Priory Hospital Newbury

Updated 15 December 2023

Priory Hospital Newbury is a high dependency rehabilitation service for individuals with enduring mental illness working towards living life back in the community. It supports patients who require a high level of care and intensive therapeutic support.

The hospital is situated close to local amenities and transport links. It has a high dependency, community focused rehabilitation ward and flat, which provides a step down into independent living.

There are 34 beds.

• Rowan Ward - 22-bedded male high dependency ward.
• Poplar flats - 4 beds for patients who need of a safe environment and transitional support prior to moving on to live in the community and whilst waiting for an appropriate placement in the community.
• Birch ward was closed at the time of the inspection.

There were 17 patients on the ward and 2 patients in the flats receiving care at the time of the inspection. Eighteen patients were detailed under the Mental Health Act (1983). With four detained under Ministry of Justice sections.

The hospital was previously known as The Cloisters and supported both male and female patients. It opened in June 2012 with a 10-year block contract with Berkshire Healthcare NHS Foundation Trust. It originally provided rehabilitation services to patients who had spent many years at a local long term mental health hospital. The Priory Hospital Newbury was successful in discharging a number of patients who had been transferred from this hospital but also provided end-of-life care for some of the older patients.

The block contract came to an end in July 2022. The number of patients at the hospital declined. However, the hospital has started to see some increase in referrals; the complexity of the patients being referred has increased.

The hospital is currently looking at adapting its model of care. It no longer supports female patients as it has seen a reduction in demand for female rehabilitation services.

The hospital is struggling to stay within budget with the reduction in the number of patients. Some plans have been developed to reopen Birch ward as an additional step-down facility, to reopen Orchid ward as a five bedded HDU and repurpose Rowan ward to progress rehabilitation and recovery once patients had settled and were working towards a ‘step down’ facility. The hospital was also considering providing a service of patients with ASD alongside their mental health issues.

A definitive model had not yet been decided upon.

We carried out this inspection as we had not inspected Priory Hospital Newbury since April 2017. At that inspection we rated it Good overall and Good for each of the five key questions (are services, safe, effective, caring, responsive and well-led).

Prior to that inspection we had inspected the hospital in 2013 and 2015.

Th hospital is registered to provide the following regulated activities:

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

At the time of our inspection there was a registered manager in post.

What people who use the service say

Without exception, all patients spoken with said they were very well cared for and that the staff were very kind, compassionate, treated them with respect and gave them hope. They all said that ‘staff were lovely and there to help them get better’.

They all said that the doctors helped them with medication, including reducing their dependence on it and were realistic in their expectations of them.

They all enjoyed the music group, community outings and planned activities. They said they felt empowered to make requests about activities, leave, medication and family visits, and that they were encouraged to visit family or have family visit if and when they wanted.

They said they knew everyone who worked there and really liked the chef and that the food was good.

Patients said that staff were supporting them to move on but that they didn’t feel rushed which made them feel better. All were aware they had a care plan and risk assessment and said they had been involved in discussions and planning their care.

All patients were aware of when they had leave from the hospital and when their next leave review was. They said this helped keep them “on track”.

One of the patients told us the hospital had changed their life. They said nowhere else had helped as much as the staff at the hospital; they explained they were quite unwell when they arrived, and staff had never given up on him. They said the staff and the accommodation were superb and they were now becoming independent which was a high point in their life, and they could “see the path ahead” and the one they been walking. They said they couldn’t thank staff enough.

Updated 15 December 2023

Priory Hospital Newbury is a high dependency rehabilitation service for individuals with enduring mental illness working towards living life back in the community. It supports patients who require a high level of care and intensive therapeutic support.

Our rating of this location improved. We rated it as outstanding because:

• Without exception, all staff were passionate, committed, put patients at the centre of all they did, strived for excellence and enjoyed working at the hospital. Morale was good, all were signed up to the values and vision of the hospital. Staff were well supported through regular supervision, reflective practice, and appraisal.

• Without exception, all patients spoken with said they felt safe and enjoyed being cared for at the hospital. All spoken with said their lives had improved since coming to Priory Hospital Newbury. They described being given ‘another chance’, when others had given up on them, to live their best life. All had a good knowledge and understanding of their care/treatment plans, and all had a focus on being discharged and living in the community. Patients knew every member of the staff team, including the administration, cleaning, and catering staff.

