The Priory Hospital Altrincham

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This means we looked for evidence that the service met people’s needs.

At our last assessment we rated this key question Good. At this assessment the rating has changed to Requires Improvement.

Requires improvement: This meant people’s needs were not always met.

At this assessment, the service was in breach of legal regulation in relation to person-centred care (Regulation 9).

We have not awarded this service a score for Responsive.

Find out about when we will not publish a key question score and what we look at when we assess Responsive.

We do not always maximise the effectiveness of people's care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them.

• The service did not always make reasonable adjustments for patients with protected characteristics. A neurodiverse patient on Tatton ward did not have their diagnosis reflected in their care plans, there were no reasonable adjustments in place, and their care records did not include plans personalised to their individual needs in respect of their diagnosis. Two patients on Dunham ward with neurodivergent diagnoses had care plans that did not include assessment of personalised interventions to support their needs in this area. For example, one patient told us their access to group therapy was restricted due to their presentation, but this was not addressed in their care plan or supported with strategies to help them engage.
• On Tatton ward, we reviewed care records for patients identified as presenting a high risk of aggression. While the Keeping Safe care plan noted restrictions on the patient's movements and access to possessions, it did not identify triggers for aggression or guidance for staff on how to manage and de-escalate aggression. As a result, there was a risk of inconsistent staff responses during high-risk incidents.
• On Dunham ward, we reviewed the care records of a patient who had expressed a preference for a specific medicine, which was not prescribed. A rationale for this decision was not provided in the care records. As a result, the patient reported feeling they were not listened to and unsure about the decisions made regarding their prescribed medicines.
• On Dunham ward, we reviewed care plans for patients with physical health diagnoses or complications and found that some had not been appropriately followed up. For example, detailed pain management plans were not included in care plans and equipment recommended by occupational therapy had not been supplied by the provider where this additional support was indicated by the patient's needs.
• Access to group therapy was limited for wheelchair users, as sessions were held in rooms reached by a ramp with a step at the top, which prevented full accessibility. One patient told us that while alternative one to one sessions were arranged by therapy to take place on the ward, they would have preferred to be included in the group programme.
• We noted that 'Keeping Connected' care plans did not consistently reference relevant mental health symptoms or neurodiversity, where these were significant to the person's care and relationship needs.
• Care records did not always reflect patient care needs, particularly for neurodiverse patients or patients with non-alcohol substance misuse on Dunham ward. Repetitive entries across sections such as ‘What the nursing team will do', ‘What the medical team will do', indicated use of non-personalised, standard content.
• We observed a person-centred ward round where patients and carers were given time and opportunity to share their views and experiences and raise any issues they had.

We understand the diverse health and care needs of people and our local communities, so care is joined-up, flexible and supports choice and continuity.

• A varied programme of indoor and outdoor activities was offered, though weekend options were more limited and typically self- or peer-directed without therapy staff support. Patients had access to computer rooms and gym equipment in the ward gardens.
• Staff supported patients to maintain contact with their families and carers. We saw family were involved in ward rounds. Four carers told us they were able to contact and visit their relative without difficulty.
• Patients were not supported to attend their chosen place of worship in the community, however they were invited to speak with a member of staff if they wished to worship in the local area. A chaplaincy service was available and well-advertised, with posters including a photograph to aid recognition during ward visits.

We provide appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

• Staff made notifications to external bodies as needed. These included notifications to the Care Quality Commission.
• Staff ensured that people had access to information about their treatment, local services, patients’ rights, how to make a complaint, and other relevant topics. Welcome packs were available on each ward, and key information was also displayed on ward notice boards.
• Information governance systems included confidentiality of patient records. Patient care and medicine records were electronic and could only be accessed by staff who had completed the information governance training and had been provided with a login.
• Staff ensured that patients could obtain information on treatments, local services, patients’ rights, how to complain and other relevant information. Information leaflets were available on the wards and included information pamphlets for patients detained under Mental Health Act sections, checklists of banned and restricted items, Data Protection Act 2018 information forms, and a Safeguarding Statement sheet.
• Carers were provided with information on how to contact the ward and were encouraged and welcomed to attend care review meetings. However, 1 carer reported limited information sharing prior to discharge.
• Ward notice boards provided up to date information and some posters and boards were colourful and used interesting formats.
• One carer reported that their relative was provided with a folder of information and advice on discharge from Dunham ward.

We do not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. We did not always involve people in decisions about their care or tell them what had changed as a result.

