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The Priory Hospital North London Good

All reports

Inspection report

Date of Inspection: 21 October 2010
Date of Publication: 21 December 2010
Inspection Report published 21 December 2010 PDF

There should be enough members of staff to keep people safe and meet their health and welfare needs (outcome 13)

Not met this standard

We checked that people who use this service

  • Are safe and their health and welfare needs are met by sufficient numbers of appropriate staff.

How this check was done

Our judgement

Although staff to patient ratios appeared to conform to the provider’s corporate standards all staff we spoke to said there had been many occasions when there had not been enough staff on duty and this had been detrimental to patient care. Insufficient numbers of staff may have contributed to the high number of incidents on the adolescent ward and patients’ perceptions of not being talked to enough. Staffing levels had increased in the two weeks prior to our visit but there was no evidence that a needs analysis and risk assessment had been carried out as a basis for deciding what level of staffing was sufficient to meet the needs of patients and maintain their safety.

User experience

One young person on the adolescent unit said that staff ‘say they can’t take you out because they are too short staffed.’ Another told us ‘when things get out of control there are never enough staff’ and went on to describe an incident that occurred recently when a group of young people were involved in a violent incident and the police had been called to the ward. They said that those young people not involved had been kept in the education room with a member of staff. Two members of staff told us about the same incident involving six or seven young people and which resulted in a hole in the wall, a broken window and inappropriate use of the fire extinguishers.

Young people also told us ‘we don’t get talked to enough’ by staff and some staff interact with the young people whilst others do not.

Other evidence

Several members of staff on the adolescent ward told us that staffing levels had been very low until the last two weeks. One staff member described the adolescent ward as a ‘very stressful environment to work in’ and that because there were not always enough staff members on duty, the ward had felt very unsafe at times. She went on to describe a situation three weeks prior to our visit when there had been only two nurses on duty on the ward, which she felt had put the safety of young people and staff at risk. Recently there had been six or seven staff on duty during the day which she said was much better than before when it was often only three or four staff on the day shift. Several staff told us that the senior management did not always bring in extra staff when a young person required one-to-one supervision although this had improved lately. One explained that there should be five staff on duty at night, two of whom are qualified nurses and this has been the case for the last two weeks. Prior to this sometimes there was only on qualified nurse on duty on the adolescent ward at night.

Another staff member we spoke to stated that staffing ‘has been better for the last couple of weeks’ but that six weeks ago there were ’definitely not enough staff’. She said that actual patient numbers might satisfy hospital staff to patient ratios but if one or two young people are on one-to-one observation throughout the shift then this leaves few staff free to care for the other young people.

Four staff interviewed on the adult ward stated that they thought the staffing levels were insufficient. As a result staff meetings were sometimes not held, patients had been put at risk and on occasions staff had not been able to prevent patients from absconding.

A senior manager at the hospital told us that they follow corporate staff to patient ratios and that on the adolescent unit the staff to patient ratio is 1:3 during the day and 1:4 at night and that if any young person requires one-to-one supervision then the numbers of staff needed are reviewed. On the adult ward the ratios are 1:5 during the day and 1:6 at night.

Six of the weekly nursing rotas for the adolescent ward in September and October 2010 and four rotas for the adult ward in September were viewed. These were compared with the hospital patient/ bed list for the month of September 2010. These showed compliance with the stated staff to patient ratios. However it was not possible to see retrospectively when patients had been on one-to-one observation and whether extra staff had been brought in as a result.

The rotas on the adolescent ward for the weeks commencing 4 October and 11 October showed high rates of sickness absence. In the week commencing 4 October seven members of staff recorded 10 days of sickness absence between them and in the following week this rose to 11 members of staff recording 21 days of sickness absence. There were 20 members of regular staff scheduled to work during that week. High rates of sickness amongst night staff on the adolescent ward meant that night shifts had to be covered by bank and agency nurses. In the week commencing 27/09/10 one qualified nurse worked six consecutive nights and in the week commencing 04/10/10 the rota shows that one team support worker worked six night shifts out of seven. This could lead to staff tiredness and may be detrimental to patient care.

A senior manager we spoke to confirmed that staff sickness on the wards was ‘exceptionally high’.

Minutes of the hospital Clinical Governance Committee meeting on 24/09/10 noted that there had been ten recorded incidents on the adolescent ward since the previous meeting on 27/08/10. This was confirmed by one member of staff who said ‘incident after incident is happening’.

There was no evidence that senior managers had carried out a needs analysis and/or risk assessment in relation to determining the staffing levels necessary to ensure that patients’ needs were met and their safety maintai