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.”

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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.”

When the decision was taken a year ago to close the Briary Wing and move inpatient mental health services to York, it marked the end of a long and intensely political debate about the future of adult mental health inpatient facilities in the Harrogate district.  

Plans had been well advanced for a 36-bed facility at Harrogate’s Cardale Park. Planning permission had been approved and work had begun when – a year ago – Harrogate and Rural District CCG and the Tees, Esk and Wear Valleys (TEWV) NHS Foundation Trust (which runs mental health services) voted to halt the project and focus on sending patients to a new facility in York.   

The site at Cardale Park where the mental health inpatient unit was set to be built

Harrogate and Rural District CCG defended its decision at the time, arguing the move to York was to produce “the best possible care” and it wanted to invest more in community care to prevent people needing inpatient facilities – but the reality was the CCG had a £14m deficit and had to prioritise funds.  

To many politicians of all persuasions, it was another example of the long term chronic under-funding of mental health services. Conservative councillor Jim Clarke, the Head of North Yorkshire County Council’s Scrutiny of Health Committee, said at the time:  

“This is not a recent problem, this is the result of years, decades of underinvestment in mental health.”  

The Liberal Democrats, too, expressed concern that patients and their families would have to travel to York – county councillor Geoff Weber said Harrogate had been “screwed by the CCG and NHS”. 

This week, however, the CCG has reiterated its statement that the decision was not based on finance.

A spokesman said:

“The decision was made based on best practice in providing high quality mental health inpatient services and expanding the services locally available in the community. The decision to invest in community services and redeploy inpatient services to York was taken after extensive engagement.

“The solution adopted was the only option that maximised patient safety and experience, while remaining true to its commitment to providing care as close to home as possible.”

Decision came against a backdrop of health service debt and restructuring  

Since 2008 mental health services (both inpatient and community based services) in the Harrogate district have been operated by Tees, Esk and Wear Valleys NHS Foundation Trust, a specialist mental health Trust. Clinical Commissioning Groups effectively “buy” services such as inpatient mental health beds from the Trust. 

The decision to close the Briary Wing and reject the Cardale Park option came at a time of change for the Harrogate District CCG.  In November last year NHS England agreed to merge Harrogate with two other CCGs: Hambleton, Richmondshire and Whitby, and Scarborough and Ryedale.   

The North Yorkshire CCG was formed on April 1st 2020 – in the height of the current coronavirus crisis – with a requirement to cut 20% from its admin budget.  

This new North Yorkshire CCG will now be responsible for “buying” mental health services from TEWV for the Harrogate district. The CCG though has a projected deficit of £18m for this coming year and has proposed a £72m savings programme over the next 5 years.

The Stray Ferret put a series of question to the CCG and got the following responses: 

Will the 72 beds in York be enough? If it is full, where will inpatients from our district be sent? 

“Through the modelling undertaken we are confident that there will be enough beds at the new unit, especially given the expectation that there will be a reduction in admissions and length of stay. However, as now, it is sometimes more clinically appropriate for patients to be placed elsewhere.”

Will the newly merged CCG make its administrative and managerial cost savings, including the proposed £72m? 

“The CCG is now operating under a partnership arrangement with TEWV for mental health and learning difficulties which also includes NYCC.  The partnership is committed to delivering the mental health investment standard which ensures that investment into mental health is protected but there is acknowledgement that services need to transform and innovate to deliver improvements and meet an increasing demand for services.

“The 20% reduction in running costs applies to all CCGs and this has been achieved through the recent merger to form the North Yorkshire CCG.”

What impact will the current pandemic have on all health services and what will be prioritised as a result?

“Under the North Yorkshire Mental Health and Learning Disability Partnership, we are working jointly with TEWV to agree how the funding available is used.”