Hampshire and Isle of Wight Healthcare NHS Foundation Trust

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

This means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question Requires Improvement. At this assessment the rating has changed to Good.

Good: This meant people were safe and protected from avoidable harm.

We rated this key question as good because:

• Staff reviewed safety daily and reported any incidents that occurred.
• Staff were trained in safeguarding and there was a safeguarding lead for the service.
• Young people were involved in developing their own risk assessments.
• There were enough staff employed across the service, with the correct skills, to keep young people safe.

However:

• Staff statutory and mandatory training compliance was 67%.

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.

Staff told us that they knew how to report incidents using the trust electronic incident reporting system and that all staff could access the system. Staff knew what they needed to report as an incident and were open and honest with young people and families when things went wrong.

There were 16 incidents reported in the 12 months prior to the inspection. There were 15 incidents that had an impact rating of moderate harm. One incident was rated at the highest level of severe harm and this related to a disclosure of historical abuse that had not occurred at the hospital. Of the remaining incidents three related to self-injurious behaviour.

There was a daily safety huddle where staff reviewed any incidents from the previous day, and staff discussed incidents at the weekly Multi-Disciplinary Team (MDT) business meetings and weekly staff meetings. Managers shared minutes of the meetings with the ward team so staff could see any learning that had been identified. Staff told us there was a debrief meeting after every shift where any incidents were discussed and any learning identified. Following more serious incidents, senior staff arranged swarm huddles to discuss learning from the incident. A swam huddle is a blame-free team meeting held soon after a patient safety incident to quickly identify what happened, possible causes and agree on immediate actions to prevent it happening again. The Trust patient safety team reviewed incidents that meet local and national Patient Safety Incident Response Framework (PSIRF) priorities, so that they could also find any learning and shared this across the trust.

Young people could be referred to the service from a variety of sources. Most referrals came from community teams and health-based places of safety. All young people referred to the hospital would have a full assessment before being admitted, unless they were urgent admissions. Once the young person had been admitted and their local community team had worked with the hospital staff in preparation for discharge. The trust had good links with other health and social care providers to ensure that the young people could access any services they needed while admitted to the hospital. The hospital discharged most young people to the family home. The hospital staff worked with other care providers if this was the agreed pathway for discharge. The hospital had a transition team who worked with the young people preparing for discharge.

The Hospital had a 100% compliance rate for safeguarding adults and children level one training and 80% of staff had completed safeguarding children at level three. Staff we spoke with could explain what type of incidents they would report to safeguarding and how to raise a safeguarding alert.

The trust had a safeguarding policy, and the ward had a safeguarding lead who provided safeguarding supervision for staff to learn from safeguarding issues.

The service had made 19 safeguarding referrals in the year prior to the inspection. This included referrals that related to young people with protected characteristics such as race and disabilities.

There were policies in place for people visiting the service including children, the service did not allow children under 16 to visit the ward. The service had accommodation that could be used for families visiting so that they could stay at the hospital when visiting their young person.

The service monitored restrictive practices to reduce them and used restraint, in the form of physical interventions, and rapid tranquilisation, rarely. However, we did identify some blanket restrictions. Access to the hospital garden was restricted for all young people including those not detained under the Mental Health Act and there was no sign on the door advising patients what they should do if they wished to use the garden.

Mental Capacity Act

Staff helped the young people to make decisions about their care and this was recorded in their care record. Staff helped young people to understand information by using easy read versions of care plans and Mental Health Act information.

Staff we spoke with understood their role under the Mental Capacity Act, the 5 guiding principles and when Gillick competencies applied. Gillick competence is a legal principle allowing healthcare professionals to treat a child under 16 without parental consent if the child has sufficient maturity and understanding to fully grasp the treatment's risks, and implications. Staff could access advice about the Mental Capacity Act if they needed it.

We reviewed 2 out of the 8 young peoples’ care and treatment records, which included a risk assessment and crisis plan. There was evidence in each file about how staff had involved the young people involved in developing their risk management plan and when the young person’s family had been involved.

