Northamptonshire children's mental health service taken out of special measures but inspectors still have concerns

St Andrew's Healthcare Child and Adolescent Mental Health Service (CAMHS), is to exit special measures and has been rated as Requires Improvement overall following an inspection by the healthcare watchdog.

However, concerning findings have been found by inspectors including five members of staff not wearing protective masks correctly and heightening infection risks, bin liners were found in toilets, which could be used for children to self-harm and 1,116 incidents of restraint were reported between March and August 2020 on 26 children, equating to 44 restaints per patient.

It comes as the Care Quality Commission also investigated 16 incidents of restraint on CCTV footage that had taken place in August and September 2020 - one of which involved "staff dragging a young person for a few seconds when they lifted her feet off the ground", which has since been investigated by the council.

The independent hospital, which is now registered to accommodate 30 children and young people with mental health conditions, was rated as Inadequate and placed into special measures in June 2019. Since then service leaders reduced overall staff numbers from 312 to 139 between May 2020 and September 2020.

When inspectors returned in September and October 2020, they found that, while further work is needed, several improvements had been made and the service can now exit special measures.

The report, which has been published today, also details 249 incidents of children and young people self harming whilst on eyesight or arm's length observations between 1 May 2020 and 31 August 2020.

On one of the three bedded wards, Brook Ward, staff secluded a young person for 70 minutes in the day area of the extra care suite. The watchdog inspector detailed in his report that staff had not recorded the rationale for this, their review or that they had informed the necessary parties.

CQC’s Deputy Chief Inspector of Hospitals (and lead for mental health), Dr Kevin Cleary, said: “Our return to St Andrew’s Child and Adolescent Mental Health Service showed a number of improvements had been made and standards for patients had improved.

“Earlier this year we restricted new admissions to the service due to the level of concern we found, so it is encouraging to see the service has been making some of the necessary improvements.

“Generally, we found that staff went the extra mile for children and young people. The service supported learning, continuous improvement and innovation. Staff placed strong emphasis on patient feedback about the new wards and made changes to plans throughout the transformation process to meet their needs.

“However, our inspection also found further work is needed to ensure people using the service always receive appropriate care and treatment and are protected from the risk of harm."

The hospital, which is run by St Andrew’s Healthcare - is rated as Requires Improvement overall and for whether the service being provided is safe and well-led. It is rated as Good for whether the service provided is caring, responsive and effective.

There are now new hospital leaders in place who had taken positive action to change the culture of the service and staff are now raising issues in an open and honest way, the inspector has written.

Nicer parts of the report detail how carers reported to inspectors that staff went the extra mile to ensure patients were supported, for example; they hired a soft play out of hours for a patient’s birthday and supported another patient to cook with their family via a video call.

But Dr Cleary added: “Inspectors remained concerned about the consistency of standards across wards. Managers had not yet ensured the practice across all wards was of a consistent standard. Inspectors found discrepancies in medication management, patient observations, completion and quality of seclusion records and ward safety checks.

“Whilst we saw an overall improvement in seclusion and restraint practice, we remain concerned about the levels used by the service and will continue to monitor this and require evidence of an active programme of improvement.

“Whilst it was clear much work had been done to drive through improvements at the service, it is vital that the provider ensures this continues. We are monitoring the service closely and will return to carry out further inspections to check on progress.”

Katie Fisher, St Andrew’s CEO, said:“ Today is a significant step forward on our transformation journey. Our staff have all worked incredibly hard to continuously improve and develop our CAMHS service, and have done so in the middle of global pandemic, which has resulted in the unit being taken out of special measures.

“Earlier this year and following feedback from our partners and regulators, we recognised that things needed to change, and we decided to remodel the service and reduce the number of young people we care for from 90 to 30, as we look to ‘rightsize’ the organisation.

“But there is still more to do and several challenges to overcome, as we address the areas which need further progress. But we can now look forward to the future with confidence as we continue on our path to becoming a high-performing specialist mental health service.”