Archived: Child and Adolescent Mental Health Services (CAMHS)

Updated 17 December 2020

St Andrew’s Healthcare Child and Adolescents Mental Health service registered with the CQC on 11 April 2011. The service has a registered manager and a controlled drug accountable officer. The Child and Adolescents Mental Health service is now based in Smyth House, a refurbished building situated on St Andrew’s Healthcare Northampton site. The service was based on seven wards in Fitzroy House at the start of the inspection and moved to three wards in Smyth House during the inspection process. Smyth House offers sensory rooms, music and arts rooms, a gym, gardening areas and outside space (courtyards). The service offers education opportunities through St Andrew’s school, which is Ofsted registered and rated as outstanding. The other registered locations at Northampton are Men’s services, Women’s services and Neuropsychiatry services.

St Andrew’s Healthcare also deliver services in Birmingham and Essex.

St Andrew’s Healthcare Child and Adolescents Mental Health service in Smyth House has three wards and is registered to accommodate 30 children and young people. At the start of the inspection the service was operating seven wards in Fitzroy House. There were 21 children and young people using the service when we inspected.

We inspected the following wards at Fitzroy House:

• Acorn, bespoke service for one young person.
• Berry, bespoke service for one young person.
• Bracken, a ten bedded medium secure ward for males with learning disability.
• Brook, a ten bedded low secure ward for males with learning disability.
• Maple, a ten bedded low secure ward for females with complex mental health needs.
• Marsh, a ten bedded low secure ward for males with complex mental health needs.
• Meadow, a ten bedded low secure ward for females with complex mental health needs.

We inspected the following ward at Smyth House:

• Seacole, a ten bedded mixed gender low secure ward.

We planned to visit the other two wards in Smyth House (Stowe, a ten bedded mixed gender low secure ward and Sitwell, a ten bedded medium secure ward for males with learning disability). The visit ended earlier than planned due to a young person presenting with coronavirus symptoms requiring the inspection team to leave the service.

St Andrew’s Healthcare Child and Adolescents Mental Health service has been inspected 12 times.

St Andrew’s Healthcare Child and Adolescents Mental Health service is registered to provide the following regulated activities:

• Treatment of disease, disorder or injury
• Assessment or medical treatment for persons detained under the 1983 Act

This service was last inspected in December 2019. The service was rated inadequate overall and continued to be in special measures. The service was rated inadequate for safe, requires improvement for effective, inadequate for caring, good for responsive and inadequate for well led.

We found issues of immediate concern during the December 2019 inspection and issued an urgent Notice of Decision under section 31 of the Health and Social Care Act 2008, imposing conditions on the provider. These concerns related to breaches of the following regulations:

• Regulation 12 Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 Safe care and treatment.
• Regulation 13 Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 Safeguarding service users from abuse and improper treatment.
• Regulation 17 Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 Good governance.

We found that the provider made improvements to the service since the last inspection. We found some issues relating to the safe and well led key questions and have issued requirement notices in relation to these. Details can be found in the requirement notices section of the report.

Updated 17 December 2020

The Child and Adolescents Mental Health service is now based in Smyth House, a refurbished building situated on St Andrew’s Healthcare Northampton site. Smyth House has three ten bedded wards.

At the time of inspection, the service was still based in Fitzroy House and we inspected seven wards. We completed a follow up visit to Smyth House and inspected one ward. Further details can be found later in the report.

This service was last inspected in December 2019. The service was rated inadequate overall and continued to be in special measures which they were placed in July 2019. We issued an urgent Notice of Decision under section 31 of the Health and Social Care Act 2008, imposing conditions on the provider. We told the provider it must make immediate improvements to ensure young people were kept safe through ensuring staff only use approved restraint techniques, that seclusion practice complies with the Mental Health Act, that incidents are investigated in a timely manner, that safety checks and observations are carried out robustly and that staff treat young people with kindness and adopt practices that are least restrictive and not punitive. In addition, we told the provider it must ensure it fosters a positive culture and that the service is overseen by effective leaders who have appropriate processes in place to always ensure oversight of the service.

At this inspection we rated St Andrew’s Healthcare Child and Adolescents Mental Service as requires improvement because:

• Whilst the service had made several improvements senior leaders had not yet achieved consistency of standards across all wards. Governance processes and aspects of practice were inconsistent across all wards and not yet fully embedded.
• There were inconsistencies in safety practices across the wards. Staff on Meadow, Maple, Brook and Bracken wards (four out of eight wards) did not always ensure a safe environment. On Maple and Bracken ward we found plastic rubbish liners in children and young people’s toilets which could be used to self harm. We did not find this issue on the remaining six wards. Five staff across Meadow, Brook and Bracken wards did not wear protective masks correctly and we identified issues relating to infection risks for two young people on Acorn and Berry wards. However, we raised this with the ward manager who implemented new infection control processes for both young people whilst we were on site.
• Not all staff managed risks to children and young people and staff effectively. Staff on Bracken, Brook and Maple wards did not always follow the provider’s policy and procedures on the use of enhanced support when observing children and young people assessed as being at higher risk harm to themselves or others. This was managed effectively on all other wards. We found one example of staff observing the same young person for 11 hours of their shift on Brook ward. Staff routinely observed for periods of four hours and above on Brook ward. Staff did not always record children and young people’s presentations and risk factors correctly on Bracken and Maple wards. The provider reported 249 incidents of children and young people self harming, across seven wards, whilst on enhanced observations between 1 May 2020 and 31 August 2020.
• Levels of staff restraint of children and young people, including prone restraint and use of rapid tranquillisation had increased on Acorn, Meadow and Maple wards since the last inspection, although had reduced more recently. Staff on Maple ward did not always follow National Institute of Clinical Excellence guidance or the providers policy when using rapid tranquillisation. In one example they did not monitor a young person's physical health after rapid tranquillisation. We did not find this issue on the remaining seven wards.
• Not all staff followed systems and processes when safely prescribing, administering, recording and storing medicines. There was missing medication on Brook ward. Staff had not always recorded medicine fridge temperatures on Bracken and Maple ward. Staff had not disposed of expired medical equipment on Maple and Bracken wards.

