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Nov 2022

Last Updated: 01/11/2022

Health

Staffing problems still affecting mental health services for Harrogate district residents

by Vicky Carr

| 02 Nov, 2022

The Care Quality Commission says services are below the standards expected.

Tees, Esk and Wear Valley NHS Foundation Trust's Roseberry Park hospital.

Mental health services for people across the Harrogate district still require improvement, according to the health regulator.

The Care Quality Commission (CQC) found the services provided by Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) were below the standards expected.

However, inspectors said there had been some improvements since the last inspection report in December 2021.

At that time, TEWV's forensic in-patient and secure ward services were found to be inadequate, with the trust ordered to make urgent improvements. Now, the service is rated 'requires improvement', though the 'safe' aspect of the inspection is still rated 'inadequate'.

The report said:

"Fifteen patients we spoke to raised concerns regarding there not being enough staff on the wards. Patients told us staff spent a lot of time in the office which sometimes made them feel neglected.

"Two patients told us that they had not received their prescribed medication on the day we arrived due to staffing. Another patient told us they did not know who their key worker was.

"However, most patients said that staff were caring towards them."

In-patient and secure wards for Harrogate district residents are provided elsewhere in the north-east after the mental health unit at Harrogate District Hospital, the Briary Ward, was closed down in 2020. The CQC inspection of TEWV's services was carried out at Roseberry Park Hospital in Middlesbrough.

The Briary Wing, Harrogate District Hospital, which was closed in May 2020.

Inspectors said data provided about staffing levels over an eight-week period suggested the service was regularly understaffed to an unsafe level. However, managers said the data was inaccurate and there was always a nurse and support staff on duty.

The report said:

"Staff were frequently being moved to different wards during their shift based on risk, which meant they were often working in environments and with patients they were unfamiliar with.

"This was impacting on several areas within the service; incident data showed staff were not always able to provide a timely response to incidents. Staff were unable to carry out all clinical duties on time, such as administering medication and completing clinical audits.

"Staff were regularly unable to take their breaks off the ward. Patient’s hospital ground leave, Section 17 leave (permission to leave the hospital) and visits from friends and family were being cancelled daily at short notice.

"Patients told us they felt neglected and did not have enough time with staff. Carers we spoke to highlighted staffing pressures as a concern and felt it was impacting on patient’s continuity of care and their ability to visit their loved ones."

Areas for improvement

The CQC set out 12 areas where the service must be improved in order to meet legal requirements, including adequate staffing levels, cleaning all wards, ensuring staff have up-to-date training, and reporting all incidents quickly and accurately

Naomi Lonergan, care group director of the secure inpatient services at TEWV, said:

“We have been working hard to improve the service since the previous Care Quality Commission inspection in June 2021 and we are encouraged by the improvement in the rating.

“We have recruited 70 health care assistants since the last inspection and we are working with local universities to support the recruitment of registered nurses. This is in addition to developing an international recruitment strategy which is already making a difference.

“We have set up a health care assistant council and one for nurses to improve how colleagues contribute to the quality of care within our trust.

“We are also focused on creating a community on our wards, through the work we do with our recovery and outcomes team who put on events and activities for people in our care that help their recovery.

“We recognise that there is more to be done. This includes an unrelenting focus on patient safety with our absolute priority being on safe staffing and safeguarding our patients. We continue to prioritise the experience of our patients, their carers and colleagues to make the improvements we need to and we are confident the service is making these changes and will continue to do so.”

Mental Health Act detainees driven over 60 miles out of Harrogate

Plans submitted to add more bedrooms to Harrogate mental health hospital

Children's mental health services 'requires improvement'

Meanwhile, TEWV's specialist community mental health services for children and young people which were rated 'inadequate' in the 'safe' category last year have now been rated 'requires improvement'.

In a report published in September, following inspections over the summer, the CQC said:

"Although staffing levels, caseloads and waiting times for treatment had improved since the last inspection, the service did not always have enough nursing and support staff to keep patients safe. Vacancy rates varied by team...

"Caseload sizes had reduced across the community teams. Most of the staff told us there had been significant improvements to caseload sizes and caseloads were more manageable. Only two of the staff we spoke with raised concerns about staffing levels and caseload sizes."

Inspectors said a recruitment drive meant two new matrons were about to begin work, with a focus on managing staff caseloads.

The average waiting time for treatment had reduced to 104 days, compared to 371 days in 2021, and the number of children waiting more than 12 months had reduced to 275 from more than 1,000 in the same time period.

The CQC, which inspected six teams within the community mental health service for children, said TEWV must adequately staff its service and continue to work to reduce waiting times.

Brent Kilmurray, chief executive of Tees, Esk and Wear Valleys NHS Foundation Trust, said:

“We are pleased that the CQC have raised the rating for our community children and adolescent mental health service (CAMHS) in the safe category.

“The CQC report acknowledges improvements that have been made, including how quickly we responded to address the issues identified at the previous inspection. It also recognises that we are achieving our targets of maintaining contact with children and young people on waiting lists.

“This is a step in the right direction, and a testament to the hard work from our CAMHS community teams across the trust.

“We know there is still work to do and more opportunities to improve the service. We will now focus on embedding the recommendations from the report to ensure that we provide the best care to the young people in our communities.”

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Staffing problems still affecting mental health services for Harrogate district residents

Areas for improvement

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Children's mental health services 'requires improvement'