The Priory Hospital Middleton St George

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 requires improvement. At this assessment the rating has changed to good.

This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

Leaders had the skills, knowledge, and experience to perform their roles. Staff knew and understood the provider’s vision and values and how they applied to the work of their team. Staff felt respected, supported, and valued, but were concerned about the visibility of senior leaders and changes to the hospital’s ward structures. Governance processes operated effectively. Performance and risk were managed well. Teams had access to the information they needed to provide safe and effective care. Staff collected analysed data about outcomes and performance. They used this to identify improvements.

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.

Leaders ensured there was a shared vision and strategy that staff in all areas knew, understood and supported. Middleton St George is part of the Priory Group whose vision was to be become the leading European provider of mental health and rehabilitation services. The provider’s values were striving for excellence, being positive, putting people first, acting with integrity and being supportive.

Staff knew and understood the vision and values and how they were applied in the work of their team. The senior leadership team had successfully communicated the vision and values to the staff in this service.

Staff had the opportunity to contribute to discussions about the strategy for the service during team meetings, daily huddles and during supervision and appraisal sessions.

Governance processes operated effectively. There was a clear framework of what must be discussed at team meetings to ensure that essential information was shared. The service had policies to guide staff in the day-to-day operation of the service. Staff collected and analysed data about outcomes and performance. They used this to identify improvements in response to our previous assessment.

We scored the service as 3. The evidence showed a good standard. The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. However, staff felt managers were not as visible as they could be.

Leaders had the skills, knowledge and experience to perform their roles. Leaders had a good understanding of the services they managed. Managers understood the needs of the patient group and their current health status and spoke with staff and patients on the wards. The registered manager and clinical manager had a good understanding of the challenges staff faced and oversight of issues and concerns.

However, the hospital was undertaking a change with some wards closing and others opening. Staff felt that managers had not been visible and had not engaged in a meaningful consultation about those changes.

Nearly all staff expressed concern about the hospital and lack of senior managers visibility.

Managers were aware of staff feelings and had allocated a manager to an individual ward which they attended as often as possible. The hospital manager had held events such as breakfast clubs to engage with staff.

Leadership development opportunities were available, including opportunities for staff not currently in management roles.

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.

Staff felt there was a positive culture at the service. No staff member we spoke to complained they had been the subject of racial discrimination or bullying.

We saw evidence that there were regular team meetings for staff to discuss any issues. All the staff we spoke with, told us that they were confident they could speak up if they had any concerns about the way they or the patients were treated. All staff we spoke to knew how to use the whistleblowing process.

All staff told us that they felt they could raise concerns to management about the service without fear of retribution. There was a national network of freedom to speak out champions as well as a freedom to speak out champion at the hospital.

There were daily opportunities for patients to feedback to the service any concerns or suggestions for change.

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

Staff were able to apply to work flexibly to account for personal circumstances such as caring responsibilities and health issues. Managers put reasonable adjustments in place for staff members to help them carry out their role.

There was a mix of staff from different backgrounds and ethnicities on the wards which were representative of the patient group. The provider had various networks championing equality and diversity such as the multicultural network, women’s network, disability network, carers network, LGBT+ network, and an equity, diversity and inclusion group.

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. Equality monitoring was undertaken by the provider's human resources team and via recruitment processes.

Quality Statement Score:3.

We scored the service as 3. The evidence showed a good standard. The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

There was a clear framework of what must be discussed at a ward, team or directorate level in team meetings to ensure that essential information, such as learning from incidents and complaints, was shared and discussed. This was evident from meetings and minutes of meetings that we observed. Evidence showed us that governance systems had improved since the last time we carried out an inspection where we had found seclusion records were not complete, and the hospital was no longer in breach of that regulation. The current systems enabled effective management of risk, issues and performance.

Staff had implemented recommendations from reviews of deaths, incidents, complaints and safeguarding alerts at the service level.

Staff undertook or participated in local clinical audits. The audits were sufficient to provide assurance and staff acted on the results when needed. Actions were clearly set out and followed through where they were necessary.

Staff maintained and had access to a hospital wide risk register. It was clear that this was being used to effectively track current risks. Staff rated risks so higher ones could easily be identified and there was an effective system of reviewing these risks.

The service had plans for emergencies, for example, adverse weather or a flu outbreak. These were contained within an accessible contingency management plan.

Staff had access to the equipment and information technology needed to do their work. The information technology infrastructure, including the telephone system, worked well and helped to improve the quality of care. However, a small number of staff told us that the electronic patient record was sometimes slow to access.

Team 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 work seamlessly for people. They share information and learning with partners and collaborate for improvement.

Managers described how the service was engaging with external stakeholders and partners. They recognised the importance of these relationships and ensuring that they were being kept informed and involved.

We saw one commissioner offering support via a media link, and they were arranging for the discharge of a patient.

We scored the service as 3. The evidence showed a good standard. The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

Staff were given the time and support to consider opportunities for improvements and innovation and this led to changes. Staff told us about quality improvement initiatives on their wards including the use of ‘safewards’. The aim of the ‘safewards’ model is to make psychiatric wards more peaceful through reducing conflict and implementing positive interventions such as soft words and mutual expectations.

Staff discussed ideas and career development in supervision, appraisal and at team meetings.

Staff used quality improvement methods such as audits and knew how to apply them. Staff participated in national audits relevant to the service and learned from them. Examples of these were highlighted at the clinical governance meetings whereby there were audits for weekly observation and engagement with patients, business continuity and emergency planning and national cleaning standards.

Wards had not started participation in accreditation schemes relevant to the service.