The Priory Hospital Preston

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• 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.

Staff did not always make adjustments or take into account the needs of autistic patients and did not always identify the needs of people with a learning disability. However, staff supported patients and carers to share their views, involved patients in discussions about their care and treatment and made sure people could access care support and treatment when they needed it.

The service was in breach of Regulation 9 for 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 scored the service as 1. The evidence showed significant shortfalls. The service did always not make sure people’s needs were at the centre of their care and treatment. They did not work always in partnership with people, to decide how to respond to any relevant changes in people’s needs.

The service did not always provide person centred care for patients who were neurodiverse. We observed the ward environments were noisy and that doors were regularly banging on some of the wards. 3 patients raised concerns about sensory issues including bright lighting, which 1 patient described as blinding, the temperature on the ward being too warm and excessive noise on the wards.The provider had made some adjustments to support patients with this, including air conditioning in the lounges and acoustic panelling being fitted on Elswick ward.

Staff were not always clear about patients’ diagnoses. For example, managers on 1 ward were unsure if a patient with additional needs had a learning disability or an autistic spectrum disorder. We found out later in the inspection the patient had both. Other staff we spoke with were not always clear if patients had specific needs linked to neurodiversity.

We reviewed the records of 2 autistic patients, one of whom also had a learning disability. 1 of the patients did not have a care plan to support communication difficulties identified in their communication assessment and there was no evidence of behavioural support plans or speech and language therapy (SALT) input. Staff had attempted to complete a sensory assessment, but the patient had not engaged with this process. Staff had created some basic communication cards to help the patient understand their care plan although this did not help with everyday communication.

Staff had only partially completed the communication section of the assessment for another patient with autistic spectrum disorder. They had not completed a sensory needs assessment or a positive behavioural support plan for this patient.

Staff involved patients in decisions about their care and treatment. Records evidenced that patients were involved in discussions about their treatment in multi-disciplinary team meetings. Patients told us they could speak to staff about their care and treatment and particularly mentioned being able to speak to the psychiatrist about their care.

We scored the service as 3. The evidence showed a good standard. The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

The service worked closely with the local trust and all beds were commissioned by that trust.

Staff supported patients to maintain contact with their families and carers. Families told us it was easy to arrange visits, however 1 family member said it could be difficult to access the service during the evening. Staff also contacted families and carers regularly to provide updates where patients had given them permission to do so.

Staff supported patients to access their chosen place of worship within the community.

We scored the service as 2. The evidence showed some shortfalls. The service did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Staff made notifications to external bodies as needed.

Information governance systems included confidentiality of patient records.

The service did not always comply with the Accessible Information Standard. Staff had not always met the needs of patients with communication needs, for example staff had identified that 1 patient who had a learning disability had communication needs but had not developed a communication plan to meet those needs. However, staff had considered some aspects of supporting patients with communication needs, for example they had created mood charts, pain scales and pictorial information for using kitchen appliances for patients.

Staff ensured that patients could obtain information on treatments, local services, patients’ rights, how to complain and so on. The information provided was in a form accessible to the particular patient group. Staff made information leaflets available in languages spoken by patients.

Staff ensured carers, families and commissioners were regularly updated about the patient’s progress.

We scored the service as 3. The evidence showed a good standard. The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support.

Patients knew how to complain or raise concerns. The service had received 20 complaints in last 12 months. Of these 2 complaints were upheld, 1 was partially upheld, 1 patient withdrew consent for the complaint to be investigated, 5 were still ongoing and 11 were not upheld.

No complaints had been sent to the Ombudsman in the last 6 months. Patients were informed about their right to contact the Ombudsman in the services response to complaints.

Cottam ward had received 10 complaints, whereas Rosemary ward had received 4 complaints and Elswick ward has received 3 complaints. The remaining complaints were not specific to a particular ward. The main theme of complaints related to quality of care.

Staff knew how to handle complaints appropriately and supported patients who wanted to complain.

We reviewed 3 complaints. Although one complaint did not cover all the concerns raised, complaints were mostly responded to appropriately and the responding member of staff offered an apology in line with the provider’s complaints policy.

3 out of 5 carers told us they had not been given information on how to complain but all carers said they felt they would be able to raise a complaint if required and that this would be taken seriously.

Staff received feedback on the outcome of investigation of complaints and acted on the findings.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure that people could access the care, support and treatment they needed when they needed it.

Staff ensured the needs of patients with mobility issues were met – for example, wheelchair users were placed in bedrooms at ground level or had access to lifts. Staff made reasonable adjustments for patients such as arranging for shower chairs where needed for people with mobility needs.

There was adequate medical cover day and night, doctors were present on site 24 hours a day.

Staff did not always ensure patients had access to post-discharge care such as Section 117 aftercare. For example, staff had not invited social care staff to a patient’s Section 117 discharge meeting or informed them when the patient was discharged. Staff did not always plan for patients’ discharge effectively, as relevant professionals were not always invited to discharge meetings. Family members were not always informed of discharge meetings.

Managers carried out discharge audits and found some areas of concern were improving such as an increase in relevant professionals attending discharge meetings and staff completion of Section117 documentation.

In the last 12 months, there were 30 delayed discharges from inpatient wards. Cottam ward and Elswick ward had 12 delayed discharges each and Rosemary ward had 6 delayed discharges. The main reason for delayed discharges was due securing appropriate accommodation for patients, which was outside of the provider’s control.

We scored the service as 2. The evidence showed some shortfalls. Staff and leaders did not always actively listened to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

Staff within the service and the wider organisation promoted a culture in which the people using the service felt empowered to give their views. Staff held regular patient forums to obtain patient’s views, and changes had been made following these. For example, new patient activities had been introduced, and aspects of the environment had been adapted. Patients had access to advocacy services, and the service had employed a lived experience partner who supported patients to express their views and represented patient’s views within staff meetings. However, staff had not always met the needs of autistic patients and those with a learning disability and adaptions were not always in place to ensure those patients had equitable experiences and outcomes.

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 equality, diversity, inclusion and human rights. 97% of staff had completed diversity and inclusion training.

We scored the service as 2. The evidence showed some shortfalls. People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future.

Staff supported patients to make decisions about their care and treatment and their future. For example, staff discussed issues such as future support for mental health, drug and alcohol use and housing with patients and made referrals for ongoing support where required.

Staff did not always create personalised care plans to account for the patient’s needs, wishes and feelings, we reviewed 8 care plans and found that 5 were personalised and holistic, however 3 did not contain sufficient information to meet patient’s needs.

Staff mostly ensured relevant healthcare professionals were involved in planning the care and treatment of people with complex needs, however staff were not always involved in discharge planning.