The Priory Hospital Middleton St George

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• 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 assessment we rated effective as good

At this assessment the rating has remained good. Staff assessed the physical and 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. The ward team included or had access to the full range of specialists required to meet the needs of patients on the ward. Staff from different disciplines worked together as a team to benefit patients. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.

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 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff completed a comprehensive mental health assessment of the patient in a timely manner at, or soon after, admission. Multidisciplinary team (MDT) ward rounds occurred weekly, where risk assessments and care plans were reviewed with the patient present. We saw meetings were repeated when a patient did not engage and we saw a consultant go to see a patient who declined to attend the meeting. Family members, carers, and advocates were involved where appropriate, with options to join online or by telephone.

Patients were offered copies of their care plans and asked to sign to confirm agreement or note any concerns. Independent advocacy was automatically offered in line with legal requirements, and an on-site advocate supported patients with benefits and rights.

Capacity assessments were requested when needed for specific decisions, and best interest meetings were held where required. Daily morning meetings reviewed risks and observation levels, supported by structured handovers and documentation tools.

Staff assessed patients’ physical health needs in a timely manner after admission. There was a dedicated physical health care nurse and a doctor from the local surgery attended weekly.

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.

Staff provided a range of care and treatment interventions suitable for the patient group. The interventions were those recommended by, and were delivered in line with, guidance from the National Institute for Health and Care Excellence. These included medication, psychological therapies, activities and education.

Staff ensured that patients had good access to physical healthcare, including access to a dentist, optician and specialist healthcare providers.

Staff assessed and met patients’ needs for food and drink and for specialist nutrition and hydration.

Staff participated in clinical audit, benchmarking and quality improvement initiatives.

The team included the full range of specialists required to meet the needs of patients in the service. This included doctors, nurses, occupational therapists, clinical psychologists, pharmacists, support workers and activities co coordinators. At the time of our assessment the hospital social worker post was vacant, however the provider was in the process of interviewing applicants for the post.

Care records showed that physical health assessments were on-going from admission, with weekly/daily checks on weight, pulse, blood pressure and other aspects of physical healthcare, with the patients consent. Physical health screening tools such as National Early Warning Score (NEWS2) were used to assess patients’ health.

Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patients. Staff completed learning disability and autism awareness training. There were 8 courses related to autism or learning difficulties. Five of those courses had been completed by 100% of staff, the Oliver McGowen mandatory training had been completed by 99% of staff and the hospital had introduced Oliver McGowan level 1 and level 2 training which staff had just started attending prior to our assessment.

Managers provided staff with supervision and appraisal of their work performance and ensured they had access to regular team meetings. The percentage of staff that had an appraisal in the last 12 months was 99%. The percentage of staff that received regular supervision was 96.75%.

Mental Health Act

The provider reported 96% 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.

Patients detained under the Mental Health Act were able to access independent advocacy.

Staff explained to patients their rights under the Mental Health Act in a way that they could understand.

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.

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 held regular weekly effective multidisciplinary meetings (MDT). These were attended by all disciplines including nurses, psychology, occupational therapy, care co coordinators and the advocate. We attended two MDT meetings during the assessment.

Staff shared information about patients at effective handover meetings within the team for example, shift to shift. We attended a daily hospital wide morning briefing and saw that all patients, incidents and changing risks were discussed. There was also a daily morning meeting on each ward at which all patients were discussed.

The teams had effective working relationships, including good handovers, with other relevant teams for example, care co-ordinators, community mental health teams, and the crisis team.

The teams had effective working relationships with teams outside the organisation for example, the local authority, social services and GPs.

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.

Staff made sure patients had access to physical health care, including specialists as required. We saw that patients had accessed dentists and opticians. Staff met patients’ dietary needs and assessed those needing specialist care for nutrition and hydration. Patients told us that any religious or dietary needs were met with options such as halal food and vegan diets supported.

Ward activities helped promote a healthy lifestyle, for example patients could access the gym and take part in other sports activities.

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.

Staff used recognised rating scales to assess and record severity and outcomes for example, the National Early Warning Score (NEWS)2. The Model of Human Occupation Screening Tool (MOHOST) was used as an occupational functional ability assessment.

An occupational therapist delivered various sessions in relation to self-care, productivity and leisure as well.

Staff used technology to support patients. Patients had access to phones and could use video links to maintain contact with family members and friends.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centered care and treatment.
Staff took all practical steps to enable patients to make their own decisions. Where there were concerns in relation to a patient’s capacity to make a specific decision, we saw in records reviewed that staff had completed capacity assessments in order to support them with this. These showed the person was involved, as well as their family members where appropriate. Where people lacked capacity to consent to a specific decision, records showed that assessments were completed to ensure decisions were made in the person’s best interest.