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The Priory Hospital North London Good

Inspection Summary


Overall summary & rating

Good

Updated 10 January 2020

We rated Priory Hospital North London as good because:

  • Staff treated patients with compassion and kindness. They respected patients’ privacy and dignity. They understood the individual needs of patients and supported them to understand and manage their care, treatment or condition.
  • Staff assessed the physical and mental health of all patients on admission. They worked with patients to develop individual care plans, which they reviewed regularly through multidisciplinary discussion and updated as needed. Care plans for young people on the child and adolescent mental health wards were of a high standard and reflected all young people’s needs.
  • Teams included a range of specialist staff to meet the needs of patients. Staff provided a range of care and treatment interventions suitable for the patient group and consistent with national guidance on best practice. They ensured that patients and young people had good access to physical healthcare and supported patients to live healthier lives.
  • Staff understood how to protect patients and young people from abuse and the service worked well with other agencies to do so.

  • Staff involved patients in risk assessment and actively sought their feedback on the quality of care provided.
  • Staff felt respected, supported and valued. They reported that the provider provided opportunities for career progression and they felt able to raise concerns without fear of retribution.
  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with the whole team and the wider service. Staff ensured that patients had easy access to independent advocates.
  • Staff supported patients to make decisions on their care for themselves. They understood the provider’s policy on the Mental Capacity Act 2005 and assessed and recorded capacity clearly for patients who might have impaired mental capacity. Staff assessed young people’s competence using the Gillick competency, which they understood well.
  • Leaders had the skills, knowledge and experience to perform their roles, had a good understanding of the services they managed, and were visible in the service and approachable for patients, young people and staff.

​However:

  • There were not always a sufficient number of nursing staff working on Birch Ward. This meant young people did not always get escorted leave from the ward. Staff were unable to always take breaks and staff supervision was not taking place.
  • The child and adolescent wards only had adult size defibrillator pads in the resuscitation bag. On Oak Ward some items, such as disposable forceps, were past their expiry date.
  • Although the hospital monitored restrictive interventions, it did not have a restrictive interventions reduction programme to think long term about how to minimise the use of restraint and rapid tranquilisation.
  • Following an incident investigation, all patients in the hospital had their bedrooms searched twice per month. This was a blanket practice unrelated to individual patients’ or young peoples’ level of assessed risks.
  • When patients decided to discharge themselves, medicines for the patient to take away with them did not come with important warning labels. This was not best practice.
  • The vacancy rate for registered nurses on Lower Court was high at 43%. Long term agency staff were used to minimise the risks of inconsistent care, but further recruitment was needed.
  • Although staff on Lower Court discussed patients’ potential risks regularly, changes to patients’ risk levels were not always clearly documented in their care records.
  • Staff prescribed sedative medication to help with sleep for clients having detoxification treatment, without exploring other options first. This was not good practice.
  • Staff did not always clearly record when clients having detoxification treatment were offered relapse prevention medicines.
  • The did not have ways for patients, young people, and carers to be involved in the operation of the hospital.
Inspection areas

Safe

Requires improvement

Updated 10 January 2020

We rated safe as requires improvement because:

  • There were not always a sufficient number of nursing staff working on Birch Ward. This meant young people did not always get escorted leave from the ward. Staff were unable to always take breaks. The vacancy rate for permanent registered nurses on Lower Court was 43%. This was a high vacancy rate. Where possible, long term agency staff were used to minimise the risks of inconsistent care.

  • The hospital did not have a restrictive interventions reduction programme. In the six months before the inspection there had been 99 incidents of patients being restrained. A restrictive interventions reduction programme is designed to minimise the use of restraint and rapid tranquilisation.

  • Following an incident investigation, all patients in the hospital had their bedrooms searched twice per month. This was a blanket practice unrelated to individual patients’ level of assessed risks.

  • When patients decided to discharge themselves, medicines for the patient to take away were placed in standard boxes, but important warning labels regarding the medicines were missing. This was not best practice. The management team acted immediately to remedy this situation during the inspection.

  • The child and adolescent wards only had adult size defibrillator pads in the resuscitation bag. On Oak Ward some items, such as disposable forceps, were past their expiry date.

  • All wards were safe, clean, well-furnished and well maintained.

  • Staff assessed and managed risks to patients and themselves well and followed best practice in anticipating, de-escalating and managing challenging behaviour. Staff used restraint only after attempts at de-escalation had failed.

  • Staff

    understood how to protect patients and young people from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. The provider had dedicated staff leads for safeguarding adults and children.

  • Staff regularly reviewed the effects of medicines on each patient or young person’s physical health.

  • The wards had a good track record on safety. The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.

