The Priory Hospital North London

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Our overall rating of safe at The Priory Hospital North London Acute is Good.

We have not awarded this service a score for Safe.

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

Staff we spoke with were able to describe how and when to report an incident. They could give examples of recent incidents and the changes made as a result of learning. Staff reported serious incidents in line with the provider’s policy. All incidents were logged on an electronic reporting system and reviewed by senior staff.

In the last 12 months, there had been 198 incidents at the service. Of these, 62 incidents related to self‑harm and 31 related to violence and aggression. Staff met regularly to discuss incidents and learning. Each morning, staff attended a meeting where all incidents from the previous 24 hours were reviewed.

Staff were aware of the duty of candour and told us they were open and transparent with patients and their families when things went wrong.

Staff said they were consistently involved in discussions about incidents. They were aware of recent incidents, could describe what had happened, and understood the actions required to maintain the safety of the patients involved.

The hospital accepted referrals and admissions from both NHS trusts and privately funded patients. Referral and admission processes ensured that essential information was obtained to determine whether the hospital could safely meet the patient’s needs. The hospital gave examples of occasions where admissions had not been accepted because staff could not safely meet the patient’s needs.

Patients and carers told us they were involved in discharge planning.

Most patients we spoke with confirmed that they were provided with an admission booklet which provided key information about the service.

Staff involved relevant healthcare and social care services to support continuity of safe care, both during admission and following discharge. Staff worked to ensure patients did not remain in hospital longer than necessary. Patients were only discharged when they had an appropriate crisis plan in place and a safe discharge setting had been identified.

Staff had a clear understanding of safeguarding and their responsibilities in relation to this. They knew how to identify adults and children at risk of, or experiencing, significant harm and understood the procedures to follow. Information about safeguarding leads and processes was clearly displayed throughout both wards.

Staff followed safe procedures for children visiting patients. Visits did not take place on the ward. Appropriate facilities were available elsewhere on the hospital site when required.

Staff received safeguarding training appropriate to their role, including levels 1, 2 and 3 for both adults and children. Compliance rates across this training was 75%. The lowest compliance of was 69.6%, in children’s levels 1 and 2 training. Compliance with level 3 safeguarding training was 84.5%.

Staff demonstrated a good understanding of how to recognise and report abuse and worked with other agencies to ensure people were protected.

Staff were able to give examples of safeguarding concerns they had identified and managed. They notified the local authority within appropriate timeframes and worked collaboratively to keep patients safe from harm.

We reviewed 7 patient care records across the 2 wards. Records showed that staff completed comprehensive risk assessments on admission and reviewed these regularly, including weekly at ward rounds or following an incident. Risk assessments were updated with relevant information and considered a range of potential risk factors, including risks of self‑harm.

Patient risk levels were discussed daily at the multidisciplinary meeting, where staff reviewed recent incidents and any emerging concerns.

Staff received training in restrictive interventions, with a compliance rate of 63.6%. This training was delivered through a five‑day course and emphasised the use of de‑escalation techniques before any restrictive interventions were used.

Staff told us they used de‑escalation techniques as the first response to managing incidents and only used physical restraint when these approaches were ineffective and necessary to maintain the safety of the patient or others. In the past 6 months, there had been 24 incidents on Lower Court where staff used holds as a form of restraint and 60 on Oak Ward, totalling 84 incidents across both wards. Staff reported that the service had experienced a period of high acuity in recent months, which they felt contributed to the increased use of restraint.

We reviewed a sample of observation records and found them to be thorough, with no gaps identified. Records showed that staff completed and documented observations consistently. During night‑time observations, staff recorded that they had observed patients taking at least two breaths while sleeping, in line with the provider’s policy.

People were cared for in safe environments that were designed to meet their needs. Facilities, equipment and technology were well maintained and supported staff to deliver safe and effective care. Oak ward was unable to facilitate those patients who may have mobility issues, due to the environmental layout.

Ward areas were clean, well maintained, well-furnished and fit for purpose. Staff carried out regular risk assessments of the care environment. They told us they completed daily security and environmental checks to ensure the wards remained safe for patients.

Staff could not observe patients in all parts of the wards due to the layout, which did not allow for clear lines of sight in every area. Where there were blind spots, risks were mitigated through the use of convex mirrors, closed‑circuit television (CCTV) and zonal observations to improve visibility and patient monitoring.

Staff completed ligature risk assessments for each ward. They were able to describe how ligature risks were managed through observation, engagement and individual risk management plans. Staff knew where to locate the ligature risk assessments, heat maps and ligature cutters. They also took part in monthly emergency simulation training, which included ligature scenarios.

During our first day on site, we observed an unlocked bin with an accessible rubbish bag in a patient‑facing area. This was escalated to senior management, and by the second day of inspection all rubbish bags had been removed from unlockable bins. The provider also introduced a new policy across the service to address this risk.

Staff had easy access to personal alarms, and patients had access to nurse call systems in every room.

