The Spinney

Updated 6 December 2022

The Spinney is an independent hospital that is run by Elysium Healthcare Limited. It 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 service provides medium secure, low secure, psychiatric intensive care and rehabilitation services for male patients. It has 97 beds split over nine wards and units.

The forensic inpatient secure wards were:

• Hesketh ward, a 15-bed medium secure ward
• Hindsford ward, a 10-bed low secure ward
• Lever ward, a 15-bed low secure ward for people with a learning disability and/or autism
• Shevington ward, a 14-bed medium secure ward
• Pennington ward, a 10-bed medium secure ward
• Rivington ward, a 16-bed medium secure ward.

The psychiatric intensive care unit was:

• Hulton ward, a 10-bed psychiatric intensive care unit. At the time of the inspection only seven beds were open.

The rehabilitation unit was:

• The Coppice, a seven bedded ward
• Milford, currently a self-contained flat for one patient.

The service had a registered manager. This is the third time we have inspected The Spinney since it has been managed and overseen by Elysium Healthcare Limited.

We last inspected the Spinney in 2018. The service was rated outstanding following that inspection. There were no regulatory breaches and no actions to be taken that would have led to a regulatory breach if not carried out at that inspection.

The main services provided by this hospital are forensic inpatient or secure wards. Where our findings on the forensic inpatient or secure wards – for example, management arrangements – also apply to other services, we do not repeat the information in the reports for those services but cross-refer to the forensic inpatient or secure wards part of the service.

What people who use the service say

In relation to forensic secure wards:

We spoke with 11 patients across the medium and low secure forensic wards. They told us that, overall, they received good care and felt safe. They said staff were respectful and treated them with kindness and compassion. Patients felt listened to and involved in their treatment. They could have a copy of their care plan if they wanted it. However, nine of the 11 patients we spoke with said there was not enough variety of food at mealtimes, and the portions were too small. Some patients said they felt hungry between meals. One patient told us they were not allowed a bowl of cereal in place of their lunch, and another patient said snacks were not available at night. Two patients told us they would have liked to have gone out for fresh air when they wanted to because they could only access outside space at set times.

In relation to psychiatric intensive care services:

We spoke to three people on the psychiatric intensive care unit who all said the staff were visible on the ward and were very caring, helpful and respectful. However, all three patients said the small communal shower room was a concern. They told us that it leaked onto the communal corridor floor, and it didn’t always preserve dignity. One patient told us there needed to be more choice on the food menu and larger portions. Two patients told us their leave had been cancelled because there were not enough staff to facilitate it. They did not like being limited to the number of times they could access electronic cigarette breaks and fresh air, and that the hot water was not hot enough and access to hot drinks was set from 6: 00 a.m. to 11:00 p.m. One patient said the limited access to ground leave was not enough and another patient said there was not enough to do.

In relation to mental health rehabilitation services:

We spoke with four people using the rehabilitation service. All those we spoke with told us they felt safe on the ward. They each had their own bedrooms, which they could lock. They said the atmosphere was quiet and calm. They thought there were enough staff and that they were kind and supportive. They thought the food provided was good and said it was healthy.

All patients understood that they could have copies of their care plans, but some patients did not want them. They told us how they were involved in their care and about their plans for moving on. Three patients described how they managed their own medicines and the support staff provided. Three of the people we spoke with shopped and cooked for themselves. One patient told us about his employment outside the hospital.

The people we spoke with described the activities they took part in, both at the hospital and in the community, such as education, swimming, the gym, art, music and photography. One had won a Koestler award after staff submitted their work. The Koestler Awards is an annual scheme to award creative work in literature, the arts or sciences by people who are physically confined, such as in secure hospitals or prison.

Updated 6 December 2022

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

• The service provided safe care. The ward environments were safe and clean, and there was an extensive refurbishment programme under way. The wards had enough nurses and doctors. Staff assessed and managed risk well. They managed medicines safely and followed good practice with respect to safeguarding. There was a clear emphasis on honesty and learning when things went wrong.
• The environment was peaceful and calm. There were extensive grounds that were well maintained, with areas that patients had been involved in building, such as the hope garden.
• The provider worked with patients to understand their perspective of security and their feelings about it. Patients and carers were actively involved in the provider’s restrictive interventions reduction programme.
• Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They had a clear view of how physical wellbeing and a healthy lifestyle was essential to recovery. They involved patients in developing their care plans and encouraged them to take responsibility as much as they could. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice.
• There were strong relationships with other organisations, so that patients had options and choices away from the hospital, including education and work experience. Patients had a wide-ranging choice of activities on site. The hospital had outstanding provision that included a gym and sports hall, plus music, art and photographic studios.
• Staff engaged in clinical audit to evaluate the quality of care they provided.
• The service understood how physical wellbeing and healthy living supported mental and physical health and was integral to recovery. There was a comprehensive healthy living programme that educated patients about fitness, healthy eating and nutrition. In addition, two physical healthcare nurses supported patients with their physical health needs.
• 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 staff received training, supervision and appraisal, and encouraged them to develop their skills and share best practice. 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.
• There was a clear culture of empowering patients by ensuring they were central in their care. Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They recognised the needs of diverse groups. They actively involved patients and families and carers in care decisions. There was strong support for carers, so they could engage with plans for the service and share their views and experiences.
• Staff acquired the skills they needed to develop an enhanced programme of specialist care to meet the specific needs of a patient whose presentation was outside their usual expertise.
• We saw dedicated and motivated teams who worked hard for patients, carers and staff, to enhance their experience and optimise recovