Trust’s ‘challenges’ with managing gender identity service before closure

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A trust is experiencing “ongoing challenges” as it manages a gender identity services clinic for young people ahead of its closure and replacement with regional services, a health watchdog said.

The Care Quality Commission (CQC) said it inspected mental health services for children and young people at the Tavistock and Portman NHS Foundation Trust in order to ensure the trust’s other services were “continuing to deliver safe and effective care and treatment”.

It was announced last July that the London-based Gender Identity Development Service (GIDS) clinic would be shutting down, to be replaced by a regional network.

An independent review, led by Dr Hilary Cass, was commissioned in September 2020 amid a rise in demand, long waiting times for assessments and “significant external scrutiny” around the GIDS approach and capacity.

The Cass review’s final report is expected towards the end of 2023.

The CQC said it did not inspect the GIDS on this occasion, but carried out inspections of the specialist community mental health services for children and young people (Camhs) at the Tavistock and Portman NHS Foundation Trust and the community forensic mental health team at the Portman Clinic in January and February this year.

The CQC said: “The trust has gone through significant change in terms of its senior leadership team.

“It is also experiencing ongoing challenges with managing the gender identity services for young people during the period before it transfers to new regional services. These inspections were to ensure other services provided by the trust were continuing to deliver safe and effective care and treatment.”

The watchdog’s reports, published on Wednesday, saw the Camhs service rated as ‘requires improvement’ for safety, which is a drop from the previous ‘good’ rating.

Inspectors visited the Camden north and south child and adolescent community teams and the Camden Adolescent Intensive Support Service (CAISS) team.

The CQC said it found that staff were not always up to date with important training, with five of 13 staff in the Camden Camhs south team not having completed mandatory resuscitation training at the time of their visit.

It said the service also did not provide alarms for staff or in rooms where therapies with the patients took place in case there was an incident.

In its report, the CQC said the general manager said that while the service considered installing alarms buttons in rooms, it concluded that children and young people would press them and cause false alarms, therefore alarms were not trialled or implemented.

The watchdog also found that rooms where clinicians met with young people to have confidential discussions were not well soundproofed, which the watchdog said “could compromise the young person’s confidentiality”.

The CQC found that staff in the Camden Camhs south team also said they were not provided with mobile phones to communicate with the young people as part of their care and were expected to use their own phones and hide their personal number.

Jane Ray, CQC deputy director of operations in London, said:  “This method raised the risk of staff accidentally sharing their personal numbers which is unsafe.”

She added: “In both services, none of the offices and therapy rooms had panic alarms fitted and staff didn’t carry personal alarms which was concerning as therapy rooms were located away from busy areas in the centre.

“However, the service effectively managed any risks to staff by only seeing people using the service if another clinician and reception staff were in the building. The service also planned to introduce a software application for reception where staff could raise the alarm to call for assistance if they needed to.”

She said inspectors found that the Portman Clinic had made progress on improving services since the last inspection and that “people told us they felt supported and safe and that all staff treated them with kindness, compassion, and respect”.

Among its recommendations, it said the trust must ensure staff complete mandatory resuscitation training; should consider the use of room and personal alarms for staff who wish to use them when working on site or visiting patients off site; and should review whether rooms for confidential assessments and treatments are adequately soundproofed to maintain confidentiality.

A spokesperson for the Tavistock and Portman NHS Foundation Trust said: “Although our overall rating remains ‘Good’, we accept the areas identified for improvement in the reports on our Portman Clinic and specialist Community Mental Health Services for children and young people.

“We are making immediate improvements in the identified areas.”

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