• Most of the patients we spoke to told us they had been provided with a copy of their care plan and had the opportunity to discuss these, specifically in ward meetings. However, 1 patient had not received a copy of their care plan, and 2 others reported not being involved in the development of their care plans. Two patients felt their views were not considered, and 1 reported that their preferences had not been taken into account.
• The service had received a total of 30 complaints across the 2 acute wards in the last 12 months, and 59 compliments in the same period. It is not evident from data provided by the provider how many of the 30 complaints were upheld following investigation. Examples of complaints received included the following areas: quality of care and treatment; medicines; staff attitudes, behaviours, and responsiveness; the hospital environment and facilities. Specific compliments were received from patients who had undertaken the Alcohol Treatment Programme, and compliments especially referred to the quality of care and treatment. Compliments were also received from student nurses who had valued the teaching and learning experience at the hospital.
• Ward community meetings were held regularly and were generally well attended. We reviewed detailed minutes from ward meetings. The minutes format did not clearly show whether actions had been completed. Separate meetings were also held for patients participating in the Alcohol Treatment Programme. We saw in meeting minutes that patients raised concerns about noise and light disturbance at night on more than one occasion. This indicated that environmental factors impacting sleep were not being effectively addressed, which could affect patients' rest, recovery, and overall well-being.
• Patients and carers knew how to complain or raise concerns. They told us they would feel comfortable raising concerns with staff including the ward manager. The ward welcome booklets had a section on complaints and how to give feedback including to the CQC however the booklet did not include CQC contact details of who to give feedback to.
• Patients were invited to provide feedback on services. We saw posters on the wards with links and QR codes for giving comments.
• Staff ensured patients had access to advocacy services. Two advocacy providers supported the hospital, though one was due to discontinue shortly after our assessment. Contact details were displayed on the wards, and patients reported seeing advocates regularly on the wards.
• The provider enabled patients to give feedback on the service they received, via the Patient Feedback Form. This form was used to provide feedback in ward Community Meetings and for the Clinical Governance Committee.
• Staff received feedback on the outcome of investigation of complaints via team meetings. We saw evidence in Tatton ward team meeting minutes of complaint outcomes discussed under the section Lessons Learnt Feedback. We did not see complaints discussed in Dunham ward team meeting minutes.

We do not always make sure that everyone can access the care, support and treatment they need when they need it. 

• Dunham Ward had one wheelchair-accessible room. At the time of inspection, two people required wheelchair-accessible accommodation. This meant that one of these patients was assigned a bedroom, which did not have a fully accessible bathroom.
• Environmental limitations impacted people’s access to some areas of the service. For example, the therapy room was not wheelchair accessible, and the main café could only be reached via a back entrance. This affected patients’ experience of independence and inclusion.
• Patients told that staff invited them to request support if they needed it. However, patients reported that responses were inconsistent when the ward was busy or when staff were redeployed on other wards in the hospital.
• Therapy staff facilitated ward-based art sessions for a patient who was unable to attend group sessions due to accessibility issues. However, the patient expressed a preference for having been able to participate in the group experience.
• Patients diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) reported difficult accessing the group therapy, and their individual needs were not supported in these sessions.
• The service could not deliver the full recommended treatment as there was no psychologist within the team to deliver psychological interventions including one to one intervention and groups. For example, National Institute for Health and Care Excellence Guidelines: Psychosis and schizophrenia in adults (Quality Standard QS80); Depression in adults (Quality Standard QS8); Anxiety disorders (Quality Standard QS53).

We do not always actively seek out and listen to information about people who are most likely to experience inequality in experience or outcomes. We do not always tailor the care, support and treatment in response to this.

• The needs of patients with disabilities were not always met. Wheelchair users sometimes lacked suitable bedroom facilities and faced restricted access to some areas of the hospital and therapy rooms.
• Community meetings were held regularly, providing patients with an opportunity to give feedback. However, it was not always clear whether actions had been followed up, as these were not consistently documented.
• The lack of support and barriers to meaningful involvement for neurodivergent people limited their abilities to experience the same quality of care and outcomes as their peers.
• The provider had undertaken equality impact assessments of their policies and procedures to ensure they did not place vulnerable people or people with protected characteristics at a disadvantage.
• Staff were trained in equality, diversity and inclusion and both Tatton and Dunham wards had 100% compliance.

We support people to plan for important life changes, so they can have enough time to make informed decisions about their future.

• Staff generally involved relevant professionals in planning care for people with complex needs. However, the absence of psychological services on Tatton ward limited access to a full range of multidisciplinary interventions, reducing opportunities for patients to benefit from comprehensive therapeutic support.
• Staff mostly created personalised care plans that took account of patients' needs, wishes, and feelings. Care plans were goal orientated and identified actions for patients and clinical, nursing, and therapy teams to help achieve these. Care plans focused on Keeping Safe, Keeping Well, Keeping Healthy, and Keeping Connected. However, 3 of the 12 patients we spoke to reported that they either had not received a copy of their care plan, or that they had not been involved in the development of their care plan.
• The Alcohol Treatment Programme and General Inpatient Therapy Programme on Dunham ward included a range of structured sessions aimed at supporting sustainable recovery and promoting long-term benefits. These included Cognitive Behavioural Therapy, psychoeducation on anxiety management, emotion regulation, mindfulness, and strategies for maintaining recovery progress.