A “poor quality” care plan and medical records filled with “gaps” might have contributed to "criminally unsafe care", before a teenage girl's death in a County Durham hospital, a court has today heard.

Teesside Magistrates’ Court was told that the care plan for Emily Moore, 18, during the eight-day hospital stay that preceded her death in February 2020 was so poor it was “criminal”.

Tees, Esk and Wear Valleys Foundation Trust (TEWV) stands accused of failure to provide safe care in the days preceding the 2020 death of 18-year-old Emily Moore.

Emily 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).

Read more: 'Poor quality records and plans' in run up to Emily Moore's death

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 known history of self-harm with ligatures.

The Care Quality Commission, which is prosecuting the case, has said that Lanchester Road Hospital breached regulations 12 and 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Expert witness Tim McDougall, nursing specialist for the CQC and director of nursing at Lancashire and South Cumbria NHS Foundation Trust, said he found the care plan “inadequate”, and believed that alongside “gaps in the records”, this contributed to unsafe care that put Emily “at risk of serious avoidable harm.”

A plan that had been filled out more comprehensively, Mr McDougall believes, would have “reduced the likelihood of Emily coming to harm, as nursing staff would have clear guidance on her known risk history.

“I would have expected to see a care plan with specific risks included, reflecting guidance from NICE, the Department of Health, and the CQC guidelines in managing ligature risk.

“Using my knowledge of mental health care settings, it is usual that you depend on bank and sometimes agency staff through – there are unfamiliar people passing through someone's care.

“An agency nurse coming onto a ward does not increase risk, but an agency nurse coming onto the ward in the absence of a care plan does increase risk.”

He added that, using the records available, he “was not able to conclude that all of the observations had taken place.”

Prosecutor for the CQC, Jason Pitter KC said that, taken together, this constituted a "criminal offence" in his opening statement on Monday. 

But in a written statement, TEWV chief nurse Beverly Murphy outlined that of the 101 total staff shifts that were filled whilst Emily stayed at Lanchester Road hospital, only two were filled by agency staff – and these were both for healthcare assistant roles, rather than nursing staff. Thirteen further shifts were staffed by TEWV bank nurses.

Counsel for the trust, Paul Greaney KC, argued that the plan was “fit for its purpose”, though he admitted that “it was not the gold standard.”

He added: “When you are trying to get someone better, you have take a degree of risk and manage that risk.”

Expert for the trust, Dr Francesca Denman, said that complete records outlining Emily’s risks were available in “four or five clicks” through electronic medical notes, “if you know your way around.”

Dr Denman added that plans made for Emily’s care were “reasonable”, and that she was “pleased” that records showed multidisciplinary meetings were attended by nursing staff, doctors, and Emily’s family, saying this showed “excellent practice”.

She added that noted made from meetings were “good and comprehensive, putting things together in a single understanding.”  

“Emily appeared to have settled fairly well onto the ward.”

Dr Denman also warned that the over-restricting patients, such as locking Emily’s bathroom door, as was discussed to reduce her risk of self-harm with a ligature.

Though this would "eliminate risk", would create “miserable” patients.

She said: “Progressively incarcerating the patient more and more can restrictively in a desperate attempt to avoid any adverse event makes them miserable.

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“[The patient] feels caged, they feel hopeless, and they seek ways to harm themselves more ingeniously. The relationships they have with staff become custodial and restive – they are not conducive to the aim of helping.

Dr Denman added that: “From the patient's perspective, it matters what is done,” though she agreed that “the purpose of the making of records communicates information between staff", and that this contributes to the delivery of effective care.

The trial continues.