The Care Quality Commission
  • Mental Health
  • Independent mental health service

Priory Hospital East Midlands

Overall: Requires improvement read more about inspection ratings

Mansfield Road, Annesley, Nottingham, Nottinghamshire, NG15 0AR (01623) 727900

Provided and run by:
Partnerships in Care Limited

All Inspections

10-18 January 2023

During a routine inspection

The service remains in 'special measures.' This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this time frame and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

Priory Hospital East Midlands is in Annesley in Nottingham and is one of the hospitals of Partnership in Care Limited. It has two female wards: one specialist acute ward and one psychiatric intensive care ward. The service works with patients in achieving their goals and preparing them to move back into the community, or into other appropriate accommodation. We carried out this unannounced inspection because we received information giving us concerns about the safety and quality of the service.

Our rating of this location improved. We rated it as requires improvement because:

  • The ward environments were not always and clean. There was a lack of cleaning staff to ensure that the hospital was cleaned regularly.
  • Staff were not able to fully observe patients in the seclusion room due to the observation area in the bathroom section of the seclusion room being used for storage.
  • Staff did not adhere to infection control procedures in relation the laundry of patients and staff clothing and bedding.
  • Staff did not always assess and managed risk well in relation to manage items that are deemed to be a risk for individuals. When managing risk staff did not use the correct practice when performing restrictive interventions.
  • Managers did not always ensure that these staff received training, supervision, and appraisal. Staff had not received additional specialised training to support the care and treatment of patients.
  • Medical staff did not follow the providers policy when admitting patients to the service, this meant that patients physical health was not complete in a timely way and medication had not been prescribed. Whilst the service had an on-call duty doctor system in place, the doctor on call was not always contactable.
  • Patients were not always discharged promptly once their condition warranted this or changed.
  • Staff did not always treat patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients.
  • Leadership had recently changed, and governance process and systems were still not fully embedded.

However:

  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. The ward staff worked well together as a multidisciplinary team.
  • The wards had enough nurses and doctors. They minimised the use of restrictive practices and followed good practice with respect to safeguarding.
  • Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • The service managed beds well so that a bed was always available locally to a person who would benefit from admission.

30 August 2022

During an inspection looking at part of the service

Priory Hospital East Midlands is located in Annesley in Nottingham and is one of the hospitals of Partnership in Care Limited. It has two female wards; one specialist acute and one psychiatric intensive care ward. The service works with patients in achieving their goals and preparing them to move back into the community, or into other appropriate accommodation.

We carried out this unannounced inspection because we received information giving us concerns about the safety and quality of the service. We were notified of three recent medicines errors, which involved nurses administering intramuscular injections to a patient. This medicine had not been prescribed by a doctor. We also received information of concern relating to the restraint of people using the service. We only focused upon specific areas in the safe and well led key question. We did not inspect the effective, caring and responsive questions.

Due to the focused nature of this inspection, we did not re-rate this service. The previous rating of Inadequate remains. At this inspection, we found:

  • Staff had reported numerous medicines errors through the providers internal electronic incident reporting system.
  • A visiting community pharmacist had identified recent medicines errors. The provider had not identified these independently due to a lack of oversight around medicines management.
  • Doctors had not always ensured medicine charts were clear and concise, which increased the risks of errors.
  • Doctors did not re-write medicines charts as and when needed. Numerous patients had several charts which was unnecessary. Additionally, doctors had not numbered the medicines charts correctly.
  • Discontinued medicines charts remained in patient medicine files. Staff had not removed these.
  • Some staff inaccurately recorded methods of physical interventions in patient records, which could lead to ambiguity around unapproved restraint methods being used.
  • One patient care plan and positive behavioural support plan did not fully reflect specific risks in relation to staff restraining.
  • Registered nurses had all completed training in medicines management, but we noted that some staff most recently completed in 2017.
  • Staff did not consistently record conversations held with patients when medicine errors had been made.

However:

  • We found staff had improved with recording physical health care observations after administration of rapid tranquillisation.
  • Managers had taken appropriate actions with staff when they had been made aware of recent medicines errors.

