- Independent mental health service
The Priory Hospital Altrincham
Assessment report published 28 August 2025
Contents
Ratings - Child and adolescent mental health wards
Our view of the service
We rated the ward for children and adolescents as requires improvement because parents, young people and stakeholders told us that there was a lack of psychological interventions on the ward and there was no psychologist in the team, and there had been significant staff turnover with consultant psychiatrists, the ward manager and hospital managers leaving. There was a lack of consistency with staffing, with bank, agency and staff from other wards working on the ward which meant young people did not have consistency of support and found it difficult to follow their agreed plans with staff they were not familiar with.
Agency staff were not always supported on the ward, they did not always have an induction into the ward or given clear guidance on how best to support the young people.
Care records did not always reflect the needs of the young people. Handovers did not always include an accurate summary of events. Handover and daily allocation records were not always completed fully.
Staff were not following the dress code policy and managers did not ensure this was fully implemented.
However, staff received regular supervision and training.
We saw examples of staff communicating positively and compassionately with young people.
Mental Health Act and Mental Capacity Act Compliance
Mental Health Act
- 94% of staff had received training in the Mental Health Act.
- Staff were trained in and had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles.
- Staff had easy access to administrative support and legal advice on implementation of the Mental Health Act and its Code of Practice. Staff knew who their Mental Health Act administrators were.
- The provider had relevant policies and procedures that reflected the most recent guidance. However, there were several Mental Health Act policies and procedures that were not updated in accordance with policy review dates.
- Staff had easy access to local Mental Health Act policies and procedures and to the Code of Practice.
- Patients had easy access to information about independent mental health advocacy. We saw information on display on the ward, including details of the advocates and a “you said, we did” display.
- Staff explained to patients their rights under the Mental Health Act in a way that they could understand, repeated it as required and recorded that they had done it.
- Staff ensured that patients were able to take Section 17 leave (permission for patients to leave hospital) when this has been granted.
- Staff requested an opinion from a second opinion appointed doctor when necessary.
Mental Capacity Act
- 94% of staff had had training in the Mental Capacity Act.
- Staff had a good understanding of the Mental Capacity Act, in particular the five statutory principles.
- The provider had a policy on the Mental Capacity Act. Staff were aware of the policy and had access to it.
- Staff knew where to get advice from within the provider regarding the Mental Capacity Act.
- Staff took all practical steps to enable patients to make their own decisions.
- The provider had a Gillick competency policy for consent in healthcare settings (a test in medical law to decide whether a child of 16 years or younger is competent to consent to medical examination or treatment without the need for parental consent or knowledge).
People's experience of this service
We spoke with 2 young people during the on site assessment and 4 carers following the on site assessment.
We received feedback from 6 stakeholders. We conducted a Short Observation Framework for Inspection 2 (SOFI2) observation in the service, which is a structured observation which captures people’s experience of care during the on site assessment.
Young People’s Experience
We spoke with 2 young people during the on site assessment. They told us that the staffing changes and use of staff that they did not know was difficult. Also the young people told us that the unfamiliar staff on the ward did not always understand about eating disorders and did not appreciate the struggles and challenges they were facing.
Young people told us about the lack of psychology input into the ward and said the staff changes meant they needed to start again with therapy, which had a negative impact on their progress and recovery.
However, they had felt included in decisions about their care and enjoyed the trips out that were available from the ward.
Young people also felt confident in raising concerns.
Carer Experience
We spoke with 4 carers following the on site assessment. All carers had concerns about the service. Concerns included poor communication, especially with the multidisciplinary team and not feeling like the team were working as a team for the benefit of their loved one. Actions were not completed, and feedback given following reviews was not acted upon.
Meeting facilities were poor, with reviews taking place in a portacabin and the technology was poor which meant carers struggled to join the meetings remotely.
Carers told us the staffing changes were very difficult as there was a lack of consistency, and this impacted negatively on their loved one’s recovery. There had been examples of inappropriate comments and conversations from staff, for example in relation to food and body image; staff did not seem to understand the negative impact this had on their loved ones.
Carers told us the service did not understand the impact of some of the changes on neurodivergent young people and the service did not make reasonable adjustments for their needs.
Carers told us their loved ones had not improved during admission, with some young people requiring a transfer of care and said the psychological impact of the admission on their loved one outweighed any progress that had been made.
However, carers told us that some staff were very caring and responsive to their loved one’s needs.
Stakeholder Experience
We received feedback from 6 stakeholders.
Stakeholders told us that the multidisciplinary team were not working together for the benefit of the young people, including from an information technology perspective. They said there were challenges with joining the review meetings remotely and also staff did not consistently complete actions following the meetings.
There was a lack of a clear model of care being delivered and a lack of formulations created to inform the young people’s care, and the intervention approaches offered. Stakeholders told us this contributed to the lack of progress in young people’s recovery.
They told us that staff changes have had a detrimental impact on young people receiving the required interventions.
Stakeholders identified a training need in supporting neurodivergent young people and understanding the connection between neurodiversity and eating disorders. Stakeholders shared a need for improvement in responding to young people in distress and the follow up of this for both young people and staff in relation to debriefs.
However, the team mostly responded to requests for information.
The team worked well with community teams and stakeholders were involved in review meetings.
Stakeholders shared the positive impact the activity coordinator had on the ward and their motivation in encouraging young people to be involved in activities both on and off the ward.
Stakeholders had observed kind and compassionate staff interactions with young people and had noted the positive impact that the new ward manager had made on improving the quality of care records and starting to address some of the areas for improvement.
Observation
We conducted a Short Observation Framework for Inspection 2 (SOFI2) observation in the service, which is a structured observation which captures people’s experience of care during the on site assessment. Our observations showed staff were not present in communal areas of the ward at all times. There were times after young people had received their nasogastric feed or eaten their meal, when young people were in the lounge area without any staff present. This meant young people were not being supervised and staff were not available if they required any assistance at this most difficult time of the day for young people with an eating disorder diagnosis. When there were staff in the communal area there was only very brief engagement with the young people using the service.