Report highlights ‘unsafe’ paediatric wards for children with complex mental health needs

Children and young people exhibiting high-risk behaviours are being cared for in NHS paediatric wards which may not be safe for them or other patients and staff, the Healthcare Safety Investigation Branch (HSIB) has said.

The HSIB has published an interim report as part of its investigation into the risks associated with design of paediatric wards in hospitals.

The report emphasises that paediatric wards are designed to care for patients who only have physical health needs and not for those with mental health needs. The wards contain many self-harm and ligature risks and NHS staff, patients and families commented to HSIB that the wards were crowded, busy and noisy, and therefore unsuitable for children and young people experiencing a mental health crisis and/or who have sensory needs.

The interim report cites examples of:

• Children and young people being restrained or sedated
• Rooms stripped down to remove any risk of self-harm or death by suicide
• Other sick and vulnerable patients and their families feeling concerned for their safety during incidents
• Paediatric staff being physically assaulted

These initial findings are based on visits to acute paediatric wards, speaking with ward staff, directors and heads of children services at 18 hospitals across England. The HSIB has also spoken to patients and families, mental health experts and national organisations.

The interim report states that 13 out of the 18 hospitals the investigation spoke with said that for children and young people with high-risk behaviours the paediatric ward was ‘not safe’ and was not a suitable environment, particularly if the child or young person did not have a physical health condition. The remaining five spoke of the huge challenges they face and that they try to make the environment as safe as possible but felt more could be done.

The risk of an unsafe and unsuitable environment has come to the forefront as the number of children and young people with needs other than treatment for physical conditions has risen over the last six years. Paediatric wards in acute hospitals are increasingly caring for children and young people who may display high-risk behaviours.

The HSIB concluded that the limitations of paediatric wards in providing a suitable and safe environment for children and young people with high-risk behaviour impacts on their safety and wellbeing as well as that of other patients, families and NHS staff.

Saskia Fursland, National Investigator at the HSIB, said: ‘We have published a report whilst the investigation is ongoing because our investigation is showing that while the paediatric wards can provide safety and comfort to most children and young people, the environment comes with significant risks for those exhibiting high-risk behaviours.

‘The conversations we had with the hospitals about the challenges were also reinforced by our own observations as an investigation team whilst on visits – the focus needs to be on better supporting staff to care for patients on paediatric wards while finding or creating more suitable and safer places of care for children and young people exhibiting high-risk behaviours.

‘The examples we have included in our short report are shocking and show that on a regular basis patients cannot receive the therapeutic care they need, while other patients, families and staff face the risk of distressing and threatening situations, long term trauma after incidents and even physical harm.’

Image: Sinitta Leunen