Woodbourne Priory Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last inspection we rated effective as good. At this inspection and assessment, the rating has remained good. Staff assessed the mental health of all patients on admission. They developed individual care plans which were reviewed regularly through multidisciplinary discussion and updated as needed. Staff provided a range of treatment and care for patients based on national guidance and best practice. Staff from different disciplines worked together as a team to benefit patients.

However, the service did not always discuss patients’ health, care and wellbeing needs with them. Doctors did not assess the physical health of all patients on admission. Staff did not always apply the Mental Health Act Code of Practice appropriately and did not always respect patients’ rights under the act.

We have not awarded this service a score for Effective.

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

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

Patients were not always involved in assessment of their needs. We asked 9 patients if staff asked them what support they needed when they started using the service. Three patients told us they were asked what support they needed, although 1 said this wasn’t included in their care plan. Two patients said they were not asked about the support they needed and the rest could not remember.

Patient’s needs were assessed using a range of assessment tools to ensure their needs are reflected and understood. We reviewed 10 care records across the 4 acute and PICU wards. Staff assessed patients’ needs and created care plans in all records reviewed. Staff assessed patients’ communication needs and highlighted identified communication needs on the first page of the patient’s care record. However, we found doctors were not always assessing patients’ physical health on admission to the service. In the 10 care records reviewed, doctors had not completed a physical health assessment for 4 of the patients on admission. Doctors did not assess the physical health for 1 patient on Acer ward until a month after admission. This placed patients at risk if physical health issues were not identified.

We scored the service as 2. The evidence showed some shortfalls. The service did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Most patients received care, treatment and support that was evidence-based and in line with good practice standards. The ward MDTs oversaw the care and treatment provided to each patient. This included psychology and occupational therapy input. The psychology team told us they completed formulations based on the patient’s presentation. Patients could access Cognitive Behavioural Therapy (CBT) and Dialectical Behavioural Therapy (DBT) groups. The occupational therapy team described how they supported patients on the PICU, with a focus on step down to an acute setting. Interventions included groups on how to manage section 17 leave, sensory interventions, assertiveness skills and kitchen skills. The team were focused on improving access to gym equipment following patient feedback. Therapy teams raised concerns about vacant posts impacting on their ability to provide interventions to all patients requiring them. The provider advised recruitment was paused due to low patient occupancy.

Staff and leaders were encouraged to learn about new and innovative approaches that evidence shows could improve the way their service delivered care. Staff were able to attend internal and external events that supported them to keep up to date with best practice. These included internal events with the provider’s other acute and PICU services and external events, for example, seminars on the culture of care.

Staff assessed and met most patients’ needs for food and drink and for specialist nutrition and hydration. However, in 1 care record staff assessed a nutrition need for a patient and prescribed fortisips, but these were not always provided to the patient due to stock issues. Most patients spoken with expressed that the food was of poor quality and was often served cold. Most staff spoken with agreed that the quality of food could be improved.

Mental Health Act

• The provider reported 97% of staff had received training in the Mental Health Act.
• Staff were trained in and had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles.
• Staff had easy access to administrative support and legal advice on implementation of the Mental Health Act and its Code of Practice. Staff knew who their Mental Health Act administrators were.
• The provider had relevant policies and procedures that reflected the most recent guidance.
• Staff had easy access to local Mental Health Act policies and procedures and to the Code of Practice.
• Formal patients were able to access independent advocacy, however there was no advocacy provision for informal patients.
• Staff explained to patients their rights under the Mental Health Act in a way that they could understand, repeated it as required and recorded that they had done it. We asked 9 patients if staff explained their rights to them and all said yes. We saw evidence of staff explaining patients’ rights in care records reviewed.
• Staff ensured that patients were able to take Section 17 leave (permission for patients to leave hospital) when this has been granted.
• Staff stored copies of patients' detention papers and associated records (for example, Section 17 leave forms) correctly and so that they were available to all staff that needed access to them.
• Although wards displayed a notice on the doors advising the ward was locked and anyone wishing to leave needed to speak to staff, this was not explicitly telling informal patients that they could leave the ward freely. We raised this with the provider on our first day and the wards visited on the second day had a poster displayed for informal patients.
• Staff did regular audits to ensure that the Mental Health Act was being applied correctly and there was evidence of learning from those audits.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff had access to the information they needed to appropriately assess, plan and deliver patient’s care, treatment and support. Information was shared between teams and services to ensure continuity of care, for example when clinical tasks were delegated or when patients were referred between services.

