The Care Quality Commission (CQC) has published reports on inpatient and community children’s services at Torbay Hospital, run by Torbay and South Devon NHS Foundation Trust, following unannounced inspections last year.
The inspection of inpatient children and young people services was carried out in November 2024 response to concerns about children and young people with mental health needs being cared for in an inappropriate setting. The inspection of community children and young people’s services was carried out as part of CQC’s usual checks on the safety and quality of services.
Following this inspection, inpatient children and young people’s services has been re-rated as good overall, and for being caring. How safe the service is has moved from good to requires improvement. Well-led, responsive, and effective, were not part of this inspection and retain their previous ratings of good.
The trust was asked for an action plan in response to regulation breaches found during the inspection of inpatient children and young people’s services.
The inspection for community children and young people’s services was carried out in August 2024. Its overall rating for community children and young people’s services remains unchanged and is re-rated as good overall, and for the areas of safe, effective, caring, responsive, and well-led.
The overall ratings of Torbay Hospital and the trust remain unchanged as requires improvement.
Catherine Campbell, CQC deputy director of operations in the south, said:
“Across both children and young people’s services run by Torbay and South Devon NHS Foundation Trust, we found staff worked well together as a team and with other agencies, including the local mental health trust, to provide joined-up care which benefitted everyone.
“Families who were supported by the community children and young people’s service told us staff had helped them to better understand their young person’s needs. The service was inclusive, person-centred, and staff were knowledgeable about everyone they supported.
“We found some improvements were needed at the inpatient children and young people’s services at Torbay Hospital. There were two breaches of the legal regulations relating to how the service provided safe care and treatment, and safe staffing. We have told the trust to submit an action plan so we know exactly how they are going to address the issues.
“The inspection was prompted by concerns that children and young people with mental health needs were being cared for in an unsuitable setting. We found this issue wasn’t wholly in the trust’s control as the local area lacked suitable placements in local mental health hospital settings or the community. However, some staff told us they needed more training from leaders to support these children and young people, and care plans to guide staff in these situations lacked detail.
“Staff were doing their best to provide high-quality care, but they were hindered by shortages and an increased workload. Agency and bank staff who covered nursing staff gaps didn’t always have the right qualifications and experience, which put children and young people at risk of harm. Leaders had mitigated this by reducing admissions to the service when staffing levels were stretched, but staff said workloads were still overwhelming.
“The trust is aware of where improvements are needed and has already started to address the concerns we found at our inspection. We will continue to monitor the progress of those improvements to keep people and their families safe.”
In inpatient children and young people’s services, inspectors found:
- Children and young people using the service told inspectors they felt safe, supported, and able to raise concerns.
- Staff supported children and young people to manage risks and acted where needed to keep them safe, sharing concerns quickly and appropriately.
- Incidents were reported and investigated appropriately, and leaders shared lessons learned. Staff spoke about an improving learning culture at the service.
- Staff minimised the use of restrictive practices. There was appropriate monitoring and incident reporting when physical intervention had been used.
- Staff had a strong understanding of their role to protect children, young people, and their families from the risk of abuse and knew how to raise safeguarding concerns.
- Children and young people could access specialist equipment and activities, including sensory kits which had been developed with involvement from people using the service.
However:
- Feedback from families was mixed: some praised staff communication and kindness but others felt staff were not responsive and wanted more involvement in care planning.
- Care records were incomplete, and it was unclear where families had been consulted.
- There was no private room for children and young people who required nasogastric feeding under restraint, which meant others on the ward could hear if they were distressed.
- Staff said the ward layout made it challenging to monitor people using the service. Inspectors were told the trust planned to build a new children’s unit.
- Ligature risks in the shower facilities meant children and young people with mental health needs were supervised by staff in these areas, which raised a concern about safeguarding. The trust was looking to create a facility which was free from ligature risks.
In community children and young people’s services, inspectors found:
- Care plans reflected people’s choices, individual needs, and the input from their families as well as other experts.
- The service had a positive safety culture where incidents were investigated thoroughly and learning was shared. Risks were identified and addressed appropriately.
- Staff understood their role to protect children, young people, and their families from the risk of abuse and knew how to raise safeguarding concerns.
- Complaints and concerns were investigated and leaders ensured lessons were shared with staff.
- Staff had the right skills, qualifications, and experience to provide safe care and leaders ensured new staff received effective training and support.
- Care records were clear, updated, and stored securely.
- The facilities and equipment were clean, well-maintained, and met children and young people’s needs. Staff had extensive knowledge of the additional support available, including specialist equipment provision.
However:
- Leaders needed to provide staff with additional training to support autistic children or children who have a learning disability. The trust was exploring how to provide this training.
Due to a large-scale transformation programme at CQC, the reports have not published as soon after the inspections as they should have done. The programme involved changes to the technology CQC uses but resulted in problems with the systems and processes rather than the intended benefits. The amount of time taken to publish the reports falls far short of what people using services and the trust should be able to expect and CQC apologises for this.
While publication of some reports has been delayed, any immediate action that CQC needed to take to protect people using services has not been affected. CQC is taking urgent steps to ensure that inspection reports are published in a much more timely manner.
The reports will be published on CQC’s website in the coming days.