• Care and treatment were rehabilitation and recovery oriented in line with nationally recognised best practice. 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 hospital. Staff engaged in clinical audit to evaluate the quality of care they provided.

• There were enough staff, with the right skills and experience to keep patients safe and provide high quality care. There was minimal use of agency staff and those that were used were regular agency staff. Staff were extremely skilled and provided a wide range of care, treatment, therapies, and activities to support patients with their rehabilitation and recovery journey. The clinical psychology and occupational therapy vacancies had been recruited to and appointees would start in January 2024 – this completed the multidisciplinary team.

• There was a collaborative approach to care delivery – every member of staff was respected for their views and their contribution valued. All staff were welcome to join the morning huddles and detailed discussions took place to ensure everyone understood every aspect of the care that each patient required.

• The multidisciplinary team (MDT) members worked well together, they respected each other and valued each other’s contribution. They constructively challenged each other and decisions about treatment and care were made collectively. Patients were considered partners in their care and involved in discussions and decisions made at the MDT meetings. Risk assessment and care plans were updated during the MDT meeting – what was written was agreed by all, including patients. All then followed the agreed care plan.

• A quality improvement research project had been undertaken to ensure the consistency of risk assessment and care planning. This had resulted in safer, less restrictive care being delivered. Patients were fully involved in planning their care. Records were of a very high standard.

• Quality improvement work had ensured the hospital could offer patients high quality physical health care. There was a physical healthcare nurse in post who worked closely with the specialist doctor. There were good relationships with the local GP surgery and with other physical health care specialist teams, e.g., community diabetes team.

• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.

• Good relationships had been developed with the local community and wider community which supported patients to access a wide range of activities and amenities. Patients were actively encouraged and supported to take up work opportunities, volunteering opportunities and join local clubs.

• Medicines management was excellent. Prescribing was thoughtful and considered and the medical team actively worked to reduce the medicines patients were taking. The electronic medicines system supported good practice. Patients’ medicines records were audited monthly – all patient medicine records we reviewed were accurate and complete.

• Staff used a positive behavioural support approach when patients experienced difficult or challenging behaviours. They took a least restrictive approach. Restraint and rapid tranquilisation were very rarely used.

• Staff had developed a ‘leave/absent without leave’ folder for each patient. This provided staff with clear details of each patient’s current access to leave, their Mental Health Act status and other key information. It contained an individual flow chart of the process to follow for each patient and when and who to escalate to when the patient had failed to return from leave. Staff had worked closely with the local police to ensure an appropriate response. The security nurse on each shift was responsible for ensuring they recorded when patients went on leave, when they were due to return and for initiating the appropriate response if patients didn’t return from leave on time.

• Staff were passionate about improvement and described that they were striving for excellence so they could deliver the best care possible to the patients. Quality improvement initiatives had resulted in improvements in care for patients. The hospital had a quality improvement group, an identified QI lead and plan of projects it planned to progress.

• There were good relationships with commissioners and other stakeholders. Managers were working with commissioners to increase referrals which had fallen after a block contract had been discontinued in 2023.

• All areas of the hospital were immaculately clean and well maintained. Patients had access to a large garden which provided good facilities. For example, a pool room, gazebo, BBQ, sporting facilities, seating areas, summer houses, a planting shed and small allotment plot.

• The hospital was well led, and senior leaders were knowledgeable, skilled, and experienced. They provided positive, proactive, and professional leadership and staff and patients liked and respected them. They empowered staff and encouraged all staff to lead and make decisions in partnership, so actively promoting positive outcome for patients.

• Governance systems and processes were robust and ensured the smooth running of the hospital.

However:

• There were often issues with the Wi Fi. Access could be slow and frequently dropped out which meant staff sometimes lost work or work took more staff time than it should have done.
• The hospital did not have a clear vision and strategy for its future and how it would attract more referrals to fill the empty beds and stay within budget. Some plans had been developed to reopen Birch ward to provide additional ‘step down’ facilities, to re-open Orchid ward (currently part of Rowan ward) as a five bedded High Dependency Unit and use Rowan ward to care for patients who no longer needed HDU care but were not yet ready for ‘step down’.
• Lots of excellent work, including quality improvement projects, were taking place at the hospital but hospital leaders were not always good at describing, sharing, and promoting what they did.

Updated 15 December 2023