#childsafety | Poor staff training sees trust forbidden to admit child mental health patients

A hospital trust has been banned from admitting any new patients under the age of 18 who present solely with acute mental health needs, following concerns over patient safety and poor staff training.

The Care Quality Commission has placed urgent conditions on Shrewsbury and Telford Hospital NHS Trust following a focused inspection of its children and young people’s services, which are delivered from The Princess Royal Hospital in Telford.

“Children and young people had been exposed to the risk of harm and inappropriate use of restraint”

CQC report

It also downgraded the overall rating of the trust’s service for children and young people from “requires improvement” to “inadequate”.

The inspection on 24 February had been prompted by concerning information acquired by the health watchdog around the safety and quality of assessment and treatment of children and young people who attended the hospital with acute mental health needs or learning disabilities.

During the inspection, the CQC spoke with a range of staff, including 14 nurses, a mental health matron, a lead nurse for women and children and a lead safeguarding nurse for children, among other health professionals.

In a report published today, the CQC warned that the service “did not ensure enough skilled and competent staff” were deployed to provide care to those under 18 admitted with mental health needs and learning disabilities.

Meanwhile, the health watchdog felt the service was “not inclusive” and “did not always take account of” individual needs and preferences.

Concerningly, it also found that children and young people admitted with mental illness or those with learning disabilities “did not receive adequate risk assessments on admission and those risk assessments that were completed were not updated as required”.

This meant that “action was not always taken to ensure all their needs were met and that risks were managed effectively”, the report added.

In addition, it claimed that staff failed to follow best practice in anticipating, de-escalating and managing challenging behaviours.

“We have imposed urgent conditions on the trust’s registration to keep patients safe and ensure staff are supported with appropriate training”

Ted Baker

“Effective systems were not in place to ensure restrictive practices, such as restraint, were completed safely and appropriately by staff who had undertaken nationally recognised training,” added the CQC.

The trust did not train its own staff in the use of restraint, therefore agency staff and security staff would be used when it was required.

But when reviewed by the CQC, 16 of 70 agency staff employed to care for one child had not completed their annual refresher in restraint training as required.

“This meant these children and young people had been exposed to the risk of harm and inappropriate use of restraint,” inspectors warned.

Other concerns raised showed that staff “did not fully understand how to protect children and young people from abuse” and that they “did not consistently follow” local or national guidance for safeguarding referrals.

The report also highlighted how the trust’s safeguarding policy did not state that all clinical staff working with children and young people required level three safeguarding training.

Among several improvements the trust has been urged to make, is the need to ensure this is corrected and that all staff caring for children and young people complete this training.

Staff also lacked understanding of the Mental Health Act, noted the report, which meant the rights of patients subject to detention under the act “were not always protected”.

Children and young people were also exposed to the risk of harm because the service did not always prescribe and administer rapid tranquilisation medicines “safely”, added the report.

The CQC also found evidence to suggest managers had failed to investigate patient safety incidents adequately and that lessons learned were not always shared with the team or wider service.

“We are accelerating the actions needed to improve the care we provide to children and young people using our services”

Louise Barnett

In terms of leadership, inspectors said leaders “did not have the skills and abilities to run the service” and that they “did not always take ownership of the issues that they needed to in order to keep children and young people safe”.

Following the inspection, urgent conditions have been placed on the trust’s registration which means it must not admit any new patients under the age of 18 who present solely with acute mental health needs.

The trust must also implement an oversight system to monitor staff compliance with safeguarding procedures, while ensuring all staff are trained in this area too.

It must also undertake an immediate review of clinical records of all children and young people patients who are currently in hospital with an acute mental health need.

The overall rating for children and young people’s services was moved down to “inadequate” and it was also rated as such for being safe, responsive, effective and well-led. The overall trust rating remains as “inadequate”.

Ted Baker

Professor Ted Baker, chief inspector of hospitals, said that at the time of inspection, the CQC had “found concerns that urgently needed addressing”.

“This is why we have imposed urgent conditions on the trust’s registration requiring immediate action to keep patients safe and ensure staff are supported with appropriate training,” he said.

Since the inspection, the trust has been receiving “safeguarding advice and expertise” from the University Hospitals Birmingham NHS Foundation Trust, he noted.

“The trust is also working with system partners locally to identify what wider action may be required to improve the provision of care for children and young people with mental health needs more broadly across the area and we encourage these discussions,” added Professor Baker.

“We are monitoring the trust extremely 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.”

In response, Louise Barnett, chief executive at Shrewsbury and Telford Hospitals NHS Trust, said: “We are accelerating the actions needed to improve the care we provide to children and young people using our services, including by ensuring all children admitted have risk assessment and care plans in place, rolling out more staff training and, with partners, appointing a new consultant psychiatrist to provide ongoing leadership and support.

“Keeping our patients safe and providing high quality care is our priority and we will continue to work with our local partners and the CQC to urgently address the concerns raised in this report.”

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