30 May 2022 - 10 June 2022

During an inspection looking at part of the service

Priory Hospital East Midlands is in Annesley in Nottingham and is one of the hospitals of Partnerships in Care Limited. The provider offers a specialised assessment and treatment to help patients for return to either local services or alternative appropriate accommodation.

We carried out this unannounced focused inspection because we received information giving us concerns about the safety and quality of the service.

We inspected safe and well-led key questions for the service. We did not inspect the caring, effective and responsive domains. The domains of caring, effective and responsive are currently rated as Good and will not change following this inspection.

However, we rated the safe and well-led key questions as inadequate and so the service is now rated inadequate overall. We have placed the service in special measures.

Following the inspection, the provider was issued with a section 31 letter of intent. The letter of intent informs the provider of CQC intention to take urgent enforcement action if improvements highlighted are not made immediately. The provider responded to the concerns we raised and put in place measures to safeguard people who used the service.

The provider submitted an action plan which provided us with assurance that appropriate action is being and will continue to be taken.

In addition, we served the provider two warning notices which required them to make improvement to the management of ligature risk, the way observations are carried out, the safe disposal of medicines and clinical sharp waste, the appropriate monitoring of phycial health following the administration of rapid tranquilisation and making improvements required following our last inspection. The provider must have robust governance arrangements in place to manage risk effectively, to ensure there are always enough staff with the right skills and competence to meet patients needs and that all staff had the information they needed to understand what care they needed to deliver to patients and that they had robust systems in place to ensure that staff entering the building had their identitity check and had the right skills and experience to keep patients safe and meet their needs. The provider is required to ensure they make the required improvements by 29 August 2022.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate overall or for any key question or core service, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service.

The service will be kept under review; if we have cause for concern we will not hesitate to inspect and take any appropriate action to ensure those using the service are safe and well cared for.

Our rating of this location went down. We rated it as inadequate because:

  • Some of the concerns raised at the previous inspection such as staff not following infection prevention and control procedures, wards being unclean and not fit for purpose, food not being labelled appropriately, patients' physical health monitoring not being carried out adequately after receiving rapid tranquillisation and the use of blanket restrictions had not been fully addressed.
  • Since the last inspection in December 2021 there had been no progress in reducing restriction interventions within the service. We saw the restrictions on access to the garden on Barton ward was still in place.
  • Staff had completed individual risk assessment for patients at risk of ligating however we were concerned that the toilets in ensuite bathrooms posed a ligature risk. The service had not reduced or removed all risks identified to keep patients safe, in particular the risk of patients having access to potential ligature anchor points in vacant unlocked bedrooms.
  • The service did not act in a timely manner to resolve maintenance issues. On Littlemore ward we found a patient’s shower was leaking into their bedroom.
  • The service did not have enough staff who knew the patients and staff did not always receive basic information to keep patients safe. The service relied heavily on agency staff and there was high use of agency staff. Leaders did not have oversight of agency staff and there weren’t the necessary checks in place in order to check identity of agency staff entering the building. The service did not always manage safe staffing well, not all shifts had an appropriate gender mix of staff.
  • There had been no improvement to the way staff managed rapid tranquilisation since the last inspection in December 2021. Staff did not always follow the provider’s use of rapid tranquilisation policy to ensure all patients received physical health checks following administration of rapid tranquilisation.
  • Staff did not always follow the provider’s infection, prevention and control (IPC) policy and did not always wear face masks correctly (as required during the pandemic) putting patients at risk of Covid 19.
  • Some staff did not feel respected and valued by senior leaders.
  • Staff did not always follow the provider’s observation policy by observing patients in an appropriate and prescribed way in line with good practice.
  • Handovers were completed, however not all risks and information were recorded and handed over in a timely manner. This meant that staff were not always aware of risks or key aspects of care for patients.
  • The service did not have effective systems in place to manage contraband or restricted items by storing them in the correct way. This issue was raised at the inspection in December 2021.
  • The service did not always manage medicines disposal safely.
  • Managers did not always investigate complaints thoroughly. Managers failed to ensure all complaints had been fully recorded, investigated and changes made to practice to ensure they did not reoccur.

However,

  • Incidents that were recorded were thoroughly investigated
  • The patients we spoke with told us that staff were caring, approachable and respectful.

