CQC takes urgent action at services for children and young people at Shrewsbury and Telford Hospital NHS Trust

The Care Quality Commission (CQC) has taken urgent action to keep people safe following a focused inspection of children and young people's services at The Princess Royal Hospital in Telford.

The inspection on 24 February was prompted by concerning information about the safety and quality of the assessment and treatment of children and young people who presented to the service with acute mental health needs or learning disabilities.

Inspectors found that children and young people admitted to the hospital due to a deterioration in their mental health or those with learning disabilities did not receive adequate risk assessments on admission. In addition, there were no systems in place to ensure restrictive practices, such as restraint, were completed safely or appropriately.

As a result of the inspection, urgent conditions have been placed on the trust's registration. The conditions demand that the trust must not admit any new patients under the age of 18 who present solely with acute mental health needs.

The trust must undertake an immediate review of clinical records of all patients under the age of 18 who are currently admitted with an acute mental health need.

In addition, the trust must implement an effective oversight system to continually monitor staff compliance with safeguarding procedures, and ensure all staff are trained in this area.

The conditions require the trust to report to CQC on a weekly basis detailing the action it is taking to ensure the safety of patients using the service.

Ted Baker, Chief Inspector of Hospitals, said:

'When young people with mental health needs or learning disabilities receive care in an acute setting, all possible steps must be taken to ensure the environment is a safe one for them.

'The provision of safe care for vulnerable young people on acute wards is an issue we have previously raised in our inspections of acute trusts. We are working with NHS England and Improvement to support all trusts to deliver safe care in these circumstances.

'On this occasion, when inspectors visited the children and young people's services at Shrewsbury and Telford Hospital NHS Trust, they 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.

'Following the inspection, the trust has been receiving safeguarding advice and expertise from the University Hospitals Birmingham NHS Foundation Trust which it has an Improvement Alliance with.

'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.

'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.'

Following the inspection, the trust was told to make several urgent improvements, including:

• All staff caring for children and young people must complete level three children's safeguarding training
• Restraint must only be used when necessary after all other de-escalation methods have been undertaken
• When restraint is needed it should be undertaken by staff that have completed nationally recognised training
• The rights of children and young people detained under the Mental Health Act 1983 must be protected and staff must understand their responsibilities when caring for children and young people detained under the Act
• Robust safeguarding systems and processes must be in place in line with national and local standards and procedures
• 16 and 17-year olds must be provided with the choice of receiving their care and treatment on children's and young people's wards where appropriate

Following this targeted inspection, the overall rating for children and young people's services went down from Requires Improvement to Inadequate. The service was also rated Inadequate for being safe, responsive, effective and well-led. The overall trust rating remains as Inadequate.

Full details of the inspection are given in the report published here.

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