services including assessment, therapy, prescribing and support for families. They work with individuals up to the age of 18. During this inspection we visited the CAMHS service in both Liverpool and Sefton.

ADHD and ASD teams provide assessment and diagnosis for Attention Deficit Hyperactivity Disorder and Autism. They commence treatment and prescribing for ADHD. During this inspection we visited the ADHD and ASD services in both Liverpool and Sefton. We also visited the ADHD and ASD post-diagnosis support team that was only commissioned in the Sefton area. The service supported children or young people and their parents and family to understand the diagnosis and the needs of the child or young person and helped develop personalised strategies areas such as behaviour management.

Mental Health Support Teams (MHST) are part of a national programme to reduce inequalities and increase access to mental health support for children and young people. They work with schools to engage with children and young people. They provide low level psychosocial interventions to people with low to moderate needs and offer a pathway into CAMHS services for those who require it. MHSTs do not provide a regulated activity under the Health and Social Care Act 2012. However, we visited the teams in both the Liverpool and Sefton localities to understand how services engaged with local schools.

We did not visit the community Eating Disorder service as part of this inspection.

At our last inspection of this service, in 2020, we rated the service as good and did not identify any regulatory breaches. At this inspection we rated the service as outstanding. We did not identify any regulatory breaches.

Mental Health Act and Mental Capacity Act Compliance

Mental Health Act

The Trust had a Service Level Agreement in place with a local mental health trust to provide Mental Health Act and Mental Capacity Act management services.

Staff were trained in and had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles. Staff completed training on the Mental Health Act as part of their mandatory training programme. At the time of our inspection compliance with the training was 98%.

The provider had relevant policies and procedures that reflected the most recent guidance. Staff had easy access to local and specialist Mental Health Act policies and procedures, these included a policy covering the legal aspects of assessment and treatment of children and young people with a mental health disorder. Staff had access to the Mental Health Act Code of Practice.

Staff had access to administrative support and legal advice on implementation of the Mental Health Act and its Code of Practice. Staff knew how to contact Mental Health Act administrators. Managers made sure that the service applied the Mental Health Act correctly by completing audits and discussing the findings. The Community and Mental Health Division produced an annual use of the Mental Health Act report for the Trust board.

Mental Capacity Act

The Trust had a Service Level Agreement in place with a local mental health trust to provide Mental Health Act and Mental Capacity Act management services.

Staff had a good understanding of the Mental Capacity Act, in particular the five statutory principles. Staff completed training on the Mental Capacity Act, including the use of Gillick competence as part of the mandatory Safeguarding Level 1 training. Compliance with the training was 96%.

The provider had a policy on the Mental Capacity Act. Staff were aware of the policy and had access to it. Staff knew where to get advice from regarding the Mental Capacity Act and Gillick competency.

Staff recorded capacity to consent. Consent and capacity were captured on the electronic records system. However, it was not always reflected on the electronic records system as to how capacity had been assessed. Staff took all practical steps to enable children and young people to make their own decisions. Staff understood how to follow best interest policies and ensure that decisions recognised the importance of the person’s wishes, feelings, culture and history.

Managers made sure that the service applied the Mental Health Act correctly by completing audits and discussing the findings.

Updated 21 June 2018

We have not rated this service before. We rated it as good.

For a summary of this service see the overall trust summary section.

Updated 8 July 2020

Our rating of this service stayed the same. We rated it as good because:

• The service provided safe care. The wards had enough nurses and doctors. Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.
• Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the children and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
• The ward team included or had access to the full range of specialists required to meet the needs of children on the wards. Managers ensured that these staff received training and appraisals. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They followed good practice with respect to young people’s competency and capacity to consent to or refuse treatment.
• Staff treated children with compassion and kindness, respected their privacy and dignity, and understood the individual needs of each child. They actively involved children, families and carers in care decisions. Consideration was given to children‘s care after they were discharged and the service offered extensive support to carers to ensure they could support children after discharge from the service.
• Staff planned and managed discharge well and liaised well with services that could provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.
• The service was well led, leaders had the skills knowledge and experience to perform their roles, staff felt respected and valued and performance and risks were managed well.

However:

• The ward environment was not well maintained. There were a number of maintenance jobs that had not been completed. There were infection control risks on the ward that had not been identified. We found equipment that was out of date. Checks on equipment were not up to date. Cleaning records were poor and did not provide assurances of regular cleaning and clean stickers were not in use.
• There were no personal emergency evacuation plans to provide guidance to staff around the evacuation of individual children. We raised this and personal emergency evacuation plans were put in place by the second day of our inspection.
• Clinical supervision levels were low at 54%, staff received other methods of supervision but these were not always recorded and it was not clear whether staff were receiving the level of supervision they needed.