01 September and 07 September 2021

During an inspection looking at part of the service

Priory Hospital East Midlands provides care and treatment on wards for adults of working age and psychiatric intensive care units for females. It also provides forensic inpatient/secure wards for females.

We inspected specific parts of the safe key questions across all three wards to check that patients were being cared for safely. Because of this, we have only re-rated the safe domain.

We served three warning notices under Section 29 of the Health and Social Care Act 2008 against the provider. We told the provider it was failing to comply with the following Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 12 Safe care, and treatment, Regulation 15 Premises and equipment and Regulation 17 Good governance.

We told the provider it must become compliant with the regulations by 1 November 2021. The provider told us the action they are taking to make the required improvements and we will continue to monitor this.

We rated Priory Hospital East Midlands as requires improvement because:

  • Managers did not ensure the wards were clean and fit for purpose. All three wards were very dirty, the furniture across all the wards was dirty and some items were damaged.
  • We found environmental and maintenance issues across all three wards that had not been addressed to ensure the premises were safe and fit for purpose.
  • We saw unsafe flooring on Harris ward. We saw a patient had a walking aid who struggled to use the aid on the carpet.
  • We found raised metal door hinges on the floor in the bedroom areas on Littlemore Ward, which could have been a trip or self-harm hazard. The kitchen fridge was untidy, dirty and food was not labelled and a bedroom had not been cleaned to remove bodily fluids. There was no access to a communal bathroom for patients.
  • The garden steps on Barton ward were unsafe and this posed a potential trip hazard and could also have been used to cause harm or injury.
  • Managers did not ensure that the hospital was clean and that they were safely managing Infection Prevention & Control.
  • Staff did not safely or effectively manage risks relating to contraband security. On Barton ward the security log was not reflective of what was stored in patients’ lockers.
  • Managers did not ensure that they reviewed the use of blanket restrictions regularly and adopted a least restrictive approach.
  • Staff did not always ensure that patients physical health had been monitored after receiving rapid tranquilisation.
  • Managers did not have an effective system in place to ensure that patients’ who require long-term segregation are cared for in an environment that meets their needs and reflects their preferences, or in line with the Mental Health Act Code of Practice.
  • Staff did not always get the time they required to read patients care plans or review updates to the patients risks.
  • Medicines records were not complete and did not contain details on dose, when patients received them.

However:

  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice.
  • The wards had enough nurses and doctors and followed good practice with respect to safeguarding.
  • The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal.
  • The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
  • Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.

20 - 21 December 2017

During a routine inspection

We rated Annesley House as good because:

  • We observed positive interactions between staff and patients.
  • Patients had access to physical healthcare appointments and staff monitored patients’ physical healthcare.
  • Care plans and risk assessments were up to date and person centred and showed patient involvement. Patients and their families were involved in decisions about their care.
  • Patients were supported to maintain their independence through real work opportunities and a variety of therapeutic activities facilitated by the occupational therapy team.
  • The provider made sure there was the right amount of experienced staff to care for patients on all of the wards. Staff were inducted into the service, given regular supervision and appraisals and suitably trained.
  • We saw evidence that showed all patients had access to individually tailored psychological treatments and were offered additional sessions if needed.
  • Staff knew how to report incidents and we saw evidence that when this happened, managers shared the learning from these incidents with all staff.
  • Staff morale had improved since the last inspection. Staff said they felt well supported by their managers and that change had been managed well throughout the service.
  • There were effective systems in place to monitor key performance indicators for patient care and staff development.
  • The hospital participated in national quality improvement programmes.

However:

  • Not all staff were clear it was unsafe to access rooms that did not have a functioning alarm or nurse call system on a one-to-one basis with patients.
  • Staff did not always implement individual risk assessments during periods of observation and this meant some staff were unclear as to how they should observe patients during the night if there was a risk they might harm themselves through hanging or strangulation.
  • Staff were unsure about when and how often they should search a patient and their room.
  • Some patients told us they did not feel supported by all staff on the ward and that the provider had not given them the opportunity to give feedback about the service.

17 July 2017

During an inspection looking at part of the service

The service was rated as requires improvement overall in May 2017. It was not rated at this inspection.