Staff only used physical interventions and rapid tranquilisation as a last resort. We reviewed incident data for the 12 months prior to our inspection and saw that staff had only used physical interventions on 20 occasions and only when attempts to de-escalate the young person had not succeeded and always for the shortest time possible.

We saw that the young people were involved in their care programme approach (CPA) meetings and attended their weekly MDT reviews. We attended a CPA meeting and saw that the young person was involved and that the young person was able to give their opinion and that this was listened to.

Staff provided all care plans to the young people in an easy read format.

The provider actively gathered feedback from the young people and their families via ward meetings and experience surveys.

The young people had access to an advocate if they wanted one who visited the ward regularly. There was a picture of the advocate displayed on the ward.

The staff checked the ward environment regularly to ensure that it was safe and free of potential risk. When risks were found, staff arranged for them to be removed or made plans to manage the risk. For example, the garden did not have a secure fence, so staff always supported young people in the garden.

The ward layout allowed staff to easily see the young people and would use enhanced observation when young people needed extra support.

Staff completed a ligature assessment every year. There was a map that allowed staff to clearly see higher risk areas and staff members were always present on the ward.

Staff always carried personal alarms so they could call for immediate assistance from other staff if they felt unsafe.

There was a seclusion room on site which staff had not needed to use for the 12 months prior to the inspection. The seclusion room was designed to allow staff to observe young people. It had a two way communication system which allowed young people to speak with the staff observing them. There was a clock that young people could see which had stopped, although the staff replaced the battery in the clock while we were on site.

The hospital had both a clinic and treatment room on site, both were clean, tidy and large enough to allow staff to provide treatment to young people if needed. There was emergency equipment in place that staff checked regularly to ensure it was in working order.

At the time of the inspection the hospital was funded to have 6 senior registered nurses, 6 registered nurses and 18 healthcare support workers . There was one vacancy for a senior registered nurse, two vacancies for registered nurses and 4 vacancies for health care support workers. There were 2 health care support workers waiting to start with the service. Over the 4 months prior to our inspection 90% of all shifts were covered.

The ward manager could adjust staffing to meet the needs of the ward to cover activities, home visits and if the young people needed additional support. The ward could use bank and agency staff if they could not cover shifts by their regular staff. In the last 3 months a total of 33% of shifts were covered by bank staff and 1% of shifts were covered by agency staff. The hospital used bank and agency staff who were familiar with the service.

There is always a nurse on the ward 24 hours a day.

The service also employed 2 senior nurses, one in a clinical development role and one as the lead for eating disorders. There were 2 psychologists and a psychology assistant, 2 occupational therapists and an occupational therapy assistant, a speech and language therapist, a family therapist and a creative therapist. These staff also worked within the day service located on the same site.

Staff told us that they rarely cancelled leave due to a lack of staff.

There were always doctors available to support patients when needed. There were 2 resident doctors, 1 specialist registrar and 2 consultant psychiatrists. The consultants was based at the hospital Monday to Friday. The staff can access doctors out of hours via an on-call system.

The overall compliance for statutory and mandatory training was 67%. However, leaders reported that the staff training compliance was currently low due as the training had been harmonised following the Trust merger and in line with national training guidance. The training system was updated in September 2025 which had impacted eligibility and compliance rates.

The ward was clean, tidy and in a good state of repair. Equipment in the clinic room was well maintained, and staff could report any issues if they needed items serviced or replaced.

Staff completed cleaning records daily. Staff signed to say they had completed cleaning tasks. We reviewed 2 months’ worth of records and only 1 entry had not been completed. Staff checked fridge temperatures daily.

Staff adhered to infection control principles and there were hand sanitation dispensers at the entrance to the ward.

Staff followed good practice when managing medicines. Only one nurse carried keys for the clinic room and medicine cupboard and spares were kept safely and securely off the ward. Staff recorded the clinic room temperature and knew what action to take if it exceeded the maximum. The trust had a process in place for ordering and disposing of medicine and the correct clinical waste bins were available.

We checked 10 different medicines in the medicine cupboard and found one had expired the previous month. Staff disposed of it.

Staff had access to up-to-date information about medicines via an online formulary.