However:

• The provider had made a number of improvements that we told it needed to be made following our inspection in December 2019. There were new hospital leaders in place who had taken action to change the culture of the service and staff reported a shift to people taking responsibility and raising issues in an open and honest way. Leaders displayed the values of the service and ensured staff worked with children and young people in ways which were supportive and not punitive. We saw an overall improvement in seclusion and restraint practice, safeguarding investigations and staff had stopped using punitive language in children and young people’s records. Leaders implemented new governance systems, improved their processes and acted to address poor staff conduct quickly.
• Generally, we found that staff went the extra mile for children and young people; carers told us staff hired a soft play centre out of hours for a young person's birthday and staff supported a young person to cook with his mum via video calls during the coronavirus pandemic. Staff treated children and young people with kindness, dignity and respect on seven of the eight wards inspected. We observed positive and relaxed interactions between staff and children and young people. We observed care delivered by staff that demonstrated staff knew the needs of the children and young people on the ward. Young people told us staff were kind and supportive and good at helping them stay calm. Carers spoke positively about staff and told us staff supported them to keep in contact with their relative throughout the coronavirus lockdown.
• Staff involved children and young people and their carers in their treatment and care. The service placed strong emphasis on children and young people’s feedback about the new wards and made changes to plans throughout the transformation process to meet their requests. Staff encouraged children and young people, and their carers to be partners in their care through co-production work and monthly carer’s meetings. The service trained carers in trauma informed care to deliver training to staff through sharing their experiences as a parent. Staff described this as “powerful, thought-provoking and extremely insightful”.
• Staff provided a wide range of care and treatment interventions suitable for the children and young people on the wards. The interventions were those recommended by, and delivered in line with, guidance from the National Institute of Health and Care Excellence. Interventions included a full therapy programme and the use of recognised rating scales to assess and record severity and outcomes.
• Staff and children and young people had access to an extensive range of rooms and equipment to support treatment and care. Children and young people had access to the provider’s school for educational activities. Staff ensured that children and young people had access to appropriate spiritual support. The service had a multifaith area and access to chaplaincy support, which included access to leaders from different religions including Christianity, Islam and Wicca.
• The teams included, or had access to, the full range of specialists required to meet the needs of children and young people on the ward. Staff had the right experience, qualifications, skills and knowledge to meet the needs of the children and young people. Teams held regular and effective multidisciplinary meetings.
• The service supported learning, continuous improvement and innovation. The service published research into dialectical behaviour therapy outcomes and adverse childhood experiences in relation to the impact of physical health on mental health. The provider set up a developmental trauma centre with the aim of being a centre of excellence for trauma informed care.

On this inspection we found that the service made enough improvements and we are lifting the hospital from special measures.

Updated 17 December 2020

Safe- Requires improvement

Effective- Good

Caring- Good

Responsive- Good

Well-led- Requires improvement

Updated 16 September 2016

• Rose ward is a medium secure male ward.

• Tallis, Tavener, Althorp, Berkeley Close (1st floor) are male locked wards.

• Berkeley Close (ground floor) is a female locked ward.

• Berkeley Lodge, 37 and 38 Berkeley Close and 19 The Avenue are locked units

• Walton is for male patients with Huntingdon’s disease.

• Harper – specialist ward for male and female patients with Huntingdon’s disease.

Updated 16 September 2016

• Hawkins is medium secure ward for men with learning disabilities (LD).

• Sitwell is a medium secure ward for women with LD.

• Naseby is a low secure ward for men with LD.

• Spencer North is a low secure ward for women with LD.

• Mackaness is a male medium secure ward for people with ASD.

• Harlestone is a male low secure ward for people with ASD.

Updated 16 September 2016

• Seacole Ward is a medium secure ward for women.

• Stowe Ward is a medium secure ward for women.

• Sunley ward is a medium secure ward for women.

• Elgar ward is a low secure ward for women.

• Spencer South is a low secure ward for women.

• Sinclair ward is a low secure ward for women.

• Robinson ward is a medium secure ward for men.

• Fairbairn is a medium secure ward for men with hearing difficulties.

• Prichard ward is a medium secure ward for men.

Updated 16 September 2016

• Thornton ward is a locked rehabilitation unit for women.

• Ferguson ward is a locked rehabilitation unit for men.

• Spring Hill House is a locked facility rehabilitation unit for Women offering 23 beds.

Updated 16 September 2016

• O’Connell ward is a locked ward for male older adults.

• Compton is a locked ward for male and female older adult patients.

• Foster is a locked ward for male older adults.

• Cranford is a medium secure ward for male older adult patients.

Updated 16 September 2016

• Sherwood ward is the psychiatric intensive care unit.