Effective

Good

Updated 10 January 2020

We rated effective as good because:

  • Staff assessed the physical and mental health of all patients on admission. They developed individual care plans, which they reviewed regularly through multi-disciplinary discussion and updated as needed. Care plans for young people on the child and adolescent mental health wards were of a high standard and reflected all young people’s needs.
  • Staff provided a range of care and treatment interventions suitable for the patient group and consistent with national guidance on best practice. They ensured that patients had good access to physical healthcare and supported patients to live healthier lives.
  • Staff used recognised rating scales to assess and record severity and outcomes. They also participated in clinical audit, benchmarking and quality improvement initiatives.
  • The ward teams included, or had access to, the full range of specialists required to meet the needs of patients on the wards. Managers made sure they had staff with a range of skills needed to provide high quality care. They supported staff with appraisals, supervision and opportunities to update and further develop their skills. Managers provided an induction programme for new staff.
  • Staff from different disciplines worked together as a team to benefit patients. They supported each other to make sure patients had no gaps in their care. The ward teams had effective working relationships with other relevant teams within the organisation and with relevant services outside the organisation.
  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well. Managers made sure that staff explained patients’ rights to them.
  • Staff supported patients to make decisions on their care for themselves. They understood the provider’s policy on the Mental Capacity Act 2005 and assessed and recorded capacity clearly for patients who might have impaired mental capacity. Staff assessed young people’s competence using the Gillick competency, which they understood well.

​However:

  • Clients having detoxification treatment were prescribed sedative medicine in their first three days of treatment to help with sleep. This was done before other sleep hygiene measures or other, non-addictive medicines were considered, which does not follow best practice guidance.
  • Staff did not always record when they offered relapse prevention medicines.
  • There was still work to do to ensure all care plans on Lower Court were personalised, holistic and recovery orientated.
  • Nursing staff on Birch Ward did not always receive monthly supervision as planned.

Caring

Good

Updated 10 January 2020

We rated caring as good because:

  • Staff treated patients with compassion and kindness. They respected patients’ privacy and dignity.

    They understood the individual needs of patients and supported them to understand and manage their care, treatment or condition.

  • Staff involved patients in care planning and risk assessment and actively sought their feedback on the quality of care provided. They ensured that patients had easy access to independent advocates.

​However:

  • The provider did not have ways for patients and carers to be more involved in the operation of the hospital.

Responsive

Good

Updated 10 January 2020

We rated responsive as good because:

  • Staff planned and managed discharge well.

    They liaised well with services that would provide aftercare and were assertive in managing the discharge care pathway. As a result, patients did not have excessive lengths of stay and discharge was rarely delayed for other than a clinical reason.

  • The

    design, layout, and furnishings of the wards supported patients’ treatment, privacy and dignity. Each patient had their own bedroom with an en-suite bathroom and could keep their personal belongings safe. There were quiet areas for privacy.

  • Staff facilitated young people's access to high quality education throughout their time on the wards.

  • ​The food was of a good quality and patients could make hot drinks and snacks at any time. 

  • The wards met the needs of

    all patients and young people who used the service – including those with a protected characteristic. Staff helped patients with communication, advocacy and cultural and spiritual support.

  • The

    service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with the whole team and the wider service.

Well-led

Good

Updated 10 January 2020

We rated well-led as good because:

  • Leaders had the skills, knowledge and experience to perform their roles, had a good understanding of the services they managed, and were visible in the service and approachable for patients and staff.

  • Staff knew and understood the provider’s vision and values and how they were applied in the work of their team.

  • Staff felt respected, supported and valued. They reported that the provider provided opportunities for career progression and felt able to raise concerns without fear of retribution.

  • Our findings from the other key questions demonstrated that governance processes operated effectively at ward level and that performance and risk were managed well.

  • ​Ward teams had access to the information they needed to provide safe and effective care and used that information to good effect.

  • Staff engaged actively in national quality improvement activities.

Checks on specific services

Child and adolescent mental health wards

Good

Updated 10 January 2020

Acute wards for adults of working age and psychiatric intensive care units

Good

Updated 10 January 2020

Substance misuse services

Updated 29 April 2015

The Addiction Therapy Programme service was providing a good service. People using the service had their risks assessed. Care plans and their supporting assessment tools were comprehensive and complemented the group work programme. Therapy staff were skilled and experienced and facilitated the provision of a quality addiction therapy programme. However, the provider should consider whether locating the addiction therapy programme on a mixed ward appropriately meets patient needs. The provider gathers information addressing abstinence maintenance and relapse for patients who complete the addiction therapy programme, and should consider analysing this information as part of its outcome measurements. The Lower Court ward did not meet single gender standards.

Hospital inpatient-based substance misuse services

Good

Updated 10 January 2020