A hospital trust is on trial in connection with the death of one of its teenage patients, with concerns raised about "inadequate" care plans and "poor" record keeping.

Emily Moore, 18, died while being treated as an inpatient at Lanchester Road psychiatric hospital in Durham, in February 2020. The hospital is run by Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV).

She had been able to take her own life in her room on the hospital's Tunstall ward, despite being on 15-minute observations, and her tendency to self-harm being known. 

Now, the Care Quality Commission (CQC) is prosecuting the hospital trust for alleged breaches of regulations 12 and 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The CQC alleges that TEWV “failed to provide safe care” for Emily because of the “poor quality” of her care plan and staff record keeping, resulting in a “significant risk of avoidable harm”.

The prosecution claims that the care plan made up for Emily did not "specifically guide staff" on how to care for her, did not include details of the risks Emily posed to herself, or guide staff on how to manage those risks. 

But counsel for the Trust told the court that the care plan needed to be viewed "in context" with other medical notes, which were available to medical staff easily through the electronic record-keeping system. 

Last year, the Trust pleaded guilty in connection with the deaths of Christie Harnett, and Patient X, who cannot be identified due to reporting restrictions.

Christie, 17, died whilst under the care of the since-closed West Lane Hospital, in Middlesbrough, in 2019.

Patient X died whilst being treated at Roseberry Park Hospital, in Middlesbrough, in 2020.

Jason Pitter KC, the prosecuting attorney for the CQC, told Teesside Magistrates Court that the care provided to Emily Moore, during her eight-day long stay at Lanchester Road Hospital was subject to “poor quality” record keeping and an “inadequate” care plan.

He outlines that Emily had only been moved to the ward as a consequence of turning 18 and ageing out of the child and adolescent mental health service.

He said that Emily’s “admission to the Tunstall ward was due to the inability to find a more suitable placement” when Emily turned 18 in early February 2020. She was moved from a specialist inpatient unit in Prudhoe, Northumberland, which is run by a different hospital trust.

Teesside Magistrates court was shown a video of the three expert witnesses - Tim McDougall, Tim Bryson, and Dr Francesca Denman - meeting to discuss the adequacy of the care plan. 

Mr McDougall, expert witness and Director of Quality, Nursing and Healthcare Professionals at Lancashire and South Cumbria NHS Trust, said that Emily's care plan "should have been better quality".

Although he was unable to find a "causal" link between the "inadequate" safety plan and Emily's death, he believes one could have "limited the risk of the outcome".

Mr McDougall added: "There is a risk that if you’re a nurse who is coming onto the ward and picking [the care plan] up, without that overall understanding."

But expert witness Dr Chess Denman, commissioned by the Trust, said: "A better care plan may have resulted in better care, but not in safer care."

On Emily's admission, a care plan and safety summary were completed, highlighting her significant history of ill mental health and her risk of self-harm.

However, a barrister for the CQC argued that the “quality of records was poor. All that was practicable to be done was not done, and not done with all due diligence”.  

In his opening statement, Mr Pitter highlighted that though the risk posed to Emily through the presence of ligature points in her hospital room and adjoining bathroom was documented, her care plan lacked specific guidance, and there were gaps in recording Emily’s observations.

Record-keeping was “not compliant with TEWV training on support, observation and engagement”.

He added: “The plan did not mention her risk to herself, or guide staff on how to care for her.”

Taken together, the CQC has argued that this resulted in risks to Emily being left “unmanaged”.

The defence counsel for TEWV, Paul Greaney KC said that “for the content of the plan, the Trust acknowledges that it could have been improved upon”, but emphasised to district judge Marie Mallon, that “the inspection of any set of notes relating to any patient on any ward in the country would be likely to reveal some imperfection”.

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Mr Greaney said the plans to nurse Emily with supportive observation “was a clear and appropriate mitigation measure” for the management of her risk.

He added more detailed records were available to all staff through the electronic records system PaRIS, and were “accessible by two clicks,” and that well-attended and collaborative staff meetings about Emily’s care “represent good practice, not just acceptable practice.”

The trial continues.