Priory Hospital Solihull

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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 this key question good. At this assessment the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

Staff completed thorough assessments of each patient’s mental and physical health needs on admission and reviewed these regularly. Care plans were personalised, holistic and recovery focused. The service delivered a broad range of NICE‑recommended psychological therapies and ensured all patients received meaningful psychological input. Extended assessments enabled staff to identify co‑morbid conditions such as autism, mild learning disabilities and ADHD, improving diagnosis and care planning.

Teams worked well together and shared information effectively through daily multidisciplinary flash meetings, structured handovers and regular review meetings. Partnerships with external professionals supported continuity of care and informed discharge planning.

The service used a variety of recognised outcome measures to review progress and inform treatment, giving a consistent picture of how well people were doing over time. Staff understood and respected patient’s rights around consent, explaining information clearly and completing decision‑specific capacity assessments when required. When patient’s lacked capacity, staff made decisions in their best interests in line with the Mental Capacity 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.

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.

We reviewed 10 care records. Staff undertook a comprehensive assessment of each patient either upon, or shortly following admission. Initial assessments were comprehensive and included mental health as well as physical health. If a patient had declined any assessment, or had engaged minimally in the initial assessment, staff ensured they revisited this at the earliest opportunity and captured relevant information in the patient’s clinical notes.

Wards had a named nurse system. Named nurses developed individual care plans with patients (where possible). These were reviewed regularly through multidisciplinary discussion in the patients review meetings. Staff updated care plans as needed to reflect any changes to ensure the care plans remained current and accurate. Staff added to care plans as new needs became apparent, as part of ongoing review of care and treatment.

Care plans were personalised, holistic and recovery orientated. Every patient had 4 care plans, which covered keeping safe; keeping well; keeping healthy and keeping connected. Care plans we reviewed reflected the needs of the patients. Each care plan had individual goals and aims, reflecting the goals and aims of the patient themselves, as well as the wider MDT.

The evidence showed an exceptional standard. The service always 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. They worked to develop 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.

The MDT 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.

The team included a full range of specialists required to meet the needs of patients in the service. The MDT consisted of doctors, nurses, support workers, psychologist and a psychology assistant, occupational therapists and occupational therapy assistants. The service also accepted psychology trainees from a local university, which complimented the psychology team. Following a project earlier in the year which demonstrated an increase in patients participating in activities, the service were recruiting 2 full time activity assistants, dedicated to facilitate these activities flexibly.

Every patient was registered with a local GP practice, so other, required, specialist referrals to healthcare professionals could be easily supported. We saw a number of patients had been referred to specialist services, for example diabetes specialist clinicians, and a renal specialist team.

The medical director and the psychologist firmly believed that every patient will and should receive regular input from the psychology team. Every patient at the hospital had received some level of psychological support, either on a 1 to 1 basis, or through groups offered. Patients could access a wide range of psychology therapies. Examples of individual therapies offered included cognitive behavioural therapy (CBT); cognitive analytical therapy (CAT); dialectical behaviour informed therapy (DBT) and trauma informed interventions: eye movement desensitisation and reprocessing (EMDR). Group sessions offered included addictions; anxiety; anger management; mindfulness and relapse prevention. Therapy programmes were evaluated every 8 weeks by the MDT to ensure they were responding to the changing needs of patients.

In addition to the above, the psychology staff offered extended psychological assessments, which had led to identification of some patient’s diagnosis of co-morbid conditions. (Co-morbid conditions means that a person is living with 2 or more illnesses, disorders or conditions at the same time). Over the last 12 months, a total number of 9 patients received some extended assessments. Of these, 8 were given a positive diagnosis for either mild learning disabilities, autism (ASD) and / or attention-deficit hyperactivity disorder (ADHD). These diagnoses supported onward care planning; helped the patients understand some of their challenges through individual, tailored psychology sessions; helped staff understand how to effectively support them, through adapting positive behavioural support plans; as well as ensuring future placements and ongoing support would be appropriate.

Occupational therapists undertook individual assessments, to assess occupational functioning, cognitive functioning, as well as assessing general satisfaction with life and how this could be maximised. Staff offered practical sessions, on an individual need’s basis, such as budgeting, kitchen safety, cooking and road safety. Visits to the local community was encouraged and facilitated. Patients told us they had visited a library, leisure centre and a church. Many patients told us about a trip to a zoo, which they had enjoyed. The occupational therapy staff worked with patients to encourage integration in the local community, which included accessing education opportunities, as well as volunteering and / or paid work opportunities. The service continually participated in clinical audit, benchmarking and quality improvement initiatives.

Staff were experienced and qualified, and had the right skills and knowledge to meet the needs of the patient group. All staff had a comprehensive induction to the service. Staff attended regular, monthly staff meetings. Managers conducted annual appraisals of work, which included a discussion around opportunities to develop their skills and knowledge. All staff eligible for an appraisal, had received one.

Staff were supported regularly with supervision, both managerial and clinical. Management supervision compliance was at 100% across all wards. Compliance with clinical supervision was 100% on Arley and Elkin wards, and at 93% on Millison ward at the time of our inspection. In addition to the staff meetings and supervision, staff had the opportunity to attend and participate in reflective practice sessions, led by the psychology team. Managers ensured that staff received the necessary specialist training for their roles, and had organised additional training sessions as and when a need was identified.

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. At time of assessment, compliance with this training was 98%.

Staff had easy access to administrative support and legal advice on implementation of the Mental Health Act and its Code of Practice through the hospital Mental Health Act administrator. The Mental Health Act administrator had oversight of all Mental Health Act documentation and had systems in place to ensure legal requirements were met. The provider had relevant policies and procedures that reflected recent guidance.

