Blackpool Teaching Hospitals NHS Foundation Trust

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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

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

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement.

Requires improvement: This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. Not all young people had a risk assessment and care plan and there were issues with the safety of the environment. However, the service had robust referral and admission processes, staff understood how to safeguard young people and worked together well to manage identified risks.

The service was in breach of regulations for safe care and treatment.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 2. The evidence showed some shortfalls. The service mostly had a proactive and positive culture of safety. They mostly investigated and reported safety events. However, managers did not always listen to concerns about safety and lessons were not always learnt to continually identify and embed good practice.

The service had no serious incidents in the last 12 months. Themes for adverse incidents included young people refusing to leave the building and delays in treatment due to staffing challenges. All staff knew what incidents to report and how to report them.

Staff understood the duty of candour. They were open and transparent and gave young people and families a full explanation if and when things went wrong. There had been no incidents where the duty of candour had been applicable in the 12 months prior to our inspection.

Staff discussed incidents in the daily incident triage meeting, and staff told us about changes that had been made following incidents. For example, staff had received training, increased supervision and flow charts were put in place following incidents where unaccompanied children were left in accident and emergency. Incidents were included on the agenda of some but not all team meetings.

However, staff told us they were not always debriefed and did not always receive support following incidents and there was no evidence of learning following these incidents. For example, incidents occurred in the waiting room including an incident where a young person became very unwell and incidents where young people had been abusive to staff and staff had felt unsupported following these incidents.

We scored the service as 3. 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 the young person was received to determine if the young person’s needs could safely be met. The service had a single point of access. The service accepted referrals from professionals and self-referrals. All referrals were discussed at a daily meeting which was attended by all the different teams and a decision was made in the meeting as to which team could provide the most appropriate support for the young person. Where referrals were not accepted, the young person was signposted to other appropriate support.

Staff involved all the necessary healthcare and social care services to ensure young people had continuity of safe care, both within the service and post-discharge. The service held internal transfer meetings which enabled them to facilitate supportive transitions between services.

We scored the service as 3. 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.

Staff were trained in safeguarding, knew how to make a safeguarding alert, and did that when appropriate. Staff had access to child and adult safeguarding policies which were clear, up to date and contained useful links and flow charts to support staff to make safeguarding decisions. The service had close relationships with safeguarding teams including the multi-agency safeguarding hub and referred to safeguarding where required.

Staff could give examples of how to protect young people from harassment and discrimination, including those with protected characteristics under the Equality Act.

Staff knew how to identify adults and children at risk of, or suffering, significant harm. This included working in partnership with other agencies. For example, we observed staff discussing potential safeguarding concerns in a multi- disciplinary team meeting and following this, action was taken to raise an external safeguarding referral.

Mental Capacity Act

Staff had received Mental Capacity Act training as part of their mandatory training and were 98% compliant with this training.

Staff had a good understanding of the Mental Capacity Act, in particular the five statutory principles. Staff also used the Gillick competency (a test in medical law to decide whether a child of 16 years or younger is competent to consent to medical examination or treatment) where this was required.

The provider had a policy on the Mental Capacity Act, including deprivation of liberty safeguards. Staff were aware of the policy and had access to it.

For young people who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis with regard to significant decisions.

Staff carried out audits, but these did not include the application of the Mental Capacity Act.

We scored the service as 1. The evidence showed significant shortfalls. The service did not work well with people to understand and manage risks. They did not provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

We reviewed 7 risk assessments and risk management plans during our inspection.

Staff had completed risk assessments with young people, and these were updated at every session. However, accompanying care plans were not always updated during sessions and plans for mitigating risks were not always clear. For example, we found that 1 care plan had not been updated following safeguarding concerns being raised and following review of the last record audit, we identified 1 young person who did not have a care plan at all. We reviewed the records and found the young person still did not have a care plan at the time of our inspection.

Risk management plans were embedded within care plans. Audits showed that 7 out of 18 records that had been audited in the last 5 months did not have a care plan and therefore these young people did not have a completed risk management plan. The service had an action plan in place to monitor areas of improvement identified during audits.

However, records showed that actions had mostly been taken following risk concerns being raised, for example staff had raised safeguarding alerts and held a strategy meeting following safeguarding concerns being raised about a young person. Risk concerns were also discussed within multi-disciplinary team meetings and actions taken following these meetings.

Staff mostly involved young people and their families in care planning and risk assessments. However, not all young people had care plans and care plan templates varied in how young person focused they were.

Staff communicated with young people so that they understood their care and treatment, including finding effective ways to communicate with young people with communication difficulties.