The Care Quality Commission (CQC) carried out a follow up inspection of Annesley House on 17 July 2017 to ensure improvements were made following our inspection in May 2017. This followed CQC issuing a warning notice on 25 May 2017 to the provider requiring them to make sure patients received the required level of observation to maintain their safety and the safety of others.

We found the provider made the following improvements:

  • Staff on Oxford ward completed patient observations in communal areas of the ward and documented patient observations on the provider’s observation and engagement record form.
  • The provider had implemented a new observation and engagement policy, delivered a training programme for all staff based on this new policy and completed an audit that reported into the provider’s clinical governance processes.
  • We saw completed and up to date care plans, risk and physical health assessments.
  • Documentation relating to the Mental Health Act 1983 was in order, however we observed a patient was not read their rights under section 132 Mental Health Act in a timely manner. This was rectified by the nurse in charge.

However

  • We saw three staff members were not following the provider’s observation and engagement policy as they had included information about the patients’ mental state. One staff member did not record patient observations intermittently but recorded patient observations every 15 and 30 minutes.
  • One care plan we saw did not focus on patient discharge although the patient had unescorted section 17 leave.

16 May 2017

During a routine inspection

This was a responsive inspection and we only looked at three of the five key questions, which were safe, effective and well led. At our previous inspection in August 2015, we rated the other two key questions of caring and responsive as good. We have received no further intelligence to suggest any issues that would change these ratings.

We issued a warning notice to the provider as we identified a breach of Regulation 12 in relation to patient observations.

We rated Annesley House as requires improvement because:

  • Staff did not observe patients on Oxford Ward as often as needed to make sure patients were safe.

  • Staff did not consistently store medicines at safe temperatures and emergency equipment was not always in date.

  • There were eight vacancies for registered nurses and agency staff were used to cover. The provider did not make sure that the estimated number and grades of staff worked on each ward on every shift.

  • The provider did not offer psychological therapies to each patient to meet their assessed need.

  • The provider did not offer specialist training to all staff to help them support patients.

  • There had been two changes of managers within the last nine months, which had unsettled the hospital. There was no registered manager in post at the time of our inspection. An acting manager was in post.

  • Audits did not always identify the risks to the health, safety and welfare of patients.

However:

  • The environment was clean and safe.

  • Restraint and seclusion were used appropriately and in line with current guidance.

  • Staff followed safeguarding, Mental Health Act and Mental Capacity Act procedures and policies.

  • Staff assessed each patient’s risks and needs and developed a care plan with the patient.

  • The provider made sure that staff had mandatory training.

26 -27 August 2015

During a routine inspection

We rated Annesley House as good because:

  • Wards were clean and comfortable with a homely atmosphere. Environmental risk audits had identified risks and action taken to alleviate these.
  • Patients were safe because there were adequate staff; there were no vacancies at the time of our inspection.
  • All patients had documented risk assessments and risk management plans. Patients had access to psychological therapies and national institute for health and care excellence (NICE) guidance was evident in care planning. Each patient had a personal timetable of activities.
  • Records we reviewed showed staff assessed patients’ needs and delivered care based on their individual care plans. On admission each patient had a physical health assessment and records showed patients continued to have physical health checks.
  • The hospital kept detailed recordings of incidents when patients needed restraining and the governance group monitored the trends and action plans. The safeguarding and incident reporting processes included monitoring trends and fed back lessons learnt to staff.
  • There was a high compliance rate for staff mandatory training.
  • The majority of patients and carers we spoke with told us staff were respectful and polite. They felt staff were caring and interested in their well-being. Staff interacted with patients positively and in a kind and caring way.
  • All patients told us they had access to good advocacy services. The hospital involved patients in developing and improving services through patient alliance representatives who told us the hospital listened to them and responded to requests.
  • There was a clear admission process.
  • Staff listened to patients’ preferences and patients could personalise their bedrooms with some patients keeping pets. Patients had access to a mobile telephone, could make hot drinks and snacks throughout the day, and had access to a garden.
  • All staff said they experienced good leadership at ward and organisational level. All staff had received regular support and managers made themselves available to staff. Staff we spoke with said senior managers were very visible in the hospital and told us morale was good.
  • We saw a clear structure of clinical governance at Annesley House through to a regional and national level.
  • We saw good examples of a commitment to improve the quality of service provided.

