The whole section about record keeping has me boggle eyed.
Extract:
• Staff’s assessments of patients were unstructured, inconsistent and poorly recorded. Staff did not sufficiently record their reasoning in reaching clinical decisions. There were significant variations in the clinical approach of professionals in the team and it was not possible to clearly understand from the records why these decisions had been made.
• Staff did not develop care plans for young people. Many records provided insufficient evidence of staff considering the specific needs of young people, such as autistic spectrum disorders.
• Staff had only recently begun to record consent and capacity or competence clearly for young people who might have impaired mental capacity or competence. The records of young people who began medical treatment before January 2020 did not include a record of their capacity, competency and consent. When staff identified records without a written capacity assessment, they did not seek to address this or record it as an incident
Surely if you discovered that patient with impaired mental capacity hadn’t been properly assessed re: consent you have a duty of care to report potential negligence?
The CQC report also raises the excellent question as to why GIDS multi disciplinary clinical team doesn’t include any specialists re: autism/adhd
‘The staff team included clinical psychologists, psychotherapists, family therapists, specialist social workers and a counselling psychologist and assistant psychologists. The service also employed two psychiatrists, two specialist nurses and a large team of administrators.
Staff were experienced and qualified and had the right skills and knowledge to meet the primary needs of the patient group. However, staff did not necessarily have the skills or experience to meet the needs of young people with complex needs. For example, whilst some staff had previous experience of working with patients with autistic spectrum disorders, the service did not employ a specialist to focus on this area of clinical practice. This meant the service may not be sufficiently able to assess the needs of young people with complex needs.’
I am also concerned that this:
‘ Although staff did not provide interventions for physical ill health, we did not see consistent evidence that staff routinely asked young people about their physical health, in order to refer them to external services if needed. We reviewed physical health monitoring on 24 records. On 18 records (75%) there was no mention of physical health. Four records (16%) included a discussion of physical health at the initial meeting. This meant that staff were not consistently screening for physical health problems, unless these were included in the referral from the young person’s GP or local CAMHS.’
This is not my professional area at all, but considering how eating disorders seem to be prevalent amongst FtMtF detransitioners and that some of the GIDS patient base are on drugs that affect growth, is it unreasonable that I would expect height and weight to be recorded (and plotted on growth charts for screening purposes) at every appointment?
How can the bit about safeguarding be relatively positive, according to the CQC, when the rest of the report flags up so many missed opportunities, especially around potential comorbidities?