The Priory Hospital Preston

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement.

Requires improvement: This meant the service management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of Regulation 17 for good governance.

We have not awarded this service a score for Well-led.

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

We scored the service as 3. The evidence showed a good standard. The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

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

The provider’s senior leadership team had successfully communicated the provider’s vision and values to the frontline staff in this service. Values were shared with staff through the intranet page. The provider was launching their new plan which included the provider’s values, vision, strategic goals and plan.

Staff, patients and families had the opportunity to contribute to discussions about the strategy for their service. Managers had put plans in place for sharing the new plan with teams and discussing what it meant for the team, the patients and day to day work.

We scored the service as 2. The evidence showed some shortfalls. Not all leaders had an effective oversight of the service. However, they embodied the culture and values of their workforce and organisation. Leaders mostly had the skills and knowledge to lead effectively.

Leaders mostly had the skills, knowledge and experience to perform their roles.

Leaders did not always have effective oversight of the services they managed. Some managers were not aware of the needs of some of the patients on the wards. Leaders did not always have oversight of checks and processes such as environmental checks and handover processes. However, the service had processes in place for improving oversight and all leaders were passionate about patient care and demonstrated the culture and values of the organisation.

Leaders were visible in the service and approachable for patients and staff. Staff told us senior managers visited the wards, and they felt they could raise concerns with them.

Leadership development opportunities were available, including opportunities for staff. For example, the provider offered nursing apprenticeship opportunities.

We scored the service as 3. The evidence showed a good standard. The service fostered a positive culture where people felt they could speak up and their voice would be heard.

Patients and carers had opportunities to give feedback on the service, for example, there was a satisfaction survey that patients were asked to complete on leaving the service. Patients were also encouraged to provide feedback in community meetings. Managers and staff had access to the feedback from patients, carers and staff and used it to make improvements, for example changes had been made to the environment and activities following feedback from patients.

Patients and carers were involved in decision-making about changes to the service. For example, patients and carers had been involved in discussion about the new provider plan for 2026-2030.

The service had a whistleblowing process and freedom to speak up champions that staff were aware of and knew how to contact.

We scored the service as 3. The evidence showed a good standard. The service valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

The provider had a range of equality, diversity and inclusion networks. There were equality and diversity champions within the service, for example there were lesbian, gay, bisexual, transgender queer plus (LGBTQ+) leads, patient and carer race equality framework (PCREF) leads and neurodiversity leads.

Managers put reasonable adjustments in place for staff members to help them carry out their role.

The provider undertook equality monitoring of staff within the service to ensure it was diverse in its make-up and representative of the patient group.

We scored the service as 1. The evidence showed significant shortfalls. The service had clear responsibilities, roles, systems of accountability. However, governance systems were not always effective. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

There was a clear framework of what must be discussed at clinical governance meetings to ensure that essential information, such as learning from incidents and complaints, was shared and discussed. However, team meetings did not have a set agenda and the team meetings for each ward followed different structures. Some did not contain information such as learning from incidents which meant there was a lack of consistency across wards.

Staff had implemented recommendations from reviews of deaths, incidents, complaints and safeguarding alerts at the service level. For example, managers had introduced a competency tracker following an increase in medicines incidents and errors and learning was shared with staff through emails and 7-minute briefings.

A complete review of the multidisciplinary team meetings was undertaken, following an incident were a patient sustained a serious injury and new procedures were put in place for running these meetings. However, we found that the new process was not always effective at establishing risk, and that significant risks to and posed by the patient were not always reviewed in MDT meetings.

Staff undertook or participated in local clinical audits. Some of the concerns identified in audits, such as risk assessments not always being updated, matched some of the concerns we identified during our inspection. Although learning was identified there did not appear to be a robust process for managing ongoing/ repeat issues.

Oversight of risk management processes was not robust. Risk assessments and care plans were not always up to date and did not always contain important information about how to care for patients and keep them safe.

Managers did not always have oversight of processes and procedures. For example, we found staffing information was not always being completed at handovers and the procedure for identifying staff new to the service was not always being followed. This presented a risk to the safety of the ward.

Staff did not always understand the arrangements for working with other teams, both within the provider and external, to meet the needs of the patients. External stakeholders told us that staff worked well with them and were responsive to concerns raised.

Staff maintained and had access to the risk register at ward or directorate level. Staff at ward level could escalate concerns when required. The risk register contained a range of concerns relevant to risks within the service. The risk register was up to date and contained a range of concerns relevant to the risks within the service.

The service had plans for emergencies. For example, during our inspection, there was a planned power cut, in order to undertake essential building work. Plans were in place to manage this and ensure patients were safe and the building was secure during this time.

The service used systems to collect data from wards and directorates that were not over-burdensome for frontline staff.

Staff mostly had access to the equipment and information technology needed to do their work. However, staff told us the information technology infrastructure did not always work well and sometimes impacted on staff’s ability to carry out their roles. For example, there was an instance of staff not being able to sign a patient’s medication record due to internet problems. Information governance systems included confidentiality of patient records.

Managers had access to information to support them with their management role. This included information on the performance of the service, staffing and patient care.

We scored the service as 3. The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

Directorate leaders engaged with external stakeholders such as commissioners, community mental health teams and safeguarding teams, and commissioners had attended meetings to support them to monitor incidents and operational issues. Commissioners told us the senior leadership team were supportive of engagement with the commissioning team and said managers were responsive to concerns and requests for changes to the service. For example, work was carried out to improve discharge processes, and the wards were reconfigured to offer a female only ward in response to a need for more female beds.

Patients and staff could meet with members of the provider’s senior leadership team to give feedback and the provider included patients, families and carers in the development of the service.

We scored the service as 2. The evidence showed some shortfalls. The service did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not always actively contribute to safe, effective practice and research.

Staff were given the time and support to explore opportunities for improvement and this led to changes. For example, 7-minute briefings were produced following incidents being investigated. Some of these were recorded to enable all staff to access the information shared.

The service created improvement plans where there were concerns about care and treatment. Managers had reviewed processes and had taken action where concerns were identified. For example, the senior leadership team had restructured the multidisciplinary team processes in order to improve patient care and oversight of treatment. However, we found these processes were not fully embedded as the meetings were not always effective in maintaining oversight of patient care.

Staff had not participated in any research projects, national audits or accreditation schemes in the last 12 months.