Safety watch dog on risk in paediatric wards: action for hospitals and Integrated Care Boards

Just before the bank holiday weekend the Health and Safety Investigation Branch issued an interim report due to concerns that risk factors associated with caring for children and young people with mental health needs on paediatric wards are not fully understood or considered holistically.

They have undertaken observational visits and spoken to staff, directors and heads of children’s services at 18 acute hospitals so far.

Amongst other things, their report notes:

• Design: Paediatric wards are primarily designed for the care of children and young people who only have physical health needs and are not typically designed to keep those with mental health needs safe.
  • They contain many self- harm and ligature points
  • They are crowded, busy and noisy
  • It is easy for a patient to leave without permission

• Therapy: Limited to no specialist mental healthcare and therapeutic engagement so wellbeing can deteriorate and high risk behaviours increase.

• Pressures: A national shortage of inpatient mental health beds and limited social care placements for children with learning disabilities and / or neurodiversity.

• Restrictive practices: Have the potential to create trauma or bring back past trauma.

• Other patients: A negative psychological impact can be caused to others on the ward and there is the potential for others to be assaulted. If staff are de-escalating then they are not able to offer other patients sufficient levels of observation and nursing care.

• Staff: As well as feeling frustrated that they did not have the right training or resource, staff risk being physically assaulted and some acute hospitals have seen an increase in staff sickness levels.

Next steps

HSIB therefore suggests the following action for ICBs:

• “[they] should facilitate a system wide response to reduce the safety and well being risks associated with children and young people demonstrating high risk behaviours who are admitted to an acute paediatric ward.”

HSIB’s safety observation is that NHS organisations should ensure systemic risks associated with caring for children and young people with high risk behaviours on the paediatric ward, including the safety and wellbeing risks to patients and staff, are escalated to ICBs for consideration.

There is also Local Level Learning as follows:

• “It may be beneficial for acute hospitals to review their practices using current available guidance and the findings in this interim report.  Where possible immediate action should be taken to appropriately reduce the risks to children and young people with high risk behaviours staying on the acute paediatric ward.”

HSIB are asking for further information from any source and will report significant developments as their investigation progresses.