Response to CQC report on services for children and young people with mental health issues, learning disabilities or autism

17 February 2023

Dorset County Hospital has recognised areas for improvement and stressed the importance of partner agencies working closely together following a focussed Care Quality Commission (CQC) inspection around children and young people with mental health issues, learning disabilities or autism.

The inspection was carried out at Dorset County Hospital in August 2022, with the final report published on 15 February 2023.

Dorset County Hospital’s Interim Chief Executive Nick Johnson said: “We welcome the feedback from the inspectors and have already addressed the areas highlighted for immediate action.

“Since the COVID pandemic we have been caring for young people with increasingly complex mental health needs. This is recognised as a national issue and is a priority for the NHS as a whole.

“We recognise the importance of an open and collaborative approach with all our partner agencies to provide the best care for children and young people who need mental health support.

“Our priority will always be what is in the best interests of the young person and we will continue to work closely with our partners to ensure we can provide access to the most appropriate care and support when they attend Dorset County Hospital.”

The report highlights many examples of good practice at Dorset County Hospital in caring for children and young people with mental health issues, learning disabilities and autism.

Positive feedback about the care patients and their families received included:

• The service had suitable facilities to meet the needs of children and young people's families;
• Staff worked to ensure children and young people with mental health needs were accommodated in the most appropriate clinical area for their condition;
• Shift changes and handovers included all necessary key information to keep children and young people safe;
• The service had enough staff with the right qualifications, skills, training and experience to keep children, young people and their families safe from avoidable harm and to provide the right care and treatment;
• The senior team empowered staff at all levels to engage in the incident management system. For example, any member of staff who reported an incident or near miss could arrange a team meeting to discuss it. This helped to embed learning from incidents and staff said it contributed to an open and honest working culture;
• Staff held regular multidisciplinary meetings to discuss children and young people and improve their care. Staff worked across health care disciplines and with other agencies when required to care for children, young people and their families;
• Parents and patients, we spoke, with said they felt staff had adapted the service to their individual needs;
• One parent commented, “[Staff] have been lovely to us, nothing has been too much trouble.”;
• Staff fostered a culture of safe working practices. For example, day shift staff checked with night shift colleagues each morning to make sure they felt awake and alert enough to get home safely;
• The senior team fostered a clear safety culture, which we saw was embedded in all aspects of care.

The CQC report identified four areas for improvement which ‘must’ be addressed, and action has already been taken around these since August 2022.

1.The Trust must improve systems and processes to investigate and follow up on any allegations, evidence or concerns raised about safeguarding issued when children and young people present to the emergency department and/or are admitted to the paediatric service.

Actions Taken:

System changes have been implemented to improve the recording of actions taken by staff if they suspect or believe a child has been harmed or is at risk of harm or abuse. These include an improved digital platform for recording safeguarding actions and conversations. This means the recording of allegations, concerns and escalations that relate to risk of harm and/or abuse can be undertaken in an accurate and timely manner.

2.The Trust must assess the impact of the building work in the Emergency Department to ensure mitigating actions are identified to ensure the premises are suitable for the purpose for which they are being used.

Actions Taken:

The ED refurbishment project is complete and includes extensive alterations to increase capacity in the department. The department now has two dedicated mental health assessment rooms and a separate waiting room for children and young people.

3. The Trust must ensure care and treatment is provided with the consent of relevant persons. There was a lack of documented evidence that the child’s voice was heard, and that staff fully understood the complexity of consent, capacity and competency.

Actions Taken:

The Trust provides refresher training for all staff which includes the reinforcement of legal processes and the required documentation around consent, capacity and competency. A full review of our Consent Policy will ensure that the Trust practices are reflected within the policy and in line with national guidance.

4. The Trust must ensure all risks, including environmental risks, associated with children and young people admitted to the hospital are assessed and mitigated. Clear evidence of this must be recorded in patients’ medical notes.

Actions Taken:

Development of a paediatric document to record a holistic assessment for the child or young person, which includes a robust risk assessment, documents the child’s feelings and concerns to ensure their voice is heard, and defines the mitigating actions in place to ensure the child’s safe care.

A register of all departmental environmental risk assessments is to be held centrally to ensure availability of robust evidence of completion. The Trust is to update its policies to reflect this practice.

The full report can be viewed here.