Firshill Rise patient neglect findings prompt Sheffield NHS service shake-up

One member of Sheffield Council’s health scrutiny sub-committee said the report on major failings at Firshill Rise, which is currently closed, was “uncomfortable to read”.

The in-patient assessment and treatment service for people with learning disabilities who also have mental health and behavioural issues was found by the Care Quality Commission (CQC) to be failing in all aspects. The 2021 inspection found that “the service was not safe with concerns about staffing skills and training, medications management and safeguarding”.

It said that staff ignored patients’ requests for food and drink, they were not trained in how to safeguard patients from abuse, management systems were poor, patients and families were not involved in care planning and patients stayed too long on the unit.

All new admissions were banned without written permission from the CQC.

Richard Bulmer, head of service, rehabilitation and specialist services at Sheffield Health and Social Care NHS Foundation Trust, told councillors that the NHS trust called in the CQC after a new manager discovered that one patient had been in the unit for more than two years, far longer than is usual.

Failings

The NHS also started its own investigation.

Mr Bulmer said: “There is a recognition from the trust that there was significant failings in terms of what happened at Firshill Rise and what needs to happen about that.”

He said that the trust has carried out recruitment nationally to find high-quality members of the management team including a consultant psychiatrist who is the new clinical director, a new matron and a general manager.

“The learning we’ve taken from this is across the trust,” he said. “This includes reviewing incidents, visibility of senior leadership and triangulating information.”

Mr Bulmer said that the trust has engaged with people with learning disabilities, service users and their families to explain what changes are taking place. This includes ensuring the service is centred on the person’s needs, based on evidence and trauma informed – this means staff are trained on the impact of trauma on people and how to deal with that sensitively.

He said that the NHS has a new emphasis on avoiding people being admitted to hospital and putting community-based services in place to support people better. People with learning disabilities who need to be admitted now go mainly to adult psychiatric beds with specialised support.

Frustration

“National NHS guidance is we should be mainstreaming as much as possible. If we had a person with a mental disability who needed a heart transplant, you wouldn’t have a specialist unit for that, although it’s not quite the same,” said Mr Bulmer.

Feedback from service users was that they should be supported at home more. “There was frustration that people were stuck in hospital for quite long periods of time, such as the person who was there for two years and they should have had support to move on.

“The feedback wasn’t all negative, some users talked about it being quite a positive experience.”

He said that staff on the unit had been frustrated by the closure and the media exposure. Many have had training and development to work in other parts of the trust and get regular practical development and support sessions.

Mr Bulmer added: “They weren’t provided with supervision, there was no support for staff. That’s changed radically.”

Heather Burns, deputy director of mental health, learning disability, autism and dementia transformation at NHS South Yorkshire Integrated Care Board, said that the aim now is to keep people in the last restricted place with best practice to support them. This will require enhanced services, which is the next phase of change.

Uncomfortable

The committee heard that if Firshill Rise closes permanently as a result of no longer being needed because of changes to the service, that money could be used to provide better support including respite care in the city.

Coun Gail Smith said: “It is uncomfortable to read. Do you think there was a distinct lack of training for the staff? Why was someone there for such a long time? How did that happen and why?”

Mr Bulmer said there was not enough training, which goes wider than that unit. He said that it was a problem finding a suitable placement for the person who overstayed to move on to as they had complex needs.

He said “we should have done more”, adding: “Once someone got into hospital, it’s a ‘safe place’. That’s a real question, whether being in hospital for that length of time is a safe place. Potentially it’s institutionalising people.”

Coun Mary Lea asked what was being done to support the users and help them to discuss their experiences. Mr Bulmer said users and their families are being supported by the community disability and learning team and specialist trauma support charity Respond. They have also had a chance to speak to trust staff about what went wrong.

Mr Bulmer stressed that lessons were being learned by the entire trust which is aiming for an outstanding rating. That includes changing a closed culture around the learning disability service so that it learns from good practice in other areas.

Feedback

Committee member Lucy Davies from health and social care champions Healthwatch Sheffield said: “Although this has come from not a good place, the direction of travel is broadly in the right direction.

“We need more feedback from people who are autistic in accessing mainstream services. They are really difficult environments for people.”

Ms Burns said there are specialist staff in place and the aim is to support people with wraparound support services. Greg Hackney of the NHS trust said that it is recruiting staff who are neuro-diverse themselves to give others a unique insight.

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