Priory Hospital East Midlands

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The service provided care and treatment in a way which made patients feel safe, supported and listened to. Patients we spoke with attended the care and treatment plan review meetings and were aware of the risks on the ward. Information about safeguarding was on display around the ward area and managers were confident staff knew how to escalate and report safeguarding concerns. Staff managed risks well on the ward area and when patients access section 17 leave. However, we found medication was not always stored effectively and staff did not always monitor patients’ physical health conditions as required. Staff rectified medication storage issues found immediately and we found no impact on patients from the gaps in physical health monitoring.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Patients we spoke with told us they felt safe. They were given information about their care, and risks were reviewed regularly. They knew who to go to if they had any concerns and felt staff listened to them.

Staff told us patient safety was a priority and was mentioned in handovers. Staff felt able and confident to question peers’ practice. Staff told us debriefs happened in teams and as individuals after incidents. Management went into detail about how they worked closely with the Patient Safety Incident Response Framework network way of working. They gave examples of how they investigated a recent incident and reviewed as a team giving them a chance to learn from it and not being individually blamed for something. They all looked at the rapid intervention and treatment process and they have received good feedback on this approach and have seen a positive impact on the learning that occurred. Managers were passionate about discussing how they want staff to role model shared learning in patient safety.

Management produced a document which was sent to all staff and placed on each ward called the ‘Tuesday read’. This was a weekly document that had key points for staff to know about, news regarding the hospital and service, patient safety, policy of the month and key messages. Management had processes and meetings in place to identify learning. This included patient safety meetings, morning meetings, reflective practice after incidents and spot-checking closed circuit television (CCTV).

Staff assessed referrals into the service to ensure the care and support available was suitable for the patient. All patients are offered individual time with their named nurse or keyworker, and where possible this relationship was maintained to provide continuity. Staff regularly reviewed risk assessments and updated these to reflect patients’ current risks and needs. Staff told us they had good communication with colleagues both internal and external (including GPs and dentists) to the service to enhance quality of care and support provided.

The provider had weekly ward round meetings that involved a full multi-disciplinary team. External partners including advocates could also attended these, if the patient requested.

Patients told us that they knew to speak to a nurse or staff if they had any concerns. All patients we spoke to said they felt safe at the hospital.

Management told us that they have safeguarding meetings within staff meetings. They were confident staff knew how to report concerns and alert nurses in charge. Staff had a good relationship with local teams and at the time of the assessment had no open safeguarding investigations.

We found safeguarding information in the staffing offices on each ward. There was a separate visiting area for children, which was being decorated at the time of the assessment. We observed staff asking permission from a patient to discuss how they were with their parents on the phone.

Staff reported incidents on an electronic system, which monitored any safeguarding alerts. All staff had completed safeguarding adults, safeguarding children’s training and had access to the service safeguarding policy. Patients' care plans had a section on keeping safe, including a patient’s history section informing staff of how to support them. Staff had a good relationship with the local safeguarding team and at the time of the assessment the only open safeguarding investigations were in relation to historical incidents disclosed at psychology sessions.

Patients told us that they are aware of their risks, and they were spoken with during ward rounds.

Staff told us patients were involved in their ward rounds which is when they discussed their risks. Staff told us that risk items were stored safely and reviewed and on both wards the risk items had recently been moved. On Quartz ward, we found the risk items to be in the entrance of the ward and it was the role of the security member of staff to check items twice daily. Staff told us they had a much better handle on this and that this kept the patients safe. On Sapphire ward the risk items lockers had been moved into the activities room which was a big change from the inaccessible place it previously was kept. The new area and larger space allowed patients and staff to check all items in together. This was an area of improvement identified in the previous inspection, which had now been met.

All patient care and treatment records we reviewed had individual risk assessments in place that were regularly reviewed. Section 17 leave forms we reviewed had a 5-point risk assessment conducted before each patient left the ward areas. Each ward had improved the process of checking risk items as this was identified as an area for improvement at the last inspection. Risk items were now checked twice a day.

Patients told us that they felt safe in the hospital. They didn’t know what to do in a fire, but it was common sense on what to do in an emergency. Patients told us they had no issues with the amenities.

Management told us they completed daily walk rounds, including during the night to check the environments. The clinical lead told us they did a monthly audit of risk items on each ward. Managers had sight of weekly care plan audits including patient risks.

