The Care Quality Commission
  • Mental Health
  • Independent mental health service

St Andrews Healthcare Northampton

Overall: Requires improvement read more about inspection ratings

Billing Road, Northampton, Northamptonshire, NN1 5DG (01604) 616000

Provided and run by:
St Andrew's Healthcare

All Inspections

4 July, 5 July, 6 July 2023

During an inspection looking at part of the service

St Andrews Healthcare is an independent organisation that provides mental health care across three sites in England. We visited the Northampton site to check on the quality of care provided.

Urgent enforcement action was taken following the inspection in July and August 2021 because of immediate concerns we had about the safety of patients on the forensic inpatient or secure wards, long stay or rehabilitation mental health wards for working age adults and wards for people with learning disabilities or autism.

We imposed conditions on the provider's registration that included the following requirements:

  • the provider must not admit any new patients without permission from the CQC;
  • wards must be staffed with the required numbers of suitably skilled staff to meet patients’ needs;
  • staff undertaking patient observations must do so in line with the provider’s policy;
  • staff must receive required training for their role and that audits of incident reporting are completed.

Following the previous inspection, we wrote to the provider on 9 May 2022, to vary one condition to allow, from 10 May 2022, that St Andrews Healthcare Women’s service could admit up to a maximum of 1 patient per week to each ward without seeking permission from the Commission. The admissions could not be carried over to following weeks should an admission not occur. All other conditions outlined in the section 31 notice of decision from July 2021 remained applicable. The provider was required to provide CQC with an update relating to these conditions on a fortnightly basis.

This inspection was a focussed inspection of the wards that had conditions attached to see if improvements had been made. We found that sufficient progress had been made and that the conditions could be removed. This service has been removed from special measures due to the improvements we found.

Previous inspections have produced 2 reports: one for the Women’s service and one for the Men’s service. Following the provider re-registering as single site, we have completed a single inspection report.

Our rating of this service improved. We rated it as requires improvement because:

  • Easy read information was not available on Church ward for patients who may have required it so they could fully understand their care and treatment.
  • Staff undertook physical observations following periods of rapid tranquilisation although they were not consistently recorded in the same place within the patient care record.
  • Not all medical devices and equipment was maintained in line with the supplier’s guidance and was not appropriately recorded.
  • Medicines management processes were not always adhered to in line with the provider’s policy and procedures.
  • Not all health care assistants thought their safeguarding training was sufficient.
  • Compliance for safety intervention training was lower than required across all the wards. Not all staff on Bracken and Maple ward were up to date with basic life support training.
  • Staff on the Men’s wards did not always plan shifts effectively. Often, staff carried out enhanced observations one after the other without any break in between.
  • Staff on the Men’s wards did not always receive regular clinical supervision in line with provider’s policy.
  • Governance processes did not always work effectively to ensure good oversight of quality and performance data to ensure that ward procedures ran smoothly.
  • Staff on the Men’s wards did not always feel as though they were respected, valued and supported.

However:

  • The service had made sufficient improvements in relation to the conditions applied at the last inspection so we removed them and took them out of special measures.
  • The service provided safe care. The ward environments were generally safe, clean and appropriately risk assessed.
  • Staffing had improved. The service had sufficient, appropriately skilled staff to meet patient’s needs and keep them safe. Patients were able to access escorted leave when they wanted to, and there was a wide range of readily accessible activities.
  • Training compliance had improved for most required training, and most staff received regular supervision on the Women’s wards. Staff were provided with sufficient information to ensure patients were kept safe.
  • Staff assessed and managed risk well. Staff undertook patient observations in line with the provider’s policy and had a good awareness of individual patient’s risks.
  • Staff followed good practice with respect to safeguarding and recognised abuse, reporting concerns appropriately.
  • Incident reporting and record keeping had improved. Staff knew what incidents to report, how to report them, and they were recorded appropriately in the patient care record and the incident reporting system.
  • Culture on the wards had improved and the provider had introduced a number of approaches to prevent an occurrence of a closed culture.

18 - 20 October 2022

During an inspection looking at part of the service

This unannounced focused inspection was triggered by the receipt of information which gave us concerns about the safety and quality of services on one ward in this core service. The information of concern was received by CQC between July and September 2022. Our last comprehensive inspection of this service was in June 2016 and a follow up inspection in May 2017.

The concerns received included the following:

  • safe staffing levels and how incidents were safely managed
  • physical healthcare and care of the deteriorating patient.