Patients had access to information about independent mental health advocacy. Staff ensured this was displayed on the wards on patient notice boards. Staff explained to patients their rights under the Mental Health Act in a way that they could understand, repeated it as required and recorded when they had done this. Staff stored copies of patients' detention papers and correctly so that they were available to all staff who needed access to them.

Staff ensured that patients were able to take Section 17 leave (permission for patients to leave hospital) when the responsible clinician had granted this. Detained patients we spoke with told us they used their section 17 leave regularly. Staff ensured they completed relevant risk assessments prior to the patients leaving the ward, in line with hospital policy.

Staff requested an opinion from a second opinion appointed doctor when necessary. The service displayed notices to tell informal patients that they could leave the ward freely, and to speak to the nurse in charge if they wanted to leave. Care plans referred to aftercare requirements of patients with details of local teams who would be supporting them upon discharge.

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.

The nurse in charge of each shift handed over to the incoming shift. Each patient was discussed in turn, general presentation, incidents and risks were relayed. As was any planned leave, activities or appointments to ensure appropriate planning for the day.

The hospital held daily MDT flash meetings Monday to Friday. A range of staff attended this. We observed a meeting which was attended by the hospital director, ward managers, representatives from the medics, occupational therapy and the psychology team. Ward managers offered an overview of the previous 24 hours, to include any incidents, new or ongoing safeguarding concerns, any new temporary restrictions and rationale, identified ward fire marshals, and confirmed and reviewed staffing. Therapy staff advised of planned groups, activities and sessions. The hospital director discussed any compliments or complaints received, as well as any planned, onsite training. If a new admission was expected, details of anticipated arrival were shared. Those in attendance disseminated all relevant information to their own teams.

MDT meetings (individual ward rounds) were undertaken every 2 weeks, so all patients were reviewed monthly. We saw there was usually good MDT attendance, including the doctors, nursing staff and therapy staff. Relevant external professionals were invited, such as care coordinators. As well as the patient attending, family members were invited where appropriate.

The teams had effective working relationships with teams outside the organisation, for example, the Local Authority and the GP service. If patients progressed within the hospital and changed wards, all information was available to all staff electronically. Managers ensured relevant commissioners were up to date with progress throughout their stay and worked collaboratively towards discharge to a community setting.

Each ward held a 30-minute complex case discussion for staff. During these meetings, the MDT examined a particular patient. A number of factors were reviewed to include the clinical presentation, recent incidents, psychology formulations and reviewed how learnt coping skills and strategies had been used by the patient. Staff reported that these sessions were particularly helpful as they helped them understand why a patient may react to certain things in a certain way.

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.

Activities available on and off the ward helped to promote a healthy lifestyle for patients. Some patients told us they had been to a leisure centre and had enjoyed a swim, as well as a sauna and hot tub. Some patients told us how they enjoyed walking in the local area when on leave. The hospital had a fitness instructor who attended the hospital regularly, helping patients to use the onsite gym. Patients were supported to develop cookery skills, where cooking healthier meals was encouraged. The service had delivered groups around substance misuse and the effects this can have upon your physical and mental health.

The hospital had a dedicated physical health lead, as well as a smoking cessation lead and smoking cessation champions. Nicotine replacement therapy was offered to patients who wanted help quitting smoking. Staff were able to source and print off leaflets about smoking, how this damages your body and the benefits of quitting.

Doctors and nurses discussed possible side effects of taking some medicines, for example changes in appetite and how they could manage this. Staff could get referrals to other services, for example, a dietician as and when this was necessary for additional advice tailored for the patients.

Nurses routinely undertook physical health observations of all patients to monitor any changes in blood pressure, pulse and weight. If there were any concerns, staff monitored observations more frequently and reported to the medics for review. Some patient told us of a ‘well man’s clinic / session’ that they enjoyed going to, where male related health concerns could be openly discussed.

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.

The multidisciplinary team used several recognised outcome tools to monitor each person’s care and treatment and to support continuous improvement. On admission and after every care programme approach (CPA) review, nurses and doctors completed the Health of the Nation Outcome Scales (HONOS), which measure a person’s health and social functioning. Patients, supported by the MDT, completed the Camberwell Assessment of Need Short Appraisal Schedule (CANSAS), which helps identify their needs and priorities. The medic completed the Liverpool University Neuroleptic Side Effect Rating Scale (LUNSERS) to monitor any potential side effects of medication, and nursing staff completed DIALOG, a tool that captures how satisfied people feel about different areas of their life and treatment.

At each CPA review, the therapy team completed the Model of Human Occupation Screening Tool (MOHOST), which looks at how people manage daily activities, alongside the life skills profile, which assesses practical day‑to‑day functioning. Together, these tools provided a clear and consistent picture of each person’s progress and helped guide ongoing improvements in care.

The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff we spoke with had a good awareness of patient’s rights around consent to care and treatment. Staff took practical steps to support patients to make their own decisions on a day-to-day basis. Each ward had relevant information for patients visible which included the rights of informal patients being able to leave the ward. We saw information about detention under the Mental Health Act and how patients could access advocacy and / or a solicitor if they wished to discuss further or appeal against this.

Consent to admission and treatment had been discussed with each patient, assessed and recorded early in the admission process and revisited periodically. When staff explained patients’ rights to them, if they did not fully understand, this was recorded, with staff meeting with them again a day or 2 later to go over it again.

For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. Staff had completed a number of capacity assessments. Staff clearly recorded if the patient could understand the information, retain this, weigh up the information, and communicate their decision. If there were doubts about a patient’s capacity in relation to a specific decision, the MDT made decisions in the patients’ best interests, in line with the Mental Capacity Act. Examples of assessments we saw included diabetes management and managing finances. We saw family members and advocacy had been invited to attend best interest meetings.