Within each patient’s bed space there was a passport with details on the fire procedure. Each ward was clutter free and had no obvious risks present. Areas of non-patient access were properly locked. Ligature knives were where they were supposed to be and accessible for staff when in need of them. Both garden areas were clear of clutter. The furniture was secure on the Sapphire ward outdoor area. Both areas had high fences but were not unpleasant as you could see through them. Smoking was not permitted on hospital site.

Management told us that they had a regional process for a ‘temperature checks’ for patient safety. This would usually be completed by managers, but at Priory Hospital East Midlands members of staff complete this to promote development, however managers maintain oversight. Environmental risk assessments were completed for each ward, including ligature risk assessments. These had been reviewed regularly. We reviewed these in line with the environmental risks and found risks had been identified and appropriate mitigations were in place.

Patients told us that they felt less safe with agency staff because they don’t know them as well as permanent staff and sometimes can be less caring.

Staff told us that there was still agency use to fill posts especially to support patients on high levels of therapeutic observations. They told us that they felt the agency use was depleting and that regular bank and agency staff were used. Staff told us that they can be frustrated at times as agency and bank can appear to be less bothered as they are not permanent. Staff told us they felt comfortable in challenging poor practice. However, staff told us that there is an element of ‘us and them’ (agency and permanent healthcare assistants) and the concept of ‘it’s who you know on how things are managed’. No concerns around lack of staff were raised. Management told us that the agency usage had dropped significantly, and they only used staff that they knew from 3 agencies. They say this is to keep continuity and consistency for patients. Recruitment drives had been done to support the staffing needed for the new ward. Management told us they did a program of consultation with all staff to find their preferences in which ward they wanted to work on. Staff confirmed that this had happened and felt heard by management. Staffing predictions were in place for the new wards that were due to open. The respective managers for both new wards were beginning in their post at the end of May 2024. Managers recognised they had an issue regarding cleaning staff following the last CQC inspection and following from that inspection managers hired an external company and those issues have now gone.

We saw that on each ward there was enough staff to fulfil the needs of the patients. On Sapphire ward there was high acuity where one patient needed 3 staff to support 1 patient with 2 extra staff observing in case of an emergency response. There were other patients that needed extra support, and this had been fulfilled with substantive and bank staff. On the rota there were no gaps and each shift was fulfilled. We observed the ward managers on both wards making sure that the night shifts were also fulfilled.

Management had recruited enough staff for the ward that wasn’t open yet and vacancies were low for both wards. They were able to show us the matrix of staffing for the past 4 weeks to show the use of agency and bank staff.

Patients told us that they felt the hospital and wards were clean.

Staff told us the external cleaning team cleaned the whole of the hospital and they had cleaning jobs including touchpoints and tables. Staff felt PPE was available if needed.

We found the wards to be clean and tidy. We saw the cleaning staff actively maintaining the cleanliness of the hospital.

Cleaning checklists were in place to ensure all areas were cleaned. Ward level environmental risk assessments were in place for each ward. These were updated and reviewed regularly.

Patients told us they had no concerns with the medication they were taking. They knew what it was for, and it was reviewed at ward rounds.

Staff acknowledged that at the time of assessment Quartz ward clinic and central clinic were untidy. Medication storage was disorganised. We found that in the clinic room staff had ordered stock and had put it away in an unorganised way. Managers told us that a process was put in place for the central clinic but due to the person going on maternity leave the handover wasn’t given fully. They had now made the audits and checks of central clinics to be that of the night service manager.

We found that in each patient’s bedspace they had individualised information on the medications they were taking. There was a list of them. This included why they were taking them and information on possible side-effects.

We found most physical health checks including medicines titration tests were being completed. However, we found gaps in blood sugar monitoring forms for a patient on Quartz ward with type 2 diabetes. But there was no impact found by this and patients we spoke with told us of no issues with medicines. The sharps bin in Quartz ward clinic was full and had not been exchanged with a new one. As soon as this was identified it was changed. Medicines were electronically prescribed. The pharmacy and the hospital were linked to provided regular audits of prescriptions and the administration of medicines. Nurses audited clinic rooms and reported any findings within their regular nurse huddles they had with the clinical leads.