Specialist beds delayed after child welfare concerns

Cygnet Hospital Godden Green provides a tier 4 child and adolescent mental health service, which is commissioned by NHS England. It was planning to open 12 CAMHS eating disorder beds this year, to address a shortage in the south east which has led to many patients being placed out of area.

But NHS England has now said it has paused the eating disorders commissioning, while admissions to the other beds at the hospital are on a case-by-case basis.

This follows three “incidents” involving three different children after Christmas, according to a report to Medway Clinical Commissioning Group’s governing body. One of these led to a referral to the local authority designated officer, who must be alerted when it is alleged that a person who works with children has harmed or may harm them, or has possibly committed a criminal offence against them.

Kent Police has confirmed it investigated the incident leading to the LADO referral, involving a reported assault at the hospital, where a 17-year-old girl was allegedly pushed. 

And, on Thursday, the Care Quality Commission issued a report on the hospital, which is based near Sevenoaks in Kent. This followed an urgent focused inspection in January after concerns were raised, including by a number of staff whistleblowers who were worried about lack of supervision, poor culture and the number of incidents.

In particular, the CQC report noted:

• Inspectors witnessed a staff member “appear to push” a patient out of the way;
• Young people were going missing without leave, swallowing items such as batteries and screws and attempting to self-harm;
• Staffing levels meant staff did not always get breaks and did not always engage therapeutically with young people;
• Not all incidents were being correctly reported to the CQC;
• The hospital was heavily reliant on locums for medical cover, while the medical director and registered manager have resigned since the inspection; and
• Some senior managers and ward managers did not have the skills and knowledge to perform their roles, while risk management plans were not being reviewed and updated.  

The CQC issued two warning notices around safe care and treatment, and good governance. However, as the report was from a focused inspection, it does not affect the provider’s overall “good” rating. 

The CQC’s head of hospital inspection, Pauline Carpenter, said: “We are concerned that some of the deep-seated cultural issues that we have found over a number of inspections of Cygnet Hospital have still not been resolved.  

“In the past the hospital had been under enhanced surveillance by our inspectors, alongside a range of other stakeholders, because of the nature of our concerns. During that time there had been a number of improvements, but the problems have resurfaced. 

She added: “We will continue to work closely with NHS England, the local clinical commissioning group, the local authority and [the] provider and we will return in due course to check for real improvement that will benefit the patients and their families. If we don’t see real improvement we will consider taking further action.”   

A Cygnet Health Care spokeswoman said the provider acknowledged the report and had already started taking steps to address the concerns raised.

These improvements included the provider having “significantly strengthened its senior leadership team”, creating a dedicated patient liaison officer role to improve communications with relatives and carers, reducing the number of agency staff at the hospital, setting up an extensive training programme, and overhauling its therapeutic timetable. 

The spokeswoman added: “The care of our service users, some of the most vulnerable members of our society, remains our top priority and we are hopeful the changes we have put in place will be acknowledged by the CQC in their next inspection.”

An NHS England South spokeswoman said: “Safeguarding young people for the future is paramount. NHS England [is] committed to continue to work alongside Cygnet Healthcare, and other key stakeholders to ensure the improvements already made by Cygnet Healthcare are fully embedded into the service in order to make a difference in the therapeutic recovery for young people.”

In early 2018, a CQC report revealed incidents at the hospital were not being reported to the watchdog, leading to a fixed penalty notice. The hospital, which at the time had 24 CAMHS beds, was restricted to just eight and was warned it could lose its registration. However, within a few months, it had made “significant improvements” and was rated “good” by the CQC.

Last September, HSJ reported NHSE would commission 12 additional beds at the hospital for young people with eating disorders. These beds were expected to be operational from March 2019, leaving the hospital – which previously had a low-secure unit for men – a CAMHS only site.