However:

  • Staff we spoke with had a variable understanding of the Mental Capacity Act and generally could not tell us the five guiding principles of the act.
  • Staff implemented a range of measures to manage violence and aggression, however prone restraints occurred. The Department of Health guidance states prone restraint should not take place.
  • Records did not demonstrate that staff undertook a risk assessment before a patient went on section 17 leave, or that their capacity to understand their rights was assessed in line with the Mental Health Act (MHA) Code of Practice.
  • A significant number of staff had not completed required food hygiene training.
  • Some staff told us they required more specialist training for autism and eating disorders..

26 June 2014

During a routine inspection

The service provided was safe. People told us they felt safe in the hospital. People told us that staff were proactive in addressing any identified safety concerns. Safeguarding issues were being appropriately reported. The relevant records seen showed us that clinical risks were being managed safely.

The service was effective. Each person had an individual care record which included assessments of specific needs. Individualised care plans were in place This demonstrated to us that care and treatment was being effectively planned and delivered in a way that was intended to ensure people's safety and welfare.

The service was caring. People told us that staff had time for them and provided them with the appropriate levels of support. We noted that staff were supportive and caring with people. We found that individuals were having their rights protected under the 1983 Mental Health Act.

The service was responsive. Systems were in place to manage and investigate formal complaints made to the service. Three people who used the service confirmed that they felt able to share any of their concerns or complaints with front line staff.

The service was well led. We reviewed the action plan agreed with NHS England following the previous concerns identified by the Care Quality Commission. Evidence was seen of the actions taken by the provider to demonstrate their on-going compliance with the relevant regulations.

30 September and 1 October 2013

During an inspection looking at part of the service

We did this inspection to follow up warning notices we issued to the provider and manager about respecting and involving people; care and welfare of people and safeguarding people from abuse. In assessing compliance we spoke with six patients across the three wards which form part of Annesley House. The patients on the locked rehabilitation ward did not want to speak with us so we spent time in the communal areas of the ward observing patient and staff interactions. We also spoke with the new manager; ten care and nursing staff and seven clinical staff covering the three wards. We were accompanied by a specialist professional advisor and his comments are incorporated into this report.

We found mixed evidence in every outcome. We found there were significant improvements on the two wards still based at Annesley House, but we found that the good practice at that hospital was not adopted on the other ward.

We found patients on two of the three wards were treated with dignity and respect and fully involved in planning their care and treatment. Patients on the other ward were not happy with the way they had been treated and they did not feel involved in the care and treatment they received.

There had been improvements to the care and welfare of patients living on the two wards at Annesley House and they expressed satisfaction with staff support. The patients on the other ward did not always have their physical health needs assessed promptly and concerns were not always identified and acted upon appropriately. The patients on this ward were very unhappy with the risk assessment system in place, and there was not enough therapeutic input to assist the women on their recovery pathway.

All of the patients told us they felt safe and they all said the bullying had stopped. We found that an individual approach had been taken towards risk on two of the wards, but this had not been adopted on the third ward which was temporarily located elsewhere. This meant patients found the controls in place were excessive.

17, 27 June 2013

During a routine inspection

We spoke with patients on all three wards plus four relatives as part of this inspection.

The patients we spoke with praised particular staff for their approach, attitude and the support provided to them, but also raised concerns about the inappropriate and disrespectful attitude of some staff. Patients were not always treated in a respectful way and some treatment reported was inhumane.

Patient's safety, mental and physical health was not always properly assessed, planned and care was not always delivered in a way which met their needs and promoted their health. Consequently patients were at risk of receiving inappropriate care or treatment. Patients and staff were concerned about the absence of treatment and therapy and about the patient mix. One patient said, "My medication has doubled; my mental health is going to pot.'

Some patients did not feel safe at the hospital and bullying was a persistent problem which had not been resolved in spite of the staff taking some steps to try and address it. This was affecting people's mental health and in some cases was leading to an increase in self harm.

We found the service was not well led and managed and that the clinical governance systems in place were not effective at ensuring risks were identified and managed.

Complaints were not responded to in line with the provider's policy. Some patients feared recriminations if they raised complaints. One patient said, 'It's a waste of time reporting anything.'

