The Priory Highbank Centre

Updated 19 September 2022

Priory Highbank Centre is an independent hospital in Bury, Greater Manchester and is operated by Priory Rehabilitation Services Limited.

The service is registered to carry out the following regulated activities:

• Accommodation for persons who require nursing or personal care

• Treatment of disease, disorder or injury

• Assessment of medical treatment for persons detained under the 1983 Mental Health Act

• Diagnostic and screening procedures

The service was last inspected by the CQC on 5, 6 and 13 December 2018 where they were rated as good. The provider was issued with one requirement notice that affected long-term conditions. The legal requirements that were not being met were in relation to Regulation 18 CQC (Registration) Regulations 2009 Notification of other incidents. These requirements have now been met.

The registered manager is Helen Powell who has been in post since 4 March 2004.

The Priory Highbank Centre is a 34-bedded independent hospital located in Bury, Greater Manchester and accepts patient referrals from around the country. Referrals can be made by any health or social services professional. Funding is provided by the commissioning support unit (CSU) and clinical commissioning groups, social services, solicitors or individuals.

Within the hospital there are three units: Robinson House, Walmersley unit (upper and lower Walmersley) and Torrance House (formerly known as Lynne House).

Robinson House provides a service for 10 male patients aged 18 and over who have a diagnosis of mental disorder. They provide a long-term high dependency rehabilitation unit. The unit is part of the Priory Rehabilitation services group and is located within the main building of The Priory Highbank Centre in Bury.

There were six male patients in Robinson House at the time of the inspection and all six patients were detained under the Mental Health Act.

The unit is set over two floors. The first floor provides bedrooms for patients whilst the ground floor provides an open kitchen, dining room and lounge area. There is a conservatory and a spacious garden which can be entered from the lounge or conservatory. There was a multifunction room, a laundry/arts and craft room, a further lounge, a relaxation room and a snug.

Robinson House was last inspected by the CQC on 5, 6 and 13 December 2018 where they were rated as good. A CQC Mental Health Act monitoring visit took place on 18 June 2021. There were no issues or concerns identified.

The Walmersley unit (upper and lower Walmersley) provides interdisciplinary team assessment and slow stream rehabilitation to patients over the age of 16 years. The units facilitate rehabilitation for a range of patients, from low awareness to the more independent.

Rehabilitation programmes are tailor made to suit the assessed needs of the individual and can be delivered on a short term or longer term basis. Specialist areas include the management of patients who require assessment and those who have complex respiratory needs including tracheostomy and mechanical ventilation management. All patients are under the care of a consultant in rehabilitation medicine.

Upper and lower Walmersley wards are each located on separate floors and all patients have their own individual room with communal dining, therapy and gym areas and have access to a large garden.

The lower floor provides a self-contained apartment which includes a new salon for patients to have hair and makeup done occasionally.

Torrance House is a complex care and slow stream rehabilitation ward, with five inpatient beds. It provides care for children with acquired brain injury and complex neurological impairment from birth to age 17 years. Services provided include care and management of children with tracheostomies and / or ventilator dependent children under the supervision of a consultant in long term ventilation. Care is also provided for children with a range of disabilities, such as cerebral palsy and epilepsy.

There were fifteen patients in the upper Walmersley unit at the time of the inspection and three patients at Torrance House, with a fourth patient accessing respite at the weekends. Both units were inspected by the CQC on 5, 6 and 13 December 2018 where they were rated as good.

At the hospital there was one medical director 0.4 (WTE), one speciality grade doctor 1.0 (WTE), one consultant in long-term ventilation 0.1 (WTE) and one consultant in neuro-rehabilitation 0.2 (WTE) who worked under practising privileges. Following our inspection the service sent us a service level agreement for the consultant in neuro-rehabilitation. However, this expired 30 September 2020. Therefore there was no assurance that there was appropriate cover in place for this consultant.

For the upper Walmersley unit there were 15.7 whole time equivalent (WTE) registered nurses and 33.9 WTE healthcare assistants. At Torrance House there was 5.5 WTE registered children’s nurses and 17 WTE healthcare assistants. Shared across both units were 6.5 WTE therapists including therapy assistants, a part time head of therapy, a dietitian, a family liaison officer, two social and recreational officers, one part-time psychologist and a full-time assistant psychologist.

The accountable officer for controlled drugs (CDs) was the ward manager from the Robinson unit who was also the lead for the safe and secure handling of medicines.

Track record on safety across the service from January 2021 to January 2022 showed there had been no serious incidents reported and no healthcare associated infections.

