Written Statement: National Review of Care into Children Placed in Specialised Hospitals Not Directly Managed By NHS Wales

Members may recall that earlier this year the Children’s Commissioner for England published a report “Far less than they deserve”, raising concerns about children with learning disabilities/autism in mental health hospitals in England.

As a result of these findings I sought an assurance from the Welsh Government’s Chief Nursing Officer/Nurse Director, NHS Wales that appropriate admission arrangements and care pathways are in place for any children from Wales who may be placed in specialised hospitals in England as part of these arrangements.

In May 2019 the Chief Nursing Officer commissioned the NHS Wales National Collaborative Commissioning Unit to undertake a national care review of children receiving specialised hospital care in England. It was intended that the review would cover Child and Adolescence Mental Health in patient services (CAMHS) commissioned from external (not NHS Wales hospitals) providers such as NHS England or the independent hospital sector.

This focus of the national care review was intended to ensure that children were receiving:

• Care for the minimal time required in the right environment to meet all needs.
• Care which empowers, enables and involves.
• The right level of support to reduce risk, promote independence and improve quality of life.
• Prescribed medication at the minimum dose required to achieve the identified clinical outcomes and that side effects were being closely monitored.
• Safe, effective and high quality care, with minimal use of restraint or other restrictive practices.
• Outcome-focussed interventions by a range of skilled and experience staff.

The clinical review team visited 11 children placed in NHS and independent provider units in England. This covered low, medium, secure, psychiatric intensive care and acute wards. The review looked in depth at the appropriateness of the placement, the quality of care and the impact of that care for the children.

At the time of the review, 9 of the 11 children were considered to be in an appropriate placement with two children considered ready to move to a lower level of dependency. In terms of the quality of care, I am reassured that the review identified areas of good practice across a number of domains including: staff, care planning, medication, physical health checks, therapeutic interventions, safety and welfare, education and nutrition. Those areas that require improvement have been identified and, where necessary, providers have been given remedial action plans to address any remaining concerns.

At October 2019, 5 children remain in the same hospital at which they were reviewed, 3 children remain in hospital but have been transferred to a more local facility and one child is awaiting transfer to an NHS Wales facility. 2 children have been discharged from hospital.

The NHS Wales National Collaborative Commissioning Unit review team has ensured all findings have been shared with the providers and are now monitoring the remaining placements.

A copy of the review report can be accessed through the following link:

National care review of Child and Adolescent Mental Health Services (CAMHS) provided outside Wales