We scored the service as 2. The evidence showed some shortfalls. The service did not always detect and control potential risks in the care environment. However, they made sure equipment, facilities and technology supported the delivery of safe care.

The environment was well maintained and mostly met the needs of the patient group. The service was located within a health centre and was shared with another Trust. The building was owned by NHS property services and most day-to-day maintenance, such as fire checks and environmental checks were outsourced to a maintenance company who reported directly to NHS property services.

The reception area was separate to the waiting room. This was a large room that staff were unable to observe easily. Reception staff could not see young people once they were in the waiting room which meant it was difficult to monitor risks. The trust told us there was a system in place for monitoring young people who were high risk, however it was unclear whether this was being implemented because not all staff we spoke with were aware of the system. Rooms had alarms should staff need them.

Staff had not carried out regular risk assessments of the care environment. Environmental risk assessments had not been completed prior to our inspection. Following our inspection a ligature point risk assessment and action plan was produced which included clear plans on how to monitor young people who were at risk of harming themselves if they were unaccompanied.

The service did not have clinic rooms, however there was resuscitation equipment and first aid kits at reception, should these be needed.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure there were enough qualified, skilled and experienced staff. Staff received effective supervision but did not always feel supported or able to access development opportunities. Staff worked together well to provide care that met people’s individual needs.

Establishment figures for 2025/6 were 104.75 whole time equivalent (WTE) across the 6 teams, this had decreased from 111.99 in 2024/25. All teams, with the exception of the Mental Health Support Team had experienced a decrease in their staffing establishment numbers. There were 3.2 whole time equivalent (WTE) vacancies in the CAMHS service, 6 WTE vacancies in the RAIS service, 2.08 WTE vacancies in the Children’s LDA team and 2 WTE vacancies in the CYP therapies team. Some of these vacancies were significant as the teams were quite small, for example the RAIS team had less than 12 staff and covered out of hours services. This meant the team were reliant on bank staff to provide out of hours support. Average turnover levels were 16.4%. Sickness absence was 6.8% but varied between teams and was higher in the RAIS team. In the 3 months prior to our inspection the CAMHS service used 139 bank/agency shifts, 1 of which was unfilled and the RAIS service used 305 bank shifts, 32 of which were unfilled. The CAMHS service using were a proportion of the bank shifts to support a waiting list initiative. Following our inspection the trust told us that the bank staff posts used by the RAIS service had been converted into substantive roles and were out for recruitment.

Managers had calculated the number and grade of staff required. However, this was not reflective of current staff numbers. When staff left the service, they were not replaced. The numbers of staff were then adjusted to match staffing numbers excluding vacancies. This left some significant skill gaps. For example, the psychology provision for the core CAMHS service had been reduced, when the staff members left. At the time of our inspection, the team had access to a 0.2 WTE bank psychologist. The team has carried out a redesign to cover these skills gaps.

When necessary, managers deployed agency and bank nursing staff to maintain safe staffing levels. Both consultant psychiatrists were locums and the Response and Intensive Support team (RAIS) used bank staff to cover out of hours shifts. There were no permanent out of hours workers for this part of the service. These staff did not attend morning meetings for the team, because this was not their substantive post. This meant the team had to rely on written handovers only and were unable to discuss information with colleagues who had been on late shifts.

When agency and bank nursing staff were used, those staff received an induction and were familiar with the service.

Staff told us that staff shortages meant that clinics sometimes had to be cancelled.

Staff had received and were up to date with mandatory training, such as safeguarding training, conflict resolution training, learning disabilities and autism training and preventing radicalisation training.

We scored the service as 3. 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 service was clean, had good furnishings and was well-maintained. Cleaning records were up to date and demonstrated that the premises were cleaned regularly.

Staff adhered to infection control principles, including handwashing. Hand gel and sanitisers were available for staff use.

The Trust did not complete handwashing or infection prevention control audits because staff did not deliver clinical or physical care.

We scored the service as 3. The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

Staff followed good practice in medicines management and did it in line with national guidance. The Trust had an up-to-date medicines policy in place. The service did not keep any medicines on site and staff did not administer medicines. The service had an electronic medicines system which showed side effects, alerts and drug interactions for medicines. Prescriptions were sent straight to the pharmacy using a code which was unique to each consultant.

Staff reviewed the effects of medication on young people’s physical health regularly and in line with NICE guidance, especially when the young person was prescribed a high dose of antipsychotic medication. The service had nurse prescribers who worked with the Attention Deficit Hyperactive Disorder (ADHD) service and were involved in monitoring side effects. Staff supported parents and carers to monitor any side effects and provided information about the medicines to young people and their parents and carers.