The service had closed-circuit television (CCTV) in all communal areas and corridor areas. CCTV was recorded and was used to review incidents across the entire hospital.

Fire safety arrangements were in place. Of eligible staff, 75.4% were up to date with their fire safety training.

Desktop fire drills were carried out every 3 months. Where required, staff completed personal emergency evacuation plans (PEEPs) for patients with mobility difficulties. During our review of fire drill documentation, we found some outdated PEEPs and noted that staff had not completed an effective head count during one drill, resulting in a patient remaining in their room. Staff were aware of this issue and told us they were working to improve the process.

Clinic rooms were fully equipped with accessible resuscitation equipment and emergency drugs that staff checked regularly.

Each patient had their own bedroom, which they could personalise. Bedrooms were clean and bright with ensuite facilities.

The service made sure there were enough qualified, skilled and experienced staff who received effective support, supervision and development, and who worked together to provide safe care that met people’s individual needs. However, there were a small number of mandatory training areas where compliance was low. These were Basic Life Support with Defibrillator, Immediate Life Support (ILS), Safeguarding Adults and children (eLearning), Level 1 & 2 and Reducing Restrictive Intervention Breakaway Training and The Oliver McGowan Mandatory Training on Learning Disability and Autism Tier 1 and tier 2.

All patients we spoke with told us there were enough staff on duty to meet their needs.

The service had sufficient nursing and support staff to keep patients safe and to provide the right care and treatment. Staffing levels on each ward were reviewed daily. Vacancy rates for nursing staff were low. Managers had calculated the number and grade of registered nurses and healthcare assistants required to maintain safe care, and staff had access to a staffing matrix showing the required numbers based on patient acuity and occupancy. Ward managers prioritised safety and booked additional staff when needed.

Managers reviewed staffing each morning and throughout the day. Bank and agency staff were used when necessary to maintain safe staffing levels. The wards used regular bank staff who were familiar with patients and the environment. When agency or bank staff were used, they received an induction and were familiar with the ward. Staff told us agency use was rare.

Patients confirmed they had regular one‑to‑one sessions with their named nurse. Records showed that nurses spent regular individual time with patients.

The service completed appropriate employment checks, including criminal background checks, qualifications and right‑to‑work verification. The hospital renewed DBS checks every three years and the human resources team monitored when renewals were due.

Senior management and the HR team ensured that all consultant psychiatrists had the required checks and agreements in place before being granted practising privileges. We reviewed four practising‑privilege files and found all required documentation was present.

There was adequate medical cover day and night. A duty doctor was on call at the hospital at all times, and staff knew how to contact medical staff in an emergency. Staff were also able to contact consultant psychiatrists with practising privileges who were not based on site to discuss patient concerns.

The service assessed and managed the risk of infection, detected and controlled the risk of it spreading, and shared any concerns with the appropriate agencies promptly.

All ward areas were clean, well-furnished and well maintained. Patients raised no concerns about cleanliness during our visit. Housekeeping staff were observed cleaning high‑touch areas throughout the day.

Staff followed infection prevention and control principles, including appropriate handwashing techniques and the use of personal protective equipment (PPE). This included aprons, masks and gloves. Hand sanitiser was readily available across the wards. Staff completed infection control audits, including regular hand‑hygiene audits, on each ward. Audit findings and any required actions were discussed in handovers and staff meetings.

Staff accessed infection control training, and overall compliance across the wards was 84.1%.

We found most areas of medicines management were delivered in line with safe care, but we found improvements were needed to the recording of physical health checks after rapid tranquilisation medicines were administered in line with the providers’ own policy. Rapid tranquilisation (RT) involves giving medicine by intramuscular injection to quickly calm severe agitation.

In 2 post rapid tranquilisation records, staff had recorded observations in the first hour in line with the national minimum requirement, but not the provider’s own policy. A post-dose rapid tranquillisation physical health review is essential to monitor for adverse effects, ensure patient safety, and promptly identify and manage any complications arising from the medication.

Records did not always show why PRN (“as required”) medicines were given or whether they worked. This reduced assurance that PRN medicines were being used as intended and reviewed appropriately. There was also one example where PRN administration exceeded the prescribed maximum daily dose and this had not been identified prior to the inspection. This increased the risk of avoidable harm, such as over-sedation.

We found several areas of good practice. Staff involved people in planning medication, including when changes happened.

When managing anxiety and agitation the service understood the need to use the least restrictive approach. They tried de-escalation and oral medicines before using rapid tranquilisation. Medicines were stored securely and stock was well organised. Controlled drugs (CDs) were checked twice a day with two staff signatures. Emergency medicines were available, sealed and checked regularly. Staff monitored fridge and room temperatures and completed equipment checks, including glucometer calibration. These arrangements reduced the risk of medicines being stored or used in an unsafe way.

Staff described good general oversight of physical health monitoring. They used NEWS2 (National Early Warning Score 2) and recorded observations. Staff also described structured monitoring for detox pathways using CWA (Clinical Withdrawal Assessment).