Priory Hospital Burgess Hill

Updated 15 October 2021

The Priory Hospital Burgess Hill is a purpose-built hospital providing assessment and treatment in acute and psychiatric intensive care units, as well as low secure services for people with mental health conditions. During the inspection, the hospital had three open wards and three closed. The open wards were:

• Michael Shepherd, a female low secure unit with 16 beds.
• Wendy Orr, a male psychiatric intensive care unit with eight beds.
• Edith Cavell, a male acute service with 16 beds.

At the time of the inspection there were nine patients on Michael Shepherd ward, seven on Edith Cavell ward and four on Wendy Orr ward.

Priory Hospital Burgess Hill was last inspected in May 2021 because of concerning information we had received about patient safety. During that inspection we found a number of areas of concern. Following the inspection, we wrote to the provider and told them that we required them to provide us with assurance that they would make immediate and ongoing improvements under Section 31 of the Health and Social Care Act 2008. The provider responded with an action plan that described how they would address these concerns. In addition, the provider decided to close two hospital wards (the female psychiatric intensive care and female personality disorder wards) in order to ensure they could staff the three remaining wards safely. We reviewed the provider’s action plan and felt that the actions the provider told us they were taking provided enough assurance about how they would address the areas of concern around patient safety. However, we issued requirement notices to the provider around staff not being always able to access patients’ records and lack of robust governance processes. We also suspended the ratings for the hospital; due to the closure of two wards the ratings were no longer a true reflection of the service provided.

Previously, the hospital was inspected in August 2020. This was an unannounced, focused inspection and we focussed on areas of the key question, are services safe. During the inspection, we identified concerns and issued requirement notices to the provider related to poor recording of patients’ section 17 leave, lack of individualised risk management plans for patients, lack of induction for agency staff, poor record keeping for seclusion and post rapid tranquilisation, not having clear processes in place to review prescribing that did not follow national recommendations, Mental Health Act documents (Section 62) not always being completed and lack of substantive staff. Following this inspection, we rated the key question ‘are services safe’ as requires improvement.

During this inspection visit on 10 and 11 August 2021, we found that the provider had made some improvements, but there was more work to be done around the safety of the ward environment, general maintenance, assessing and managing risks and governance processes.

The hospital last had a comprehensive inspection in April 2019. We rated the service good overall and good in all domains.

The hospital is registered to provide the following regulated activities:

• Assessment or medical treatment for persons detained under the Mental Health Act 1983
• Diagnostic and screening procedures
• Treatment of disease, disorder or injury.

The hospital has a manager registered with CQC.

What people who use the service say

People who use the acute and intensive care services were largely positive about their experiences at the hospital. The patients we spoke with reported feeling safe and felt that the staff were kind and polite and took a genuine interest in their care and wellbeing. Patients told us that there were enough staff on the wards and that they had the opportunity to participate in a range of activities. The patients we spoke with told us that the wards were clean, quiet and calm. They also reported that they were able to seek advice and support from staff about their physical health. However, some of the patients told us that they were not given information on admission about their condition, rights and treatment, and did not have a copy of their care plans.

We also received positive feedback from the families we spoke with about the quality of care patients received from staff. Most of the relatives we spoke with felt that patients were safe at the hospital and had the opportunity to participate in activities. They also told us that they believed that staff were supportive, respectful and well trained. However, one family member told us that they were concerned about the care and treatment their relative was receiving at the hospital.

Patients on the forensic inpatient and secure wards were generally positive about the hospital and staff. They told us they felt safe on the wards and most staff were kind and supportive, although some staff members could be rude and inconsiderate. Patients said there were enough staff to talk to, but they could sometimes be very busy. Patients and carers said the medical team were very supportive and were attentive to their needs. They said staff actively involved them in planning their care and they were given copies of their care plans. However, patients told us the wards were not very clean and needed updating and that their Section 17 leave had been cancelled at short notice.

Updated 15 October 2021

The Priory Hospital Burgess Hill is an independent hospital which provides inpatient mental health treatment to adults. We undertook an unannounced comprehensive inspection to review the standard of patient care and to check if the service had made the improvements, we told them they must make from the previous inspection.

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

Although we found the hospital had made a number of improvements since our last inspection, there were still a number of outstanding improvements that had not been made. In addition, we identified some additional areas of concern.

• The ward environments were not always safe or well maintained. Bedrooms and ward areas on Michael Shepherd ward had fixed ligature anchor points. The wards were generally in need of refurbishment.
• Staff did not assess and manage risk well. Patient risk assessments were not always reviewed regularly, including after any incident, and patient observations were missed on Edith Cavell ward.
• Vacancy rates remained high for permanent registered nurses.
• Patients reported that their section 17 leave had been cancelled at short notice. Staff did not always document the rationale for the cancellation.
• Patients on Michael Shepherd ward reported the food was not always tasteful.
• Managers did not always ensure all staff had an appraisal.
• The hospital did not actively support patients on the forensic inpatients and secure ward to access opportunities for work and education.
• Governance processes did not always ensure that ward procedures ran smoothly and did not identify issues around lack of coordination between the various systems and processes in place.

However:

• Staff managed medicines safely 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 and supervision.
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• Staff were generally kind and supportive. Patients said they felt safe on the wards.
• The service managed beds well so that a bed was always available locally to a person who would benefit from admission.
• Staff assessed the physical and mental health of all patients on admission. Staff from different disciplines worked together as a multidisciplinary team to benefit patients.

Updated 15 October 2021

Our rating of this service went down. We rated it as requires improvement because: 

Although we found the service largely performed well it did not meet some requirements relating to safe care and governance, meaning we could not give it a rating higher than requires improvement. 

• The ward environments were not always safe, clean, or well maintained. Bedrooms and ward areas had fixed ligature points. The ward was in need of refurbishment.
• Staff did not ensure patients section 17 leave was always taken. When patients section 17 leave was cancelled at short notice, staff did not always document the rationale for the cancellation. Patients and carers reported that patients were not getting enough fresh air.
• Patients reported that the food was not always tasteful.
• Managers did not ensure all staff had an appraisal.
• The service did not actively support patients to access opportunities for work and education.
• The governance processes did not always address concerns or mitigate against identified risks. For example, the ligature audit had identified potential ligature points but there was no clear timeframes or action for when these will be addressed. It was not clear how patient feedback were captured and actions taken to address them.

However: 

• The service managed medicines safely and followed good practice with respect to safeguarding.
• Staff assessed the physical and mental health of all patients on admission. Staff from different disciplines worked together as a team to benefit patients.
• The ward teams included or had access to the full range of specialists required to meet the needs of patients. Managers ensured that these staff received training and supervision. The ward staff worked well together as a multidisciplinary team.
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.

Updated 15 October 2021

Our rating of this service went down. We rated it as requires improvement

• Staff did not assess and manage risk well. Patient risk assessments were not always reviewed regularly, including after any incident and patient observations were missed. Vacancy rates remained high for permanent registered nurses.
• The wards were not always well maintained and they looked in need of refurbishment.
• Managers did not ensure all staff had an appraisal.
• The governance processes were not always robust enough to sufficiently identify, remove or reduce risks on the wards. For example, the ligature audits were not always reviewed as planned.

However:

• The ward environments were clean. Staff 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 and in line with national guidance about best practice.
• 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 and supervision. The ward staff worked well together as a multidisciplinary team.
• 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. Staff understood the individual needs of patients.
• The service managed beds well so that a bed was always available locally to a person who would benefit from admission and patients were discharged promptly once their condition warranted this.