This was a focused inspection, on 1 of 5 wards in this core service and we inspected the key questions of safe, effective and well-led due to the nature of concerns reported to us. This inspection was rated based on our findings.

Our rating of this location went down. We rated it as requires improvement.

We found:

  • Leadership on Allitsen ward was not always consistent on day or night shifts. Leadership was not always visible. Leadership changes on the ward had de-stabilised the ward, and governance processes to monitor mandatory training were not used effectively.
  • Staff did not always follow the communication processes between Allitsen ward and the physical healthcare team following incidents.
  • Managers had not ensured that all shifts had the correct number of qualified nurses for the duration of the shift.
  • Not all staff on Allitsen ward were compliant with all mandatory training, and data to monitor compliance was inconsistent.

However:

  • Staff managed the routine physical healthcare of patients well and managed physical healthcare incidents well.
  • Allitsen ward showed that while nursing shifts had not started with the planned number of staff, managers filled gaps with known bank staff to bring staffing levels up to safe numbers. Staff told us that in the previous few months staffing levels had improved. The provider had improved pay and conditions for staff and had measures in place to address both recruitment and retention of staff.
  • All staff we spoke with knew how to report incidents and record them in the electronic system. We reviewed incident records against safeguarding referrals and daily care notes which confirmed this judgement. Managers shared lessons learned from incidents within teams to prevent future occurrence of the same incident.
  • Compliance with safeguarding training was 86% on Allitsen ward. All staff we spoke with understood what constituted a safeguarding concern.
  • Staffing levels meant enhanced observations had been carried out safely.

15 to 19 May 2017

During an inspection looking at part of the service

We rated wards for older people with mental health problems as good because:

  • Patients received timely access to physical healthcare, including access to specialists when needed.
  • Care records were up to date and included the patients personalised life story “This is me.” Care records showed positive behaviour plans and support.
  • Technology and equipment were used to enhance delivery of care, for example a talking tile (which had a picture of patient’s family member and a recorded message) and a digital aquarium on the wall for patient‘s viewing. Staff accessed video calls for patients to see and speak with their carers and relatives. One patient spoke regularly with their relative abroad.
  • Staff received the necessary specialist training for their role for example end of life training, dementia care mapping, and physical health care training.
  • Staff were supervised with one to one meetings, group reflective practice meetings, appraised and had access to regular team meetings.
  • We observed effective early morning handovers on O’Connell South and Compton wards.
  • Staff participated in regular clinical audits such as infection control, cleanliness audit. Clinicians were provided with research evidence from recent publications via alerts.
  • Staff told us managers were supportive, and were a visible presence on the ward. Staff knew how to use the whistle blowing process.
  • • The clinical nurse lead on O’Connell South ward was the champion for the staff survey, encouraging staff to complete the survey “My Voice”.
  • O’Connell North and South wards were working towards accreditation for the quality network older adults. An application had been submitted.

However:

  • On O’Connell South ward, the visitor’s room on the first floor had two large sash windows with no restrictors. These meant widows could be fully opened and patients may not be safe when left unsupervised in this area. When we brought this to the attention of the clinical nurse lead they told us repairs would be made to the windows within three days. The door was locked after we brought the issue to their attention.
  • The patients lift on the first floor of O’Connell South ward was not in use for one week. This was due to an infection control outbreak on an adjacent ward. We saw the lift was unclean with litter, and reported this to the clinical nurse lead. The lift was immediately cleaned. For a temporary period O’Connell South ward was accessed via another lift in the building. 

13 to 16 June

During a routine inspection

We rated St Andrew’s Healthcare Northampton as requires improvement because:

  • Not all seclusion rooms considered the privacy and dignity of patients. Staff used closed circuit television (CCTV) to monitor patients. However, monitors were visible to staff from the office and to patients on entering or leaving the adjacent low stimulus room. In adolescent services, one seclusion room had a faulty two-way intercom system. Care records confirmed that the room was used regularly and recently. In older adults services the provider did not always reduce the risk from blind spots.
  • In forensic services, the receptionist controlled access to three buildings from one reception area and used CCTV monitors to control access. When reception staff were away from their desk, access to the building was delayed for patients.
  • On Seacole ward there were issues with controlling temperatures on the ward. This was because of the air exchange system sending columns of cold air directly downwards when the ward gets above 28 degrees. The provider told us they were going to fit a safe diffuser over all of the ducts to try to diffuse the cool air over a larger area. On Seacole ward, the furniture in the night lounge was torn and dirty. In the psychiatric intensive care unit (PICU) some bedrooms, bathroom and shower areas were dirty and carpets were not clean. We could detect a strong smell of urine in some bedrooms. The shower areas upstairs did not provide comfort or promote dignity and privacy. There was a shower curtain on some, but not all showers. The door to the room did not lock and patients needing the toilet could enter. We observed staff searching patients in communal areas on two wards. One ward lacked appropriate signage and other relevant information for patients with neuro rehabilitation needs. Staff restricted access to patients wishing to use their bedrooms, and this was not individually risk assessed.
  • There were ligature points in the psychiatric intensive care unit and the provider did not ensure all patients’ risk assessments and care plans included the management of specific environmental ligature risks. There was no recorded evidence of staff and patients having an immediate debrief following an incident. A debrief is an opportunity for staff to reflect on the incident, review what action was taken, any immediate lessons learned and to offer support to patients and staff.
  • The provider had high vacancy rates in forensic, neuropsychiatry, older adults and rehabilitation services. This was particularly high for registered nurses. The provider used bureau (St Andrew’s bank staff) and agency staff to fill vacant shifts. However, a significant number of shifts remained unfilled. Staff told us when shifts were not filled, staff moved between wards to meet patient need or wards worked short of staff. Staffing levels at night were particularly low.
  • In rehabilitation, adolescent and forensic services, staff did not always complete physical healthcare monitoring following administration of rapid tranquilisation or commencement of seclusion. Staff did not always complete physical healthcare monitoring for patients prescribed specific medications and staff did not complete the relevant chart regularly or appropriately. Staff in forensic services did not always document fully what patients had been offered or received. There were gaps in records where staff had not signed the entries. In rehabilitation services, staff did not always respond appropriately to a decline in a patient’s physical health and did not use observation tools to review and assess the response needed.
  • Not all staff had completed training in the Mental Health Act (MHA) or the Mental Capacity Act (MCA). Staff did not receive annual MHA training and the provider could not demonstrate that staff had received training in the revised MHA code of practice. This meant that staff were not working to the most recent guidelines. Staff did not read patients their rights under section 132 of the Mental Health Act in some wards. If patients did not understand their rights, staff did not always make further attempts. On PICU, forensic, rehabilitation and older adult’s wards staff had not uploaded the MHA legal detention papers in full to the electronic system. Some records had part of the paperwork uploaded.
  • In some services staff did not assess patient’s capacity to consent to treatment appropriately. Staff documented patients did not have capacity but did not give a rationale as to why they had made this decision nor document any discussion. Mental capacity assessments were not decision specific. Consultants did not always accurately complete medication consent paperwork (T2 and T3 forms). Staff kept some information in paper format.
  • The provider did not have an effective management supervision structure. Supervision was highlighted as an issue in learning disabilities, older adults and rehabilitation services. Supervisions occurred monthly by peers rather than line managers in some areas. We saw that some staff had different supervisors each month. This meant there was no consistency and managers could not be sure that supervisors were addressing performance issues.
  • Not all groups of staff felt engaged with the developments and changes to the service.

However:

  • There had been improvements since the last inspection. Leadership had been strengthened and new ways of working implemented to improve the patient experience. The provider had improved governance systems and carried out recruitment drives to attract staff. There had been an overall decline in the use of agency staff over the preceding 12 months.
  • Most wards were safe, visibly clean, homely and well furnished. Patients could access garden areas and open spaces. Patients held their own mobile phones wherever possible and had private access to a landline telephone that had direct lines to advocacy and other services. Wards had a range of rooms for care and treatment and rooms for patients to meet visitors in private. Wards had seclusion rooms, low stimulus rooms and extra care suites for patient use. Patients could personalise their bedrooms and had lockable spaces to secure possessions. The provider had procedures for children visiting. Staff provided a range of activities for patients and activities were available seven days a week.
  • On most wards, staff updated patients’ risk assessments regularly and included patients’ individual needs. Staff in forensic services completed regular ligature risk assessments and wards contained very few ligature risks. Staff managed known risks with nursing observations and individual risk assessments. Staff had quick access to ligature cutters and pocket masks (for use in mouth to mouth resuscitation) in different areas of the wards. Staff used positive behavioural support plans with patients effectively.
  • Staff undertook comprehensive assessments and developed care plans that were thorough, holistic and patient centred. With the exception of rehabilitation, adolescent and forensic services, staff monitored the physical health of patients regularly and developed physical health goals and treatment for patients. Staff used outcome measures such as health of the nation outcome scale and specific tools for acquired brain injury patients. Physical healthcare services included dentistry and podiatry. Practice nurses from the GP surgery attended the wards to address patients’ physical healthcare needs. Staff made prompt referrals for any further specialist physical healthcare input.
  • Staff were passionate about their job and knew patients well. Patients told us staff worked hard and were kind to them. Most staff treated patients with dignity and respect and were responsive to patients’ individual needs.
  • We saw leadership at ward manager level. Managers said they felt supported and staff said they felt valued. Senior staff monitored incidents and discussed outcomes in team meetings. Some senior staff gave examples of learning from incidents for their ward. Staff told us morale was increasing following a period of change over the last two years and told us their managers were supportive. Multidisciplinary teams worked effectively across all wards.
  • The provider had ongoing recruitment and retention programmes to attract new staff. Staff received training in safeguarding and made appropriate referrals. There was a range of psychological interventions available for patients which patients were encouraged to attend. Staff trained in British sign language (BSL) were available to patients on Fairbairn ward. The provider had an induction programme for new staff and was supportive of further learning opportunities for all permanent staff. Staff received annual appraisals and most staff received regular supervision. Staff attended regular team meetings and recorded any actions and outcomes from these.
  • In some wards, Mental Health Act 1983 (MHA) paperwork was in order and stored securely. MHA administrators had a thorough scrutiny process. Some staff used the Mental Capacity Act to assess capacity for individual decisions. There were appropriate systems for managing and recording complaints. Patients had access to independent advocacy services. This meant that they were able to receive independent support to help them express their views and assist with any appeal against their detention under the MHA if they so wished.
  • Managers had access to dashboards for their teams, which gave details of staff compliance with mandatory training. Nurse managers reported they received prompts from the provider’s training department when staff’s mandatory training or refreshers were due.
  • The provider managed quality and safety using a variety of tools. There was a dashboard for monitoring ward performance, quality and safety against agreed targets. There was a monthly lessons learnt bulletin for staff. Staff told us they knew the whistleblowing policy and felt they could raise concerns without fear of victimisation. Managers were visible on the wards and staff felt supported by operational managers and clinical nurse leads.
  • The managers told us, and we saw the documents to show, they were offering an ‘Aspire campaign’, which supported healthcare support workers to undertake their nurse training. The provider would pay these staff a bursary to support their training, following which they would return to work at St Andrew’s for a minimum of two further years. The provider had plans to support 20 staff a year in this scheme.