6, 7 March 2013

During an inspection looking at part of the service

Two patients were very happy with the care being provided. One patient did volunteer work in the community in preparation for discharge and said, "They have turned my life around." Others were less positive about the care being provided and felt they were not getting the care, support and help they needed. As a result these patients did not feel their rights were being upheld and they did not feel safe.

We found the systems in place to assess and monitor the quality of care being provided were very good at identifying the risks to patients and others, but further action was needed to manage the potential risks to the health, safety and wellbeing of patients.

Patients expressed mixed opinions about the complaints systems. A patient who had complained to us said that following their complaint there were clear signs of progress and they hoped this would continue. We saw a letter from the patient to the manager which was more positive about their experience. This showed steps had been taken to resolve their complaint. Other patients were not so satisfied. Three people said they did not feel able to make complaints and did not feel they would be listened to. One patient told us, 'I know people have written and complained to the CQC but I'd be too frightened to.' This meant patients did not always feel able to raise concerns for fear of repercussions which could place them at risk.

26 June 2012

During a routine inspection

We spoke with five patients during our inspection. They all knew about the care and support that was planned for them and said they were consulted about this. They said if any changes were needed the staff would explain the reasons for this, and they said they were given the opportunity to share their own views about any changes.

Patients told us that they knew about their care plans and said they were involved in creating them. We observed that there was a relaxed and comfortable atmosphere on the ward where we sat; there was a good rapport between the staff and patients.

Most patients felt the staff would listen to them and take action if they had a problem; though they did comment that the staff did not always have enough time for them at the moment as a difficult situation was taking a lot of their time. This meant people did not always have the support they needed and as it was planned.

One patient commented that they felt the GP did not listen to them when they visited and did not take into account how they were feeling. We passed this information on to the manager for her to feed this back to the GP to ensure the patient received appropriate health care support.

Most of the patients we spoke with said they felt safe. However, one person told us they were being "bullied" by another patient. This person told us they did not feel safe on the ward at night because of this. We spoke with the manager about this. The manager had various ideas as to how to improve things for this patient, and had already put enhanced staffing levels in place as a means of protecting patients. The patients we spoke with all said when people were upset or agitated the staff tried to separate them from others and took them to a quiet area to calm down. None of the patients we spoke with ever felt that patients were at risk of being harmed by staff on these occasions and they told us they felt restraint was done in a controlled way.

The provider had a system in place to regularly assess and monitor the quality of services that people received but this was not always effective at protecting service users and others who may be at risk by identifying and managing all of the risks to their safety.

One person we spoke with told us they had not seen a complaints procedure. When we looked around the wards we could not see one on display. The manager told us this may have been lost or dislodged during the recent move and would make sure this was replaced. The other four people we spoke with told us they had not had any cause to complain. All of the people we spoke with told us there was an advocate who came in to see them regularly. They all said they could speak to the advocate at any time and said she was easy to approach. Other evidence suggested complaints were not always dealt with in line with the provider's policies.

14 November 2011

During a routine inspection

This was a joint inspection visit by a Mental Health Act Commissioner (MHAC) and a compliance inspector. The visit was unannounced and the report includes findings from the MHAC where they indicate non compliance with the regulations.

We asked patients about their involvement and experiences at the service. One patient told us, 'Annesley is a great place to be, it feels like home. There is a good atmosphere and staff are friendly. They very much support my needs and I am able to work towards my goal of attending college. Staff are respectful of my opinions and views and I feel valued. When I was at a previous place I was not involved at all, here the staff encourage me, I have a structured day and can access authorised leave.'

One patient commented, 'I am progressing really well here, I can see the medical team regularly and they have explained my care pathway to me, I can see how well I am doing using the recovery star plan.'

Some patients we spoke with told us they felt safe. One patient commented, 'Staff know how to provide treatment here, they know how to deal with any incidents of aggression to keep us safe.'

Another patient told us that they were not confident when they raised issues about staff attitudes. Comments included, 'Some of the staff have bad attitudes; they can be dismissive and rude. When I complain I am told to write it in the ward complaint book but when you do that they all see it and collude with each other so there is little point in raising things.'

Mental Health Act Commissioner reports

Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff.

Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We are looking at different ways to indicate the outcomes of our monitoring in the future.