The Priory Hospital Hemel Hempstead

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Staff knew how to report incidents and lessons learnt were shared. Staff knew how to protect people from abuse and neglect. Staff completed and updated individual risk assessments. There were thorough environmental risk assessments in place and the use of restrictive interventions were a last resort. There were enough suitably qualified and trained staff to keep patients safe and patients told us they felt safe.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had a proactive and positive culture of safety based on openness and honesty, in which concerns about safety were listened to. Safety incidents were investigated and reported thoroughly, and lessons were learned to continually identify and embed good practices.

There were systems in place for the recording and reporting of incidents. We reviewed incident data from December 2024 to June 2025. This showed that incidents were recorded against different category types. We saw staff recorded immediate actions that had been taken and lessons learnt. There was evidence that changes had been made because of learning from incidents, including action that had been taken following 2 unexpected deaths. Staff had access to an electronic reporting incident system. Staff we spoke with knew what incidents to report and how to report them.

Staff received feedback from investigation of incidents, both internal and from other sites across the wider organisation. We saw examples of key patient safety messages that were shared with staff. Staff met to discuss that feedback. We saw that lessons learnt feedback was a standing agenda item at staff team meetings and incidents were also discussed at flash meetings. Staff told us lessons were shared at handovers. We reviewed handover notes for both wards, day and night shifts and saw that individual risks and incidents were shared with staff.

Staff were debriefed and received support after incidents.

The service worked with people and their partners to establish and maintain safe systems of care, in which safety was managed, monitored and assured. The service ensured continuity of care, including when people moved between different services.

The service had operational procedures in place to support safe systems, transitions and pathways for rehabilitation and recovery. Staff worked within multidisciplinary teams including, nursing staff, healthcare assistants, medical staff, occupational therapists, psychologists, activities co-ordinators and social workers and worked well together to look at the patient pathway and deliver the service.

The service’s referral and admission processes ensured that all essential information about the patient was received to determine if the patient’s needs could safely be met. There was a clear care pathway in place from admission through to discharge.

Staff involved all the necessary healthcare and social care services to ensure patients had continuity of safe care. Staff work across the wider Provider network to ensure patients’ needs were met within pathways.

The service worked with people to understand what being safe meant to them as well as with partners on the best way to achieve this. The service concentrated on improving people's lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect and they made sure to share concerns quickly and appropriately.

The service's processes promoted people living free from abuse, neglect, and avoidable harm. We saw evidence that there were systems, policies, and practices in place to make sure people were protected from abuse and neglect. The service had a comprehensive safeguarding procedure and a range of policies to protect adults and children. The service had a visiting policy in place for children.

Staff were trained in safeguarding, knew how to make a safeguarding alert, and did that when appropriate. Staff knew how to identify adults and children at risk of, or suffering, significant harm.

Staff were kept up to date with mandatory training for safeguarding adults and children. Staff were kept up to date with both training on the Mental Capacity Act, Mental Health Act and the Oliver McGowan Mandatory Training on Learning Disability and Autism.

We reviewed the service safeguarding log which included the total number of safeguarding concerns raised, immediate action taken and outcomes. We saw this included working in partnership with other agencies.

The service worked with people to understand and manage risks by thinking holistically so that care met their needs in a way that was safe and supportive and enabled them to do the things that matter to them.

During the assessment we reviewed 6 risk assessments and saw that patients had a risk assessment in place on admission, and these were thorough and regularly updated. There were management plans in place for identified risks and needs of individuals. Risks included for example choking, falls and dysphagia (difficulty swallowing). However, we found 1 management plan needed updating following a change to a patient’s Section 17 leave arrangements

The service had a reducing restrictive practice policy in place. Its aim was to support the reduction of restrictive practices to ensure that least restrictive principles and practices were supported. Staff we spoke with described the de-escalation techniques they used and told us that restraint was used only as a last resort.

There was evidence of appropriate restrictions to manage individual risks that had been care planned. There was no evidence of undue restrictive interventions within patient records.

We reviewed the service incident data from December 2024 to June 2025. In the 6 months prior to assessment there had been 18 incidences of restraint on 6 individual patients. None of these incidents were in the prone position. Eight of these incidences resulted in the use of rapid tranquilisation.

The service kept a register of blanket restrictions. We saw the use of restrictive interventions and the use of any blanket restrictions on the ward were regularly reviewed by the clinical governance committee and discussed at staff team meetings.

Staff received mandatory training on Reducing Restrictive Interventions. At the time of the assessment the training compliance rate was 88%.

There were clear procedures for supportive observations and engagement, staff we spoke with knew these.

