‘Safe’ mental health care impacted by high caseloads in Sheffield, inspectors warn

High caseloads and long waiting lists are impacting specialist community mental health teams’ ability to provide “safe care” in Sheffield, the Care Quality Commission (CQA) has warned.

In its latest inspection of Sheffield Children’s Hospital NHS Foundation’s specialist community child and adolescent mental health services (CAMHS), undertaken in July, it found that children and young people “waited a long time to access the service” and clinicians had “high caseloads” which had an impact on their ability to provide “safe care”.

Despite recognising the “significant improvements” that have been made since the last inspection in 2019 – individual ratings for “being effective”, “caring” and “well-led” were boosted from “requires improvement” to “good”- inspectors rated the overall service as “requires improvement”, the same grade given at the previous inspection.

Community staff working in CAMHS were praised for being “patient” and “insightful”, and leaders were described as “knowledgeable”,  “visible” and “approachable”, however, the service was understaffed with an overall vacancy rate of 13 per cent and low rates of bank and agency staff.

Inspectors also found that the Trust did not always ensure that staff were “safe in their role” as policies, procedures and training in management of violence and aggression, lone working, and incident-response were “unclear”.

Sarah Dronsfield, CQC head of hospital inspections, praised the leadership but said that appointments that were cancelled by the service “weren’t always re-arranged in a timely way, which could put people at risk”.

Louise Haigh, MP for Sheffield Heeley, said that it is of “little surprise” to children, young people and their parents who are “struggling” to access mental health services across the city and are having to sit on “ever-lengthening waiting lists”.

She added: “The staff that work in mental health services are rightly proud of the treatment they provide, and it is welcome that the CQC acknowledged this, but waiting times are too long and practitioners’ caseloads are far too high. This is potentially prohibiting them from providing safe treatment.”

In order to comply with its legal obligations, the inspectorate has ordered the service to “reduce the length of time patients wait to access treatment” and deploy “sufficient number of staff to ensure caseloads are manageable and safe”.

The CQC also carried out an unannounced focused inspection of child and adolescent mental health wards in July, following concerns about the quality of services.

Despite a national staffing crisis and some vacancies within the service, staffing was “managed well”, inspectors found.

Daily safety huddles looked at staffing across the unit and deployed staff “to where they were needed most”; lodges were clean and staff followed infection control policies, including those related to Covid-19.

Inpatient wards retained their overall rating of “good” for being effective, caring, responsive to people’s needs and well-led. Safety remained rated as “requires improvement”.

Dronsfield said: “In CAMHS wards, staff felt proud to work in the service and told us they were part of a supportive team, who cared for people, as well as each other. It was good to see staff were supported to improve their knowledge and skills and were encouraged to progress their careers.

“However, in CAMHS inpatient wards we did find issues around environmental risks and blanket restrictions. Doors were locked to most communal areas on Emerald and Sapphire Lodges, including the female lounge and quiet rooms. Although staff were happy to unlock the doors when people wanted to go in, they couldn’t freely access these rooms, which they should be able to do to give them more independence.
“The trust has started to take action to make the necessary improvements and we will return to check on progress.”

Yvonne Millard, chief nurse at Sheffield Children’s, said: “Since our last inspection, our teams have worked incredibly hard to provide good quality services and make improvements, whilst also responding to the challenges of the pandemic and a rapid increase in the number of young people needing our care and support. We are delighted that the CQC have seen significant improvement in our Community CAMHS service in spite of these challenges.

“We recognise there is more we can do and we have already taken action on many of the points raised by inspectors. By listening and learning from others – and most importantly the young people and families we support – we can continue our journey to providing outstanding care.”

The overall rating for Sheffield Children’s NHS Foundation Trust, which is one of four dedicated children’s hospital trusts in the UK, remains “good”.