Services provided under a service level agreement were:

• Pharmacy

• Pathology and histology

• On call GP out of hours service.

Updated 19 September 2022

Priory Highbank Centre is operated by Priory Rehabilitation Services Limited and provides in-patient mental health services for adults and specialist neurological rehabilitation for adults and children.

The service is run from a large detached Victorian property set within its own grounds. It has a total of 34 beds for patients of all ages with a brain injury or a neuro-disability which as well as a long-term high dependency rehabilitation unit for patients who have a diagnosis of mental disorder.

Within the service there are three units:

• The Walmersley unit (upper and lower Walmersley) provides a service for patients requiring complex care and slow stream rehabilitation over the age of 16 years, with 19 inpatient beds. 15 inpatient beds were located in the upper Walmersley unit and 4 inpatient beds in the lower Walmersley unit. At the time of our inspection lower Walmersley was closed to in-patients.
• Torrance House (formerly known as Lynne House) – provides a service for patients requiring complex care and slow stream rehabilitation from birth to 17 years old, with 5 inpatient beds.
• Robinson House provides a service for male patients aged 18 and over who have a diagnosis of mental disorder, with 10 inpatient beds.

Facilities include a family sitting room, designated therapy areas, dining and outside areas, fully adapted gym, and a self-contained flat which can be used for patients and their families.

The Priory Highbank Centre was last inspected by CQC in December 2018 and was rated ‘good’ overall. We inspected this service using our next phase inspection methodology and carried out an unannounced inspection on 26 and 27 January 2022.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

Our rating of this service went down.

We rated this service as requires improvement overall because:

• The service did not have enough support staff or allied health professional staff to meet people’s care and treatment needs. The service approach to staffing levels did not adhere to national guidance such as the British Society of Rehabilitation Medicine (BSRM). Not all staff received and kept up to date with their mandatory training.
• The service failed to deliver the clinically assessed required therapy hours to patients.
• Managers did not always have supervision meetings with staff to provide ongoing support and development.
• The maintenance of equipment was not always monitored and placed people at risk.
• Leaders were not always visible and approachable in the service. Not all staff knew what the vision, corporate values and strategic goals were. The service did not have an open culture where all staff felt they could raise concerns without fear. Not all staff felt respected, supported and valued.

However, we found that:

• The service had enough medical and trained nursing staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. The service used systems and processes to safely prescribe, administer, record and store medicines.
• The service made sure staff were competent for their roles and managers appraised staff’s work performance,
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
• It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously and investigated them.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with four requirement notices that affected long term conditions. Details are at the end of the report.

Updated 19 September 2022

The service did not have enough support staff or allied health professional staff to meet people’s care and treatment needs. The service approach to staffing levels did not adhere to national guidance such as the British Society of Rehabilitation Medicine (BSRM). Not all staff received and kept up to date with their mandatory training. Managers did not always have supervision meetings with staff to provide ongoing support and development.

Systems to protect patients against cross infection were not always monitored. Staff did not always keep equipment and the premises clean. The maintenance of equipment was not always monitored and placed people at risk.

The service failed to deliver the clinically assessed required therapy hours to patients. The service did not provide care and treatment for children and young people based on national guidance and evidence-based practice.

Leaders were not always visible and approachable in the service. Not all staff knew what the vision, corporate values and strategic goals were. The service did not have an open culture where all staff felt they could raise concerns without fear. Not all staff felt respected, supported and valued.

However, the service had enough medical and nursing staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Staff supported patients to make informed decisions about their care and treatment.

Updated 19 September 2022

Our rating of this service stayed the same. We rated it as good because:

• The service provided safe care. The ward environments were safe and clean. The wards had enough nurses and doctors. Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.
• 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 cared for in a mental health rehabilitation ward 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. 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.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
• Staff planned and managed discharge well and liaised well with services that would provide aftercare. As a result, discharge was rarely delayed other than for a clinical reason.
• The service worked to a recognised model of mental health rehabilitation. It was well led and the governance processes ensured that ward procedures ran smoothly.

What people who use the service say

We spoke with four people who were using the service and two carers. Their views reflected what we found on inspection.

Both carers were pleased with the service their relatives received. They thought they were safe and the staff looked after them well. One said they had once raised an issue and it had been addressed to their satisfaction.

The people who used the service told us they were happy with the care they received. They felt safe on the ward. Two patients said that the ward was always clean and one told us how he had been made to feel welcome when he arrived on the ward.

Patients thought there were enough staff to meet their needs and there were always things to do, such as trips, games and gardening.

They said that staff were respectful and polite.

One patient told us how he was involved in his own care. He said that staff took notice of his views.