Consultants described how they received all necessary information about a patient to review as an MDT prior to their admission. If the patient was being transferred from another hospital, they would talk to the doctors there as part of the admission process. They told us they led on MDT reviews of patients care throughout their admission to the service. Teams ensured all the relevant people were involved in reviews of patients care, including families, community team representatives, social workers and commissioners. Staff told us about working with social workers to support patients to find suitable accommodation following discharge from the service.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Most patients were encouraged and supported to make healthier choices to help promote and maintain their health and wellbeing. We asked 9 patients if staff supported them to make choices that promoted their health and wellbeing. Five patients told us staff provided fruit to eat. Two patients told us they go to fitness classes. One patient said they were not allowed to smoke, which helped with their physical health. One patient told us they go for walks. Three patients told us they had no access to opportunities to keep themselves fit, for example, going to the gym. Staff told us that patients had access to smoking cessation support and were advised on healthy eating options. The occupational therapy team told us they supported patients with healthy eating and getting out into the community. Consultants told us they completed blood tests on admission and would screen for other health conditions, referring to external health services if require, for example, cardiology and hypertension.

Patients were involved in regularly monitoring their health, including health assessments and checks where appropriate and necessary with health and care professionals. We reviewed 10 care records and saw evidence that staff monitored patients’ physical health through NEWS2 (National Early Warning Score, a tool used to assess the degree of illness in a patient and trigger critical care interventions). Staff created care plans to support patients with specific physical health conditions, for example, diabetes and asthma.

The provider’s physical health policy highlighted the health inequalities faced by people experiencing severe mental illness and that preventable physical illnesses contributed to reducing the life expectancy of this group by 15-20 years.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

There were effective approaches to monitor patient’s care and treatment and their outcomes. We reviewed patient outcomes shared by the provider based on BPRS (Brief Psychiatric Rating Scale; a tool clinicians or researchers use to measure psychiatric symptoms such as anxiety, depression, and psychoses), GAD-7 (General Anxiety Disorder-7; a 7-item self-reported measure used to assess the frequency and severity of anxiety symptoms), PHQ-9 (Patient Health Questionnaire- 9; a patient questionnaire based on 9 items used to screen, diagnose, monitor and measure the severity of depression) and HONOS (Health of the Nation Outcome Scores; a clinician-rated tool designed to measure the health and social functioning of individuals experiencing severe mental illness. We saw staff using these outcome measures in care records reviewed. The provider monitored outcomes through monthly audits of completed outcome measures.

Patients who used the service consistently experienced positive outcomes. We reviewed outcome measurements which evidenced consistent improvement for patients admitted to the acute wards, with the greatest level of change seen in core psychiatric symptom severity (BPRS) with 100% improvement. The provider reported an average improvement rate of 67% for patients using the GAD-7 measurements and an average improvement rate of 61% for PHQ-9.

We scored the service as 2. The evidence showed some shortfalls. The service did not always respect patients rights when delivering care and treatment.

Although patients understood their rights around consent to the care and treatment they were offered, there were concerns about staff respecting patient’s rights. We asked 9 patients if staff gave them information about their care and treatment in a way they understood. Five patients said yes, 3 said no and 1 didn’t answer. All patients said staff explained their rights to them. An informal patient told us that they were aware of their rights as an informal patient, but staff were not, and staff stopped them from going out. A detained patient said staff make up their own rules in relation to rights and described a situation where staff pressurised them into taking their leave at a time that wasn’t suitable for them. We noted on our first day on site that the wards visited were not displaying posters advising informal patients that they were free to leave the ward. The Mental Health Act Code of Practice states: “Informal patients must be allowed to leave if they wish, unless they are to be detained under the Act. Both the patient and, where appropriate, their carer and advocate should be made aware of this right with information being provided in a format and language the patient understands. Local policies and arrangements about movement around the hospital and its grounds must be clearly explained to the patients concerned. Failure to do so could lead to a patient mistakenly believing that they are not allowed to leave hospital, which could result in an unlawful deprivation of their liberty and a breach of their human rights.” We raised this with senior leaders who advised they would take action to address these concerns. On our second day on site we saw new posters displayed advising informal patients they were free to leave the ward.