NHS pays out £20m in clinical negligence claims over children’s mental health care

Exclusive: NHS also spends around £77,000 each time it admits a child to a mental health ward, leaked report warns

Young people with ‘challenging behaviour’ and living in complex circumstances, who are in social crisis rather than a mental health crisis, are the most likely to be ‘inappropriately’ admitted to inpatient units (The Independent)

The NHS has paid out at least £20m over poor care in children’s mental health services, a leaked report has revealed.

The report, seen by The Independent, found the huge sum was paid out by healthcare providers over five years up to March 2020 to deal with clinical negligence claims.

That includes £9m over claims related to self-harm and £3m for claims involving assault by staff on patients, the most common cause for clinical negligence.

The review addresses improvements needed in inpatient and community children’s mental health services and highlights “significant concern” over young people being detained for “emotional disregulation disorders” and self-harm.

Young people with “challenging behaviour” and living in complex circumstances, who are in social crisis rather than a mental health crisis, are the most likely to be “inappropriately” admitted to inpatient units, the report said.

The report into child and adolescent mental health services warns there is too much variation in inpatient services and that it costs the NHS an average of £77,000 every time a child is detained.

The review is part of the NHS’s Getting it Right First Time project, led by Dr Guy Northover, and is based on data from before the pandemic.

Data from NHS Resolution obtained by reviewers found £1m between 2015 and 2020 was paid out in claims relating to suicide attempts, nine of which led to a child’s death.

The report highlighted that serious incident investigations done by providers following a patient’s death “lack involvement of the family” and lacked “robust” recommendations so were “unlikely to impact on future practice.”

Cost of inpatient care

Dr Northover’s report highlighted “significant variation” in the quality of children’s inpatient units and warned that hospitals could not explain why their model of care was different from another’s.

It added: “CYP [children’s and young people’s] inpatient beds are the second most expensive mental health beds and that has driven an approach of reducing the cost per bed day, but less thought has gone into understanding why the cost is high or if this is justified.”

The cost of children’s beds per day ranged from £600 to £1,600, with the cost for an entire inpatient stay ranging from £28,500 to £148,500.

The cost of one inpatient admission is the equivalent of a year’s mental health support for a child in the community.

According to estimates the NHS could save £21m if it were to reduce the average time spent by children in beds from 55 days to 48 days. Data showed that in more than one third of cases children were spending more than 60 days within an inpatient unit.

The report said despite the “imbalance in spend”, for too long admission into inpatient units has been driven by a lack of appropriate community services rather than the belief it is the best treatment.

It was warned that future surges in need for children’s mental health beds could not be met within the current number of beds, however that this would need to be balanced by the need to reduce the NHS’ reliance on inpatient CAMHS care in the longer term.

The report found variation in staffing models and levels across units. According to the data independent sector units had lower rates of staff per 12 beds compared to NHS units.

Inexcusable restraint

In an analysis of restraint used on children’s inpatient units the report warned it was “not excusable” that seclusion and restraint was high in children’s services and more than five times higher compared to adult services.

Other areas of concern highlighted within the report included the number and level of staff used in Section 136 suites, which are rooms within hospitals for children who are taken there by police after being picked up in crisis.

The data gathered found just 53 per cent of Section 136 suites had full or partial clinical staff and said young people will often be left within these rooms for days at a time while waiting for an inpatient bed.

Regarding the treatment of patients with eating disorders within A&E the report noted that previous recommendations from the CQC that paediatric and A&E staff have training for children’s mental health needs is not being implemented within hospitals.

The report added concerns have been raised over the use of “nasogastric tube feeding”, managing children with neurodiverse conditions and the use of restraint in general hospitals.

A spokesperson for the NHS said: “The NHS continues to prioritise children and young people’s mental health, with record investment in community services, introducing mental health teams in schools and growing our workforce by 40 per cent in the last three years alone.

“More children and young people are being treated by the NHS than ever before and there are plans in place so that an additional 345,000 are supported each year by 2023/24. So if you need help or your child needs support, please come forward.”