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 Regulation 9 Person Centred Care.

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 did not make sure people were at the centre of their care and treatment choices and we did not always decide, in partnership with them, how to respond to any relevant changes in their needs.

• We reviewed 5 care records and associated handover records. We found 2 records did not tailor the care records to the individual’s needs. One young person had received an autism diagnosis. Their care plans did not include the diagnosis, any reasonable adjustments or adaptations that they required. Another young person reached 18 years of age, the handover was not updated on that day. The care records were very brief about the person being 18, an adult on a child and adolescent ward, and did not explain to staff what they were observing and frequency of review and possible changes in risk and action required. This meant staff would not have the necessary information to support the young people effectively.
• Keeping safe care plans, for example in relation to headbanging, were generic and included following the protocol in relation to headbanging and did not include what worked well for that particular young person to reduce their levels of distress.
• We did not see in any care records an individualised psychological formulation for young people to plan and deliver interventions from. Stakeholders and parents also told us that psychological formulations were not being completed.
• Staff were being rotated around the hospital to avoid a closed culture from forming, the ward manager and other staff told us of this. However, families and young people said how difficult this was with constant changes in staff, particularly for autistic young people. Parents told us that the change in staff meant that some young people were not able to fully engage in their nutrition plans as part of their recovery was having consistency and staff around them that they were familiar and comfortable with.
• Stakeholders and parents told us that the multidisciplinary meetings were not conducive to promoting young people’s recovery, with members of the multidisciplinary team disagreeing with others and team members not fully understanding what other colleagues, in different disciplines, were focusing on with the young person. This meant that the care was not person centred and not based on a clear model of care and members of the multidisciplinary team were not working together for the benefit of the young people.
• Young people told us they did not feel listened to in ward rounds and that decisions were not communicated directly to them.

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.

• There was an education provision on site which young people talked positively about. Some young people were being supported to sit exams during the assessment.
• Staff supported young people to maintain contact with their families and carers. Families visited young people on the ward.
• There was a chaplain service which young people could access. This was promoted via posters on display.

We did not always provide appropriate, accurate and up-to-date information in formats that we tailor to individual needs.

• Staff made notifications to external bodies as needed. These included notifications to the Care Quality Commission.
• Information governance systems included confidentiality of patient records. Handover records and ‘patient status at a glance’ boards used initials to protect people’s confidentiality.
• The service did not always comply with the Accessible Information Standard. Care records did not include communication difficulties that young people experience and how staff should respond to this.
• Staff ensured that patients could obtain information on treatments, local services, patients’ rights, how to complain. Information was displayed on notice boards.
• The information on display was not always accessible. We saw information about rights and safety displayed which was in very small print and was not in a format that would encourage young people to read it.
• There was an information booklet for the ward. This explained the expectations for young people. However, this was out of date with team members listed that no longer worked at the service.
• Staff did not always ensure that carers, families and commissioners were regularly updated about the patient’s progress. Parents and stakeholders told us that they were not always kept updated on their loved one’s care and that their questions were not always answered and there was little progress, with the same actions being discussed from one meeting to the next.

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

• The service had received 4 complaints in last 12 months and one compliment.
• Two of the complaints were upheld and the other 2 were still going through the investigation process.
• All the complaints related to the quality of care and access to therapy. There were 2 action plans in place at the time of the assessment which staff were working through and these related to enabling families to give feedback, creating psychological formulations, incident management and investigation, staff professionalism, reviewing the model of care and prompting staff to deliver agreed care plans in relation to nutrition intake and physical health care.
• Patients knew how to complain or raise concerns. However, within the welcome booklet for the ward, it explained that young people could complain and give feedback including to the CQC, however the booklet did not include contact details of who to give feedback to.
• When patients and families complained or raised concerns, they received feedback in the form of a letter stating whether their concerns were upheld or not. However, the timescales were not always met, with acknowledgements and responses shared later than the expected timeframe.
• Staff received feedback on the outcome of investigation of complaints via team meetings. Staff were working through the action plans from recent complaints and also an action plan from concerns raised by commissioners.
• There had been 3 recent occasions relating to food where young people had not received food they had requested or what was part of their meal plan or there were not enough utensils. This had caused distress to the young people and staff had not understood the importance of discussing this with young people and ensuring the correct quantities were available.
• Young people, families and stakeholders told us that they did not find the multidisciplinary meetings were effective, at times not all members of the multidisciplinary team were represented, and feedback was not provided. Also the room that they met in was a portacabin with very poor Wi-Fi coverage, which made it very difficult for those trying to join remotely, including family members and commissioners to fully participate in the meeting. Young people told us that they did not feel listened to in the meetings and said that they found the meetings intimidating with lots of professionals in the room, the service had not made any reasonable adjustments to make the meetings more accessible for young people.
• Questionnaires were given to parents following the multidisciplinary meetings, however parents told us that they did not see any change following this feedback and did not get answers to their questions, they then became disillusioned with the process.
• Satisfaction surveys were completed however the data from these could not be filtered down to ward level, therefore it was difficult to understand the feedback for the service in any meaningful way.
• There was no feedback from young people via surveys however there was a suggestions book which young people added to and also community meetings that young people participated in.

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

• Staff ensured the needs of young people with mobility issues were met – there were lifts in the building to access upstairs wards. As Rivendell ward was upstairs, if people needed to use the lift, they could with staff support and supervision.
• Staff supported young people who needed to limit their exertion by the use of a wheelchair to mobilise.
• There was adequate medical cover day and night, a doctor could attend the ward quickly in an emergency and the hospital was within a reasonable travelling distance to the local acute hospital.
• Staff ensured young people had access to post-discharge care – they liaised with the community teams.
• Staff did not always document young people’s plan for discharge, including good liaison with care managers/co-ordinators. Care records did not record discharge plans including actions that needed to be taken, or goals to be achieved prior to discharge.
• 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.
• The service did not have a model of care with clear treatment stages which stakeholders and families felt delayed young people’s recovery.

We did 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.

• Staff within the service and the wider organisation did not always promote a culture in which the young people using the service felt empowered to give their views. Young people did not feel able to give their views within the multidisciplinary meetings and at times felt intimidated, they were then referred to as ‘refusing to engage’, however young people did not feel they were offered alternative methods to give feedback.
• 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 diversity and inclusion, with 100% compliance.
• Outcome measures and screening tools were not always updated. Although 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) as they weren’t repeated or updated for young people, it was difficult to monitor progress.
• Actions following multidisciplinary meetings were brief and not tailored to the individual, they included actions such as “meal plan increase” without any further details of the plan for this. This meant the care was not always tailored to the individual.

We did not always support people to plan for important life changes, so they can have enough time to make informed decisions about their future.

• Staff did not always create personalised care plans to account for the young people’s needs, wishes and feelings. We saw care plans with guidance for staff to follow the head banging protocol and referring to other documentation, rather than including what worked well for the young person to manage their distress.
• Staff mostly ensured all relevant healthcare professionals and other relevant bodies were involved in planning the care and treatment of people with complex needs. However, due to gaps in the multidisciplinary team and several staff changes, young people, parents and stakeholders told us it was difficult to have consistency and make progress in young people's recovery.
• Young people were supported with their education at the service, and we saw, and people told us that they were supported with preparing for educational examinations.
• Stakeholders and parents told us that some young people had moved from the service to alternative placements due to a lack of progress in the service.