9 -12 September 2014

During a routine inspection

  • We found ligature risk and environment audits were undertaken every six months We saw that some ligature risks had been identified and there were contingency plans in place to manage these.
  • The clinic rooms were fully equipped and resuscitation equipment was checked regularly and recorded however not all wards had equipment. There were a number of locked doors, stairs and potentially an unpredictable patient group, which may impact how quickly the equipment arrived where it was needed.
  • Not all wards had a seclusion facility available for use. Grafton and Hereward Wake wards did not have a seclusion room. On Hereward Wake, this meant that a patient requiring seclusion was being transported to a different location by secure transport. We heard on rare occasions the transport was unavailable leaving both the staff and patient at risk.
  • We were told that some agency staff and some bureau staff did not have access to the electronic notes system meaning that patient information would not be readily available in an emergency. Patients told us that due to high levels of bank and agency staff who did not know them caused them to be cared for and treated differently.
  • Patients told us that the CAMHS service were insufficiently staffed which meant that they were not always able to have their granted leave. Managers agreed that at times it was difficult to ensure the safety of the ward, whilst meeting the needs of the patients.
  • Some staff and patients told us that they did not feel safe on the learning disability wards
  • We saw rotas which showed the wards were regularly using bank or agency staff, Mackaness had three members or regular staff on duty and six agency staff on the day of our visit.
  • Fairbairn Ward management informed us the electronic system did not allow them to specify staff trained in British Sign Language. This meant patients were not always able to communicate effectively with staff to make their needs known.
  • Staff received training in de-escalation skills and conflict resolution
  • We found that in the CAMHS service prone restraint was still being used when retraining young people. We also found that risk assessments and Care plans around this restraint were not always in place.
  • We found that routine restrictive practices were in place to manage risk, behaviours related to daily care and treatments were measured using generic levels.
  • On the learning disability ward some staff did not know the safeguarding process or where they could find out about current ward issues.
  • Some staff did not demonstrate understanding about appropriate use of seclusion facilities in the learning disability services.
  • On Seacole Ward, there were errors in the recording of medication administration
  • Sitwell ward was not consistently documenting patients review of restraint
  • Sitwell ward was not following St Andrew’s Seclusion policy with regard seclusion reviews with patients.
  • Staff throughout the organisation were aware of how to report incidents and we saw good examples of staff learning from the investigation of adverse events
  • We found that the CQC had not been sent notifications relating to incidents affecting the service or the people who use it within the learning disability service.
  • We found in the older adults services that care plans were detailed, personalised and accurate to the care we observed being provided
  • We found in the learning disability service some care plans were generic and not person centred, in particular the risk safety system.
  • Staff working in the neuropsychiatry services had an understanding of current NICE guidelines.
  • The neuropsychiatry services used positive behavioural therapy for the rehabilitation of patients with acquired brain injury.
  • Nursing and support staff we spoke with in the CAMHS services did not have any understanding of positive behaviour support.
  • There did not appear to be an opportunity for patients to appeal against decisions made about their risk levels, or clear individual behaviour markers and goals for changes in levels.
  • Learning disability patients told us that the restrictions around the risk safety system made them angry.
  • We found that the risk based safety system is being used to manage non risk behaviours such as non-engagement.
  • We were told that there were issues around maintaining staff on Fairburn ward who were trained in British sign language (BSL). It often occurred that staff were trained up to a level to work with patients, then moved to work on other wards.
  • Appraisal of performance was undertaken annually.
  • Staff stated that that the training offered by St Andrew’s was excellent.
  • During our visit, we witnessed several occasions where staff responded to patient’s distress and they did so discreetly and appeared to be always mindful of the patient’s dignity.
  • In the learning disability services there was not a clear and effective system for comprehensive handovers between nursing staff due to the set nursing shifts.
  • We found on Tavener ward that informal patients were asked to sign a contract for granted leave, which does not reflect the Mental Health Act.
  • Patients on the PICU did not have access to a lockable space in their bedrooms and they did not always have their room key.
  • We saw patient’s views were included in care plans and this included relatives where appropriate.
  • Community meetings were held weekly services where patients could raise issues related to the ward, minutes were available for us to view.
  • There was little evidence that patients or their carers were actively involved in writing or reviewing their care plans on the learning disability wards. Most patients did not have a copy of their care plan or knew what their goals were. Those that did have care plans on Bradlaugh found that it was not in accessible format.
  • We looked at the Mental Health Act paperwork for patients and found it to be accurate and complete in all sections.
  • Staff were trained in the Mental Capacity Act and the Deprivation of Liberties Safeguards (DoLS).
  • Wards had examples of restrictive practices such as kitchens being locked and reliant on staff for hot drinks on Berkley close. On Althorp ward sweets were not allowed and the times for hot drinks were restricted.
  • Blanket restrictions were also seen on the CAMHS units, for example on one ward young people were prevented from having sugar and there were restrictions around the length and time of day that young people could make telephone calls.
  • Independent advocacy services were available to all patients.
  • A relative we spoke with told us the team on the ward liaised well with her relative’s professional team in their home area to ensure the care was effective and were accurately informed of their progress.
  • There remain issues around mixed gender accommodation on some older adults wards.
  • Patients told us that they felt the wards could be cleaner and the furniture in places was damaged and not replaced.
  • There had been an increase in the group of patients with Huntingdon’s disease on Tallis ward which affected the clinical risks on the ward and this was raised as a concern, this was being addressed by staff receiving extra training in this area.
  • We found that the CAMHS service had a number of “extra care” beds, these were generally patients segregated from the main ward area and cared for in isolation. The policy around such practice was ambiguous and this was confirmed by the records we viewed.
  • Each ward had a book dedicated to learning from incidents and complaints generated across the hospital site. This ensured learning not just from their own ward but from other services. We saw action plans arising from complaints and the resultant changes on the wards.
  • We found that the space on the older adults wards was a challenge to make feel homely, however we saw they had utilised the ends of corridors to create small areas of interest
  • Learning disability wards were part of the overall deregation project and were not suitable to meet patient’s needs, for example they were not accessible for patients with significant physical disabilities or requiring wheelchair access.
  • In the learning disability services significant blanket restrictions were seen for example cigarette breaks were taken hourly, drinks were at set times, access to bedrooms were restricted and no access to kitchens or sensory rooms unless accompanied by an occupational therapist.
  • Some staff in the learning disability services told us that there was little engagement with senior managers or the organisations values and they did not feel able to engage with the wider organisational systems.
  • The ward managers in the older adult’s service told us they felt supported in their roles and had excellent support from the directors of the service.
  • The PICU hospital director offered regular open clinical between 7pm and 9pm which were open for staff to attend.
  • There were recognised difficulties in the learning disability services in ensuring that the wards had the correct staff skill mix for the patient’s needs. There were regularly high numbers of bank and agency staff used across these wards.
  • We saw that staff in the neuropsychiatry services and PICU were using tablet computers to monitor outcome measures electronically while on the ward which meant that they saved time by not returning to the desktop computer and logging into the electronic note system.
  • The PICU ward was affiliated to the National Association of Psychiatric Intensive Care and Low Secure Units (NAPICU). This is an organisation which is involved in promoting and developing work within the PICU settings.
  • Hawkins and Makeness wards had recently participated in the overall William Wake House “self” and “peer review” parts of the quality network assessment for forensic mental health services.

7 February 2014

During an inspection looking at part of the service

We went back to review the improvements that the provider had made following an inspection visit to Elgar ward during July 2013. Elgar ward is a 12 bedded ward for patients aged 13-18 years of age who have an acquired brain injury. The inspection team was comprised of a compliance inspector and a specialist mental health advisor.

We spoke with two patients, six members of staff and the ward manager. We also reviewed a variety of patient and staffing records which were available on the ward.

One patient told us they liked the staff that worked on the ward. They also told us that the staff were supporting them to go on a visit to the cinema later that day and they were looking forward to doing this activity. They also told us that the ward could be improved by 'making it more homely' and that 'they had put up some posters' which had improved the environment. Another patient told us that some staff had 'shouted at me' and they had told the ward social worker and the advocate about this. The staff confirmed that the appropriate action had been taken to safeguard this young patient.

We found that staff had improved safeguarding procedures to safeguard patients from the risk of abuse and that improvements to staffing had been made on the ward. We also found that there were plans to improve the safety and suitability of premises. We also found that improvements were required to maintain accurate seclusion records on the ward.

2 July 2013

During a routine inspection

During our inspection visit of St Andrews Neuropsychiatry services, we visited Elgar ward, which is a 12 bedded ward for younger people who have an acquired brain injury. On the day of the visit there were six young people receiving treatment and care. We spoke with three young people and four of their relatives. We also spoke with five staff, the ward manager and reviewed the care records of three young people.

Most young people and their relatives told us that they were happy with the treatment and care that they received. However, we found that some young people had made safeguarding allegations about some members of staff on the ward. We found that the young people had been supported by staff and an independent advocate to discuss their concerns. We also found that the provider had put in place safeguarding measures to ensure the safety of young people and staff whilst these concerns were being investigated.

We found that the young people were involved in their planning of care and that they received treatment and care that protected their health and wellbeing. We had concerns that there were not enough staff working on the ward, that safeguarding procedures were not always followed by staff and that improvements were needed to maintain the safety and suitability of the premises. We also had concerns that records on the ward were not always being maintained and updated.

25 May 2012

During a routine inspection

The inspection was carried out by two inspectors from the Care Quality Commission (CQC). On this inspection we visited Tavener, Allitsen and Elgar wards over a period of two days.

We were supported by a Mental Health Act Commissioner who was contracted by CQC to undertake the monitoring of the Mental Health Act (MHA)1983 in hospitals who care for detained patients.

The Mental Health Act Commissioner met in private with detained patients, examined statutory documentation relating to their detention, reviewed the ward environment and spoke with ward staff.

We were also supported by an 'expert-by-experience'. They had personal experience of using or caring for someone who had used mental health services.

The patients we spoke with told us that they felt respected by staff. They told us that the staff listened to them when they had any queries. They also stated that their opinions about their care were valued and any concerns or complaints raised were investigated by management. Most patients said that they had been involved in decisions, which supported their care and treatment.

The care records of patients we looked at showed that they had their needs assessed prior to admission and their care and treatment was planned, and delivered in line with their individual care plans. The records also showed that appointments were routinely arranged for patients to see a number of health care professionals to ensure their health care needs were being met.

Mental Health Act Commissioner reports

Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff.

Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We are looking at different ways to indicate the outcomes of our monitoring in the future.