Some of the country’s most vulnerable and troubled young people were able to significantly self-harm and were allegedly sexually assaulted despite being under “constant observation” at a regional psychiatric intensive care unit.
The incidents came to light during a Care Quality Commission inspection of Cygnet Hospital in Woking which has been placed in special measures with an inadequate rating, after its eleventh inspection in seven years.
The PICU beds at the hospital were commissioned by NHS England for 12 to 18 year olds which had asked the CQC to inspect the unit because of concerns.
The PICU ward – which had been closed to new admissions at the time of the CQC visit in June – was closed completely in July and a review of its services is being carried out. NHS England said it had now reopened, with the support of the CQC and with monthly multi-agency review meetings.
Parents of patients on the ward had contacted the CQC before the inspection complaining that the cleaning regime meant young people could pick through swept up rubbish and take discarded items which could then be used to self- harm. Some parents had also raised complaints with NHS England.
The inspectors found:
- No nursing staff held specific qualifications for working with young people, although they had attended a service specific induction. There was no ongoing training beyond mandatory training.
- Young people described some staff as unsympathetic and vindictive, and some they felt intimidated. Reported comments from staff included “your parents have left you” and “if I broke your arm it doesn’t matter”. One patient said a staff member had not intervened when they were tying a ligature around their neck.
- In six months staff on the adolescent wards had used physical restraint 839 times. There were 88 case of face down restraint.
- There had been 24 serious incidents in 12 months. A patient was given a medication dose significantly above the daily maximum and had to be hospitalised.
- Young people had managed to self-harm and four had allegedly been sexually assaulted while under “constant observation”. Patients had gained access to potentially harmful items and confidential information when staff had not closed the nurses’ office door.
- Incidents which should have been reported as safeguarding alerts to the local authority were not acted on, and some incidents were dealt with internally when they should have been reported to both the CQC and the local authority.
- There was a high use of agency staff and some shifts were unfilled, meaning the hospital was understaffed.
The inspectors also noted that PICU environments are intended for stays of eight weeks or less – but two of the seven young people in the unit had been there for eight months and another two for five months.
In contrast the forensic secure wards at the hospital were rated good throughout. However, overall the hospital was rated as inadequate.
The ward takes young people of both sexes from across the south east who are detained under the Mental Health Act. It has 11 single en suite bedrooms, which were mainly occupied by young women at the time of the inspection. Two other PICU wards on site had closed some time before.
An NHS England spokesman said the suspension of admissions at the PICU meant places had to be found for young people within other services but it had ensured that individual patients continue to receive any specialised care they needed.
The spokesman added: “Following action taken by Cygnet to address concerns identified, with the agreement of the CQC, 11 PICU beds at the unit have been re-opened as part of a phased approach and we are continuing to work to ensure the provider delivers care in line with the standards required.”
A spokesman for the hospital said it took the CQC feedback extremely seriously and had acted immediately to address concerns.
He added: “Following detailed discussions with the CQC and NHS England, and with their full support, we took the decision to temporarily close the young people’s wards at the hospital to carry out a comprehensive review of the services the unit provides.
“Our absolute priority is the health and wellbeing of the people we support, and it would not have been fair on patients or clinically appropriate to seek to carry out this review whilst still providing day-to-day support. We sincerely apologise for falling short of the high standards the young people we supported and their families had the right to expect, and for the disruption the temporary closure has caused.”
CQC report, information supplied to HSJ