Nursing shortages drive children’s mental health service to ‘inadequate’ CQC rating

Posted: 15th September 2021

A mental health service for children and adolescents in Essex has been banned from admitting any new patients without permission from the Care Quality Commission, after inspectors flagged several concerns about nurse staffing levels.

A recent inspection of child and adolescent mental health wards at Essex Partnership University NHS Foundation Trust saw the service rated “inadequate” by the CQC. It had previously been rated “outstanding”.

Due to serious concerns, the CQC said “urgent conditions” had been placed on the trust’s registration and stressed that improving staffing levels was imperative.

The unannounced inspection, carried out during May and June, was prompted by a serious incident and concerning information the CQC had received about the safety and quality of the mental health inpatient services for children and adolescents.

Inspectors visited all three wards of the service, which included Larkwood ward, Longview ward and Polar Adolescent Unit.

The health watchdog’s report, published today, said ratings of the service had declined because it “did not have enough nursing and support staff to keep patients safe”.

As part of this, there were not enough staff on each shift to carry out physical interventions, such as restraints, safely or complete patient observations as necessary, said the report.

Inspectors uncovered that between 1 November 2020 and 30 April 2021, 129 shifts were not filled across all three wards, while staff told them that being short staffed was a “regular occurrence”.

In addition, the CQC warned that managers “did not accurately calculate and review the number and grade of nurses and healthcare assistants for each shift” and that staffing needs were “not regularly reviewed” to meet current patient demand.

Staff shortages meant that patients in the service did not have regular one-to-one sessions with their named nurses, and that some patients had their escorted leave or activities cancelled.

There was also an instance where a patient was unable to return from leave because of staff shortages. The patient was instead told to wait until later that day or go to A&E if their mental health became unmanageable, the CQC found.

Other concerns reported by inspectors included the service’s reliance on bank and agency staff.

“Bank and agency staff use was high, and managers were not assured as to the skills and experience of agency staff,” said the report.

“From November 2020 to May 2021, Larkwood ward used bank and agency for 4970 shifts, Longview for 2671 shifts and Poplar for 1796 shifts.”

The CQC said the service’s “lack of regular and familiar impacted on the quality of patient care”, including examples where unfamiliar staff did not know patient risks.

Staff working at the service also told inspectors how the wards used “a lot of unfamiliar agency staff” and that this “impacted on patient care and their workloads”.

In outlining staffing problems, the report recognised the impact of the coronavirus pandemic on staff shortages, as well as national challenges for wards for children and adolescents regarding patient acuity and bed availability.

The report goes on to highlight other concerns, including where staff had “missed opportunities to prevent or minimise harm and did not always act to prevent or reduce risks”.

In addition, there were times where staff had not followed trust policy and procedures on the use of “enhanced support” when observing patients assessed as being at higher risk of harm to themselves or others.

Meanwhile, lessons learned “were not always completed in incident forms or shared effectively across wards”, noted the report.

Following the inspection, the service’s rating for being safe has moved from “good” to “inadequate”, while ratings for caring and well-led declined from “outstanding” to “inadequate”.

Due to serious concerns identified, the service is prohibited from admitting any new patients without consent from the CQC.

The trust was also told to make several improvements around staffing, the reporting of incidents and the following of policy and procedures.

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.

“Our inspectors found that 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.”

Mr Dunn reiterated concerns around patient observations and highlighted times where “poor” practice led to patients self-harming during enhanced observations.

“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,” he added. “Many staff told us they felt overworked.”

Referring to the high use of bank and agency staff, he said inspectors witnessed 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,” added Mr Dunn.

“This is why we have imposed urgent conditions on the trust’s registration requiring immediate action to keep patients safe.”

The CQC was “monitoring the trust closely and continue to work with system partners to ensure patient safety improves”, he noted.

“We are aware that the trust is working hard to improve this service and is taking the appropriate steps to ensure young people are receiving safe care.”

Responding to the report, chief executive of Essex Partnership University NHS Foundation Trust, Paul Scott, said: “We take the CQC’s findings very seriously, and following their inspection visit in May we took immediate action to make sustainable improvements to our services for children and their families – these include increasing staffing levels, delivering ongoing coaching and mentoring for our staff in observing our patients and engaging with them and strengthening clinical and operational leadership.

“Patient safety is our highest priority, and we continue to work closely with the CQC and our partners to improve standards and ensure every patient has access to the best care possible.”

Source: Nursing Times

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