HSSIB investigation report – Keeping children and young people with mental health needs safe: the design of the paediatric ward (23 May 2024)

Summary

This investigation by the Health Services Safety Investigations Body (HSSIB) considers how patient safety can be improved in relation to children and young people with mental health needs while they stay on an acute paediatric ward—a ward for children and young people in a hospital that typically treats physical health conditions. It focuses on the risk factors associated with the design of these wards in acute hospitals.

Content

Findings of this report included:

• There was limited national guidance about how paediatric wards should be adapted for children and young people with mental health needs.
• Paediatric wards in acute hospitals tended to focus on adapting their environments to improve the physical safety of a room for children and young people with a mental health need. Rooms would be stripped of items deemed to be a risk.
• Evidence indicated that removing items and creating a more restrictive environment can create more conflict situations including increased aggression, physical and verbal abuse, rule breaking, medication refusal, leaving the hospital without permission (absconding), and self-harm.
• There are opportunities to better support children and young people on acute paediatric wards by improving the environment to support therapeutic care and patient safety.
• Evaluating the learning from innovations and adaptations that individual hospitals around the country have made to their acute paediatric wards for children and young people with mental health needs can improve patient safety.
• There is a gap in the communication, escalation and management and oversight of risks associated with the acute paediatric ward environment for children and young people with mental health needs.

In this report HSSIB makes the following safety recommendations:

• NHS England, in collaboration with key stakeholders, including young people with lived experience and their families, develops guidance on how acute paediatric wards could be adapted to support children and young people with mental health needs. This work should focus on improving the therapeutic environment.
• NHS England, in collaboration with key stakeholders, updates ‘Health Building Note 23: Hospital accommodation for children and young people’ to include the therapeutic environment for supporting children and young people with mental health needs.
• The Care Quality Commission uses the findings of this report to ensure healthcare providers and integrated care boards implement a robust way for risks associated with the adaptations made to acute paediatric wards to be escalated and managed.

It also proposes the following safety response for integrated care boards and healthcare providers:

• HSSIB suggests that integrated care boards work in collaboration with healthcare providers to implement a robust way for risks associated with the adaptations made to acute paediatric wards to be understood, escalated and managed to ensure that adaptations enhance patient safety.