The Priory Hospital Altrincham

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people's care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question Good. At this assessment the rating has remained Good.

Good: This meant people's outcomes were consistently good, and people's feedback confirmed this.

We have not awarded this service a score for Effective.

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

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

• We reviewed 5 care records during the assessment.
• Staff assessed patients’ physical health needs in a timely manner after admission.
• Staff developed care plans that did not always meet the needs identified during assessment. Examples included care plans which did not detail how to support people to reduce risks, and which did not explain to staff what they were observing or the frequency of review, possible changes in risk or any action required.
• Care plans were mostly personalised, holistic and recovery-oriented. They included goals.
• Staff updated care plans when necessary. There had been a recent focus on care plans, following a new ward manager joining and supporting staff through the process.

We did not always plan and deliver people’s care and treatment with them, including what is important and matters to them and in line with legislation and current evidence-based good practice and standards.

• Staff did not provide a range of care and treatment interventions suitable for the patient group. There was no psychologist working on the ward. This meant there were no psychological interventions being delivered. There was no evidence of support provided by the service to help the young people in understanding their eating disorder and symptoms, for example, managing eating disorder thoughts or challenging anorexic thinking groups or 1:1 opportunities for young people to explore these and other topics including body image. Stakeholders and families told us that the service did not deliver the therapeutic interventions they were expecting. The service focused on restoring weight of young people via nasogastric feeds. The interventions were not offered in line with guidance from the National Institute for Health and Care Excellence. NG69 Eating Disorders Recognition and Treatmentwhich states treatment should include psychoeducation about the disorder. Royal College of Psychiatrists Medical Emergencies in Eating Disorders: Guidance on Recognition and Managementstates “All patients with eating disorders should be offered NICE approved psychological treatment at the earliest opportunity.” This was not happening.
• Staff did not always ensure that patients had good access to physical healthcare, including access to specialists when needed. Concerns were raised regarding a young person who was exercising excessively, leading to physical health complications, stakeholders and families were concerned that the service did not act in a timely manner.
• Staff participated in clinical audit, including audits of the clinic room.
• The team did not include or have access to the full range of specialists required to meet the needs of patients in the service. There was no psychologist on the ward. An agency member of staff was due to start but that had been delayed. There had been several ward managers, consultants and psychologists. Young people, families and stakeholders told us this was very difficult and did not support young people’s recovery.
• Staff were not all experienced and qualified, or had the right skills and knowledge to meet the needs of the patient group. Rotas showed the use of agency staff and staff were also moved from other wards to staff the ward, some staff members told us that these colleagues were not experienced working in a setting for people with an eating disorder and had not received training in this.
• Managers did not provide new staff with appropriate induction. We focused on agency staff and found of 11 agency staff working over the timeframe we reviewed, 2 did not have an induction checklist in place and 3 were not completed in full, this meant 5 out of 11 induction checklists either weren’t in place or were not completed in full. This meant we could not be assured that people had the knowledge or skills to support the young people on the ward.
• Managers provided staff with supervision (meetings to discuss case management, to reflect on and learn from practice, and for personal support and professional development) and appraisal of their work performance. We reviewed supervision records and found that staff were receiving this in line with the provider’s policy.
• Managers did not ensure that staff had access to regular team meetings. We requested the last 3 minutes from team meetings and found that they were not detailed in content and did not have standard agenda items, and minutes showed staff would like more regular meetings.
• The percentage of staff that had had an appraisal in the last 12 months was 100%.
• The percentage of staff that received regular supervision was 100%.
• Managers did not always ensure that staff received the necessary specialist training for their roles. Eating disorder training was not classed as mandatory training for staff working in the service. This meant not all staff working in the ward had completed training in eating disorder and did not have the skills and knowledge to support patients with an eating disorder diagnosis.
• Managers dealt with poor staff performance promptly and effectively.

We did not always work effectively across teams and services to support people, making sure they only need to tell their story once by sharing their assessment of needs when they move between different services.

• Staff did not hold regular and effective multidisciplinary meetings. We asked for the minutes of the last 3 meetings, 2 were very brief, not well attended and were information giving, there were no standard agenda items. However, the meeting that took place immediately prior to our on site assessment was more detailed, with an agenda and evidence of two-way conversations.
• Staff did not always share information about patients at effective handover meetings within the team. We reviewed handover records for shifts prior to the assessment, and found that they were not completed in full, with some not including the date, others written in pencil and important information, including a young person becoming an adult not being added to the handover in a timely manner. This included risks that staff needed to be vigilant for.
• The teams had effective working relationships, including good handovers, with other relevant teams within the organisation (for example, education).
• The teams did not always have effective working relationships with teams outside the organisation (for example, commissioners and secondary and specialist health services). Stakeholders told us there were difficulties in relation to ward rounds, discharge planning, being prepared for meetings and completing agreed actions.

We support people to manage their health and wellbeing so they can maximise their independence, choice and control, live healthier lives and where possible, reduce their future needs for care and support.

• Staff supported young people to live healthier lives – for example, through participation in dietician sessions and the use of wheelchairs for young people who needed to reduce their exertion. However, there was a young person who was excessively walking and moving, and the service had not developed approaches to reduce this.
• Ward activities helped promote a healthy lifestyle for young people – for example walking groups, decorating the dining room in a person-centred way including place settings to enable young people to engage in their meal plans and reduce the emotional impact of mealtimes on young people. Individualised ‘how best to support me’ summaries were at place settings to guide staff to support young people in their preferred way during meals.
• Stakeholders shared and we saw 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.

We routinely monitor people’s care and treatment to continuously improve it and to ensure that outcomes are positive and consistent, and that they meet both clinical expectations and the expectations of people themselves.

• Staff used recognised rating scales to assess and record severity and outcomes (for example, Health of the Nation Outcome Scales Child and Adolescents, Children’s Global Assessment Scale and Eating Disorder Examination Questionnaire).
• Staff used technology to support young people effectively (for example, for prescribing and recording the administration of medicines).
• Review of the nasogastric feeding processes showed that the plans were personalised, with young people’s preferences of flavour noted and nasogastric feeding reduction plans in place with young people with the aim of increasing oral nutrition intake.

We tell people about their rights around consent and respect these when we deliver person-centred care and treatment.

• Staff took all practical steps to enable young people to make their own decisions.
• For young people who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately.
• Records showed that capacity was assessed in relation to consenting to treatment and the appropriate documentation was in place.