Archived: The Priory Hospital Southampton

We rated the Priory Hospital Southampton as good overall.

We last inspected the service in September 2015. Following that inspection, we took enforcement action against the provider, in the form of a warning notice. This was primarily in relation to failings in the provider’s governance of the service that affected the safety and well-being of patients. We also gave the provider two Requirement Notices, relating to safe care and treatment and statutory notifications, which we followed up on at this inspection. We found the provider had taken appropriate steps to address the concerns we had found previously and the hospital’s staff had worked hard to implement significant improvements.

At this inspection (8 and 9 February 2017), we found the provider had taken appropriate steps to ensure the safety of patients and staff at the service. They had taken appropriate steps to address risks to patients from the environment. Wards were well maintained and in a good state of repair. As we found at our previous inspection, there remained a number of issues related to the physical environment and layout of the wards. These issues were partly due to the hospital being in an old, historic building. For example, internal walls and alcoves on corridors made it difficult to ensure good lines of sight for staff in all ward areas. The provider had introduced additional measures to address those issues with the environment.

Sufficient numbers of staff of the right grades and experience were generally available to meet the needs of patients. There was a good range of activities, education and therapeutic interventions. However, patients said that there were fewer outings and activities on the weekends. Ward teams were multi-disciplinary and had the input of a full range of staff. Ward staff also worked effectively with other teams involved in each patient’s care. The provider ensured staff had access to a broad range of in-house and additional specialised training, together with sufficient supervision. Staff felt well supported in their roles and expressed a sense of pride in the standards of care they were providing. Ward and hospital managers were thought well of by staff, and were able to lead with appropriate authority.

Staff were sincere and caring in the way they interacted with and supported patients. They involved people in their care, and offered patients choices and access to advocacy. There was appropriate involvement of families and carers. Patients were able to give feedback on the service they received, and met regularly with staff to discuss general issues or concerns.

Staff felt able to raise concerns without fear of victimisation, and told us their immediate managers were supportive and listened to them. They described the hospital’s senior team as responsive and open to suggestions for improvements to services. Although staff morale had been affected by changes that had taken place at the hospital in recent months, most of the staff we spoke with told us they were happy to be working at the hospital and that morale was improving.

However, we also found a number of areas where the provider could make further improvements:

Some staff told us they did not always feel sufficiently trained or prepared to support the high and complex needs of some of the patients. Similarly, a number of patients told us that they felt the care and support delivered by agency staff was not always to the standard provided by the hospital’s permanent staff.

Although we found improvement since our previous inspection, there remained some variance in quality of care records across the three wards. We saw evidence of ongoing support for people’s physical health.

We rated the Priory Hospital Southampton as requires improvement overall.

Through the inspection process, we identified a number of serious concerns in relation to the governance and operation of the service. This has resulted in our taking separate enforcement action in order to ensure the provider takes immediate actions to address the concerns identified. We have since returned to check that the provider has made improvements required and we found that they have improved a number of their governance and management systems to improve safety.

When we undertook the inspection we found that the provider had not taken appropriate steps to ensure the safety of patients and staff at the service. We found there were gaps, errors and weaknesses in the service’s assessment and management of risk. We found that the provider had not taken effective steps to address the risk of ligatures on each of the wards. We identified a number of concerns in relation to the use, level and monitoring of restraint and rapid tranquilisation of patients at the service, specifically vulnerable younger people on the child and adolescent mental health services (CAMHS) ward. There was a lack of senior oversight of the safeguarding log. This meant the provider did not ensure that staff in all instances had followed safeguarding processes fully and that appropriate actions had been taken in a timely manner.

We identified serious concerns in relation to the provider’s systems for reporting incidents and learning from when things go wrong. Poor and inaccurate recording and reporting of incidents, lack of senior oversight and inconsistent investigation meant that the provider could not assure itself that incident data was accurate and reflected the actual number or detail of incidents, or the current risks within the service. It also meant that the provider might not have identified potential trends or near misses. The provider, in relation to the detail, quality and completion of incident reports, had highlighted a number of concerns in its own quality reports. However, the reports had not identified potential issues in relation to the management of incidents, or that there were a sizeable number of moderate and serious incidents requiring further investigation. The service’s risk register did not have clear action plans in place to mitigate the risks identified. Additionally, we did not see evidence to demonstrate the risk register was regularly reviewed and updated by either the provider or the service’s management team. It was not clear how the senior team, or the Board, assured themselves that these risks were being addressed effectively and with the appropriate urgency and focus.

We identified a number of concerns in relation to the use and monitoring of restraint and rapid tranquilisation of patients at the service, specifically vulnerable younger people on the CAMHS ward. We therefore recommend in this report that the provider should carry out a detailed review of the use, level and monitoring of restraint and rapid tranquilisation at the hospital, with particular attention to their use in the treatment of young people on Kingfisher ward.

We found there was variance in quality and identified gaps and inconsistencies in some care plans. We had concerns in relation to the existence and use of parallel electronic and paper based records, which meant there was a risk staff may refer to out of date records.

At the time of inspection, the hospital director was the fourth person to hold that post since December 2014 and had been in post for six weeks. A new CAMHS consultant was due to take up post in December 2015. The site’s risk register had identified the lack of substantive hospital director and CAMHS consultant as increased risks. We found there was reduced senior and clinical oversight at the service, and that the provider was aware of increased risks for serious incidents associated with CAMHS wards.  Staff had been given insufficient opportunity to give feedback on services and the systems and processes for staff engagement did not seem sufficiently robust. There was no evidence of formalised staff consultations taking place in the last two years, and some staff were unsure about the company’s values and vision and told us they felt a little isolated from the wider organisation.

However, there were also some positive findings:

At a local level, ward managers were highly thought of by their staff teams and were able to lead with appropriate authority. Staff described morale as good on each of the wards, and told us that colleagues and managers listened to and supported them. The newly appointed hospital  director was extremely positive during discussion and talked enthusiastically about improving processes and systems at the hospital for the benefit of patients. They acknowledged and responded openly and constructively to feedback from inspectors during and after our inspection visit. Following our visit we saw immediate evidence of the hospital director making improvements at the service, and were encouraged that they would take a key role in making necessary changes to drive wider long term improvement in the quality of service provision.

There was an appropriate standard of hygiene and cleanliness at each of the three wards. Staffing figures were generally at the established figures for each of the wards, which both staff and patients told us was usually sufficient.

Comprehensive examinations of people’s physical status and assessments of their mental health needs had been carried out by staff at or soon after admission to the hospital. Patients on the three wards were offered a variety of different psychological therapies. A wide range of staff including medical, psychology, occupational therapy and pharmacist supported wards. Medical, therapy and senior nursing staff were experienced practitioners.

We observed that staff treated people with compassion and were sincere and caring in the way they interacted and gave support. The patients we spoke to in person were generally positive about staff who they said treated them with kindness, dignity and respect. Patients were involved in the planning of their own care. On each of the wards, patients confirmed they either had support from an independent advocate or knew the support was available to them if ever they wanted it. We saw evidence that patients, carers and family members were involved appropriately in decisions about care and treatment.

The average bed occupancy across the three wards meant the service was generally able to admit patients quickly, and wards could keep their beds available for them to return to when they went on leave. Each of the wards had a range of different rooms and equipment to support treatment and care. The food provided was of good quality, and the service was able to provide a choice of food in order to meet the dietary requirements of different religious and ethnic groups. Staff were aware of patients’ individual needs and tried to ensure they met them. This included cultural, language and religious needs. The majority of staff were up to date with their mandatory training and received regular supervision.