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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

Staff should be properly trained and supervised, and have the chance to develop and improve their skills (outcome 14)

Not met this standard

We checked that people who use this service

  • Are safe and their health and welfare needs are met by competent staff.

How this check was done

Our judgement

Although improvements had taken place since the employment of several new senior managers at the beginning of September 2010, 85% of nurses and healthcare assistants had not received an appraisal in the last twelve months. The majority of ward staff did not receive individual clinical supervision and it was not always possible for them to attend the group supervision provided due to staffing levels. Staff did not feel supported by managers following serious incidents. There were high rates of sickness and low morale amongst staff. People who use the service are generally safe but there are risks to their health and well being and quality of care given from poorly supported staff, frequent changes in the staff rota due to staff sickness, and failure to appraise the performance of staff and assist them to develop their skills.

User experience

No comments on this outcome were received.

Other evidence

We spoke to five members of staff on the adolescent ward. Four of them told us that they lacked support from senior management in the hospital. One person said ‘it would be nice if someone would listen to me as we have more contact with patients’. Another said the senior managers were unapproachable and ‘communication does not even exist’, she added that managers were sometimes ‘rude’. This was echoed by a third who said ‘the management seem to find it difficult to understand what staff are asking for, they are not very flexible’.

One member of staff described a serious incident she had been involved in when a young person had harmed themselves. She said that no debrief or support had been offered to her following the incident and she had had nightmares about it since. This was similar to the experience of another staff member who told us about a serious incident in which the police were called to the ward. She said she did not receive any debrief or support from senior staff following the incident.

Only one of the staff we spoke to said she received individual clinical supervision, the other four, who were nursing or support workers, said they did not. They said that group supervision was provided every other Wednesday but because staff were so busy they could not always be relieved from their duties in order to attend. One occasion was described where the external supervisor sat in a room on her own as no one was able to attend the group. On another occasion staff took turns to relieve each other and attended the supervision group one at a time.

A therapist we spoke to said she received regular clinical supervision from a therapist on another ward. She said she found this very helpful and it was a good time for reflecting on her work and getting some practical advice. She had also been put in touch with a network of therapists across the south of England and received peer support from a therapist at another Priory Hospital. She had completed a three month appraisal with her manager.

None of the other staff we spoke on the adolescent ward said they had received an appraisal in the last year although one person said she had twice set dates for this meeting with her manager but it had had to be cancelled on both occasions and no new date had been set.

We spoke to five members of staff on the adult ward and they told us that there was a good team spirit. They stated there had been recent improvements in the way they were managed and this had included a staff forum made available on the intranet.

A senior manager provided us with a list of 43 members of staff employed in the hospital (Nursing Staff – Appraisal List) as trained nurses, healthcare assistants, administration worker and teachers. This list showed dates of completed appraisals for seven of the 43 employees, six nurses and one administrator. These seven appraisals had all been completed since 26 September 2010 and had been carried out by one of the new senior managers who started work at the hospital in September 2010. None of the other 36 staff members had received an appraisal in 2010. Overall, only 15% of qualified nurses and healthcare assistants had received an appraisal in the last 12 months.

Minutes of the hospital Clinical Governance Committee meeting held on 24/09/10 stated an aim to complete 50% of staff appraisals by the end of October and 75% by the end of December 2010.

We looked at four staff training records. These records showed that the four staff had received training in basic life support, child protection, fire safety, health and safety, moving and handling, protection of vulnerable adults from abuse and the Mental Health Act, as well as other training, in the last 12 months.

Several staff members expressed the view that there had been improvements in the hospital since the arrival of a new management team in September 2010. One staff member said they hoped that ‘the arrival of the new medical director and clinical services manager is the start of s