Priory Hospital Enfield

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

Prior to the inspection we received a number of anonymous concerns raised by staff regarding restrictive practices, gaps in physical health monitoring, a closed culture, discrimination in recruitment, and a punitive approach to complex behavioural issues. Overall, we did not find evidence of these concerns during the inspection.

There was a breach of regulation 17(2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At the previous inspection we found that action should be taken to review the effectiveness of the internal governance assurance framework to ensure they were fit for purpose and highlights issues requiring attention to senior staff.

At the current inspection we found that although leaders understood what the local risks were and had quality assurance measures in place, at the time of the inspection, oversight was not sufficient to find and address errors in staff documentation of seclusion, medicines administration, and rapid tranquilisation.

Leadership development opportunities were available, including opportunities for staff below ward manager level. Staff spoken with during the inspection felt supported by their colleagues and managers. They knew how to use the whistle blowing process and how to contact the freedom to speak up guardian. Staff appraisals included conversations about career progression where relevant and how they could support staff development.

There was a clear framework for the discussion of important information such as learning from incidents, complaints, audits and alerts and staff met regularly at business team meeting to discuss this. Staff had implemented recommendations from reviews of deaths, incidents, complaints and safeguarding alerts at the service level. The service had plans for emergencies. This included contingency arrangements for adverse events.

A patient representative attended clinical governance meetings. Since the previous inspection, the service had also introduced a new structured staff handover record for use between shifts and had appointed a physical health nurse for the hospital.

Quality improvement projects that the wards were involved in included reducing reliance on agency staff, improving staff attendance and shift compliance.

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.

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

Staff told us they felt comfortable to raise concerns with their line managers and that they would be listened to and that any concerns they raised would be addressed. Staff spoke positively about opportunities for professional development. There were development opportunities available for both qualified and unqualified staff.

Staff appraisals included conversations about career progression where relevant and how they could support staff development.

Staff were aware that they could access support for their own physical and emotional health needs through the provider’s occupational health service.

There had been changes in the leadership at the time of the inspection. A new hospital director was joining the service soon after our inspection, and we were able to meet with the previous hospital director and new director during the inspection. They demonstrated the skills, knowledge and experience to perform their roles. The ward managers understood how their ward was performing in terms of quality outcomes for patients as well as the condition of the environment.

Leadership development opportunities were available, including opportunities for staff below ward manager level.

Staff spoken with during the inspection did not report any cases of bullying or harassment on the wards and told us that they felt supported by their colleagues. Staff knew how to use the whistle blowing process and how to contact the freedom to speak up guardian.

Prior to the inspection we received a number of anonymous concerns regarding restrictive practices, gaps in physical health monitoring, a closed culture, discrimination in recruitment, and a punitive approach to complex behavioural issues. Overall, we did not find evidence of these concerns during the inspection. However, we did note that there some gaps in information oversight across the hospital.

The provider had investigated some whistleblowing concerns from February 2025 but did not find evidence to substantiate the concerns raised.

At the time of the inspection staff did not express any concerns about workforce equality, diversity and inclusion.

The most recent staff survey from April 2025 indicated positive scores of 79% for staff empowerment, 90% for line manager support and diversity, 87% for engagement and growth, and 88% for purpose and teamwork.

Although there was generally a clear system in place for good governance and the delivery of good quality, sustainable care, there were some areas that needed improving in relation to governance systems.

There had not been sufficient oversight by senior managers to identify and monitor gaps in seclusion records and some unclear recording of medicines administration. Although rapid tranquilisation and seclusion audits were being carried out periodically, they did not pick up all the issues that we found. During the inspection, staff found it difficult to locate records of previous cases of seclusion, and other restrictive practice. At the previous inspection we found that action should be taken to review the effectiveness of the internal governance assurance framework to ensure they were fit for purpose and highlights issues requiring attention to senior staff. During this inspection, although there had been some positive changes, we identified that there was more work to do here.

We did identify areas of good practice. There was a clear framework for the discussion of important information such as learning from incidents, complaints and alerts and staff met regularly at business team meeting to discuss this.

Staff had implemented recommendations from reviews of deaths, incidents, complaints and safeguarding alerts at the service level. There was immediate learning each time a serious incident occurred.

The service had plans for emergencies. This included contingency arrangements for adverse events.

A patient representative attended clinical governance meetings and patients completed surveys on discharge. Since the previous inspection, the service had also introduced a new structured staff handover record for use between shifts and had appointed a physical health nurse for the hospital.

Staff kept patients up-to date by displaying information on notice boards as well as discussion of any relevant matters during community meetings and one-to-one sessions. There were monthly team meetings where staff had the opportunity to raise any concerns.

Patients and carers had the opportunity to give feedback on the service through surveys and direct contact with staff. A patient representation attended clinical governance meetings to represent patient views in this forum.

Staff used feedback from patients and carers to bring about improvements on the wards.

Quality improvement projects that the wards were involved in included reducing reliance on agency staff, improving staff attendance and shift compliance, defensible clinical writing and documentation improvement, and improving the accuracy and quality of incident reporting.

On Byron Ward staff were working to improve teamwork and communication through daily multidisciplinary team meetings, structured supervision and use of a staff communication book.

Benefits of the initiative to improve staff attendance and shift compliance included a marked improvement in timekeeping, smoother handovers, improved team morale, greater trust and accountability within the team, and managers having a clearer overview of operational practice, allowing for timely intervention.