Agenda item

The Committee received a report of Dominic Gardner, Director of Operations, Teesside, Esk and Wear Valley (TEWV) NHS Foundation Trust, which provided the Committee with information in relation to the key events leading to the closure of in-patient services and West Lane Hospital, and subsequent arrangements for Young People requiring in-patient mental health care (for copy see file of minutes).

The Director of Operations, first apologised to the families of the young people affected, the constituents of the areas affected and the staff affected by the issues at West Lane Hospital.

Councillor B Bainbridge asked if the issues which led to the closure of the in patient unit could have been pre-empted. The Director of Operations confirmed that following the incidents in November, improvements had been made, but this had impacted on staff from other wards.  In April, following the return of staff who had been suspended, feedback was positive.  However, by the end of May/June there were issues relating to an increased level of clinical acuity and increased staff absence, which caused pressure on staff and increased reliance on bank staff.

With no criminal case to answer to, Councillor Jewell asked what the issues were and whether the hospital was operating a service that could not guarantee the safeguarding of patients.

Elizabeth Moody,  Director of Nursing confirmed that in hindsight, the patients on the Westwood Ward were far more challenging than what had previously been known, having issues relating to complex trauma and autism. There were much higher levels of violence, aggression and self-harm and there was a lack of coherent disciplinary procedures. The Director of Nursing added the nature of the service was that they did not want to be restrictive, however, on a day to day basis the behaviour was too difficult to manage.  The trust have policies in place but the CQC found that there was not always written evidence and staff absence and reliance on agency staff, who were not aware of the needs of the children meant that immediate action had to be taken and there was not the time needed to make the necessary improvements.

Councillor Jewell asked if there were any cultural issues which led to staff not speaking up, or Managers ignoring serious issues.  The Director of Nursing confirmed that there were issues which staff felt unable to raise and there were managers who had not worked in the unit for a long time.  Following the issues in November, staff returned and were more sensitive, so more Managers were brought in, but staff still felt unable to raise concerns.

Councillor Jewell asked if the Trust was confident that the damage could be repaired and the Director of Nursing confirmed that the immediate answer was for the hospital to remain closed. However there was a need for some in-patient facility and the Trust was working with the NHS to ensure this could be provided.

The Chair commented that there were three serious case reviews and until all of them were concluded, there was no option but for the hospital to remain closed, however she asked what happened in the meantime to young people who required care.  The Director of Operations confirmed that there were other services in the North, in Tyne and Wear (Prudhoe), however there were not always beds available, but the main priority was to ensure young people were placed as close to home as possible.  It had been recognised that sometimes young people were placed a significant distance from home and this was under review by NHS England.

The Director of Nursing confirmed that within County Durham and Darlington work was ongoing to prevent admissions by providing an intensive support service, ensuring that children were treated earlier and at home, however it was recognised that there was always a need for in-patient services.

Ms Evans commented on the distressing nature of the business and asked if how the safeguarding of service users could be ensured going forward.  She asked whether the Trust had established multiagency links and were seeking to consult with neighbouring authorities.  She also asked what role statutory health scrutiny would play in looking at the future model of care.

The Director of Nursing confirmed that Operations confirmed that due to the specialist nature of the services operating from West Lane Hospital there were only another two or three in the country and therefore they were unable to carry out benchmarking.  The chronology of events since November had led to this unfortunate situation but throughout that time, they had been working with the Local Authority Designated Officer and police.  The hospital was based in Middlesbrough so most of the links were in Teesside but they acknowledged service users were from the wider area.  The Director of Operations confirmed that they will work with health scrutiny in Durham, Teesside and North Yorkshire.

The Director of Operations reiterated that this is a specialist service which was not commissioned by Clinical Commissioning Groups but NHS England.  In terms of pathways of care for young people, local authority provision covered a number of young people with significant social needs and there was ongoing engagement with the Director of Children’s Services and families.

The Director of Nursing confirmed that families were a key consultee and they had held meetings with individuals’ families to ensure they were addressing their concerns through the Network of Families Group and staff views were considered through HR development.  Ultimately the Trust needed to await the outcomes of reports from inspection and enquiries  and would report findings back to the Committee.

Councillor Jewell noted that if the service had been operating at 60-70% capacity at the time of the incidents, what assurances could be given that children were not being placed in services at full capacity and therefore at increased risk.  The Director of Operations confirmed that procedures had been inspected by NHS England and cases were managed by the additional Manager who had been retained at West Lane which would ensure appropriate support and safeguarding procedures were adhered to.

Michelle Trainer, Head of Children and Adolescent Mental Health Services (CAMHS), Tees, Esk and Wear Valleys NHS Foundation Trust added that care teams in CAMHS were in contact with families and ensured young people received regular visits.

The Director of Nursing confirmed that although the units were under capacity on paper, the needs of the occupants were high and therefore they were not able to admit additional children.  This was the case in all units, assessments would be undertaken to ensure the needs of a young person could be met, without compromising the patients who were already admitted.  The system was complex and not based on the number of beds, but the level of care needed or staffing issues.

Resolved

That the report be noted

That arrangements be made for a progress report to be included within the Committee’s work programme.