Staff enabled patients to give feedback on the service they received. We reviewed examples of community meeting minutes and patient survey results, including actions taken because of feedback. This included action to improve the number of patients reporting that they felt involved in decisions and planning about their care, at the time of the survey in August 2024 this was 67% of respondents. Within patient records we saw evidence of patient involvement in the formulation of risk assessments and care planning and attempts made by staff to support patients to respond. Where possible, this was recorded in the patient’s own words.

The service detected and controlled potential risks in the care environment and made sure that the equipment, facilities and technology supported the delivery of safe care.

Staff did regular risk assessments of the environment. They completed and regularly updated ligature risk assessments for all internal and external areas. We saw examples of this. Identified risks were removed or reduced. For example, mirrors were installed to mitigate blind spots where staff could not easily observe patients.

Staff we spoke with knew about any potential ligature anchor points and mitigated the risks to keep patients safe. Staff assessed risks to patients and took action to reduce risks where possible.

Staff had easy access to alarms and patients had easy access to nurse call systems.

The wards complied with guidance on eliminating mixed-sex accommodation. The wards were segregated by male and female areas. All bedrooms were single person occupancy with en-suite facilities.

We observed both wards to be clean, tidy, safe and well furnished.

Managers made sure there were enough qualified, skilled and experienced people, who received effective support, supervision and development and worked together effectively to provide safe care that met people’s individual needs.

Managers calculated the number and grade of nurses and healthcare assistants required for each shift. At the time of assessment, there were vacancies for registered nurses . There were vacancies for 1.6 whole time equivalent (WTE) on Dove ward and 1.1 WTE on Robin ward and for healthcare assistants 5.1 WTE on Dove ward and 3.64 WTE on Robin ward. When necessary, managers deployed bank and agency staff to maintain safe staffing levels. Managers tried to book regular bank and agency staff, when required. For the 3 months prior to the assessment there were no unfilled shifts. Managers were attempting to reduce the use of agency staff through active recruitment, retention incentives and apprentice training programmes.

The service had low turnover rates, 2.16% for Dove ward and 3.35% for Robin ward for the 3 months prior to assessment.

The service had a lead nurse with responsibility for physical health to meet patients’ physical health needs. There was adequate medical cover day and night and at weekends. A doctor could attend the ward quickly in an emergency.

Staffing levels allowed patients to have regular 1:1 time and participate in activities on and off the ward.

There were enough staff to carry out physical interventions such as observations, restraint and seclusion if needed, safely. Staff received the necessary training and induction to do this effectively.

Staff had received and were up to date with all mandatory training courses. The training was appropriate for the patient group using the service.

The service assessed and managed the risk of infection, prevented and controlled the risk of it spreading and shared any concerns with appropriate agencies promptly.

Staff maintained equipment well and kept it clean. Any ‘clean’ stickers were visible and in date.

We observed all ward areas were clean, tidy and kept well-maintained.

The service had a programme of Infection, Prevention and Control audits, led by an infection prevention and control nurse advisor. These included cleanliness for all areas (both patient and non-patient areas), hand hygiene, mattress audit and an annual compliance audit.

The service made sure that medicines and treatments were safe and met people's needs, capacities and preferences. They involved people in planning, including when changes happened.

Systems and processes were in place to ensure the safe prescription, storage, and administration of medicines. This included secure storage of medicines, particularly controlled drugs, which require additional safeguards due to their potential for misuse. However, it was observed that clinical waste awaiting collection was not stored securely and access was not restricted. Following the onsite assessment, we raised the suitability of clinical waste storage, and the Provider promptly addressed these concerns.

We saw 1 person on Robin ward had medical gas and it was being stored safely, and staff were knowledgeable about when and how to administer it to the patient. However, it had not been prescribed and there was no information about it in the persons care plan. Medical gases, like other medicines need to be prescribed to ensure the safe and appropriate use.

Staff reviewed the effects of medication on patient's physical health regularly and in line with National Institute for Health and Care Excellence (NICE) guidance. Information about high-risk medicines, including antipsychotic medication was documented in people's physical health care plans to ensure staff carried out the necessary monitoring. For example, we saw bowel monitoring for patients on clozapine was completed.

We saw people detained under the Mental Health Act (MHA), had been prescribed and administered medicines in line with MHA consent to treatment authorisations.

Nursing staff responsible for the administration of medicines were appropriately trained and assessed as competent on an annual basis. An external pharmacy supported the service and attended monthly to review medicines optimisation in the hospital. Any actions raised by the pharmacy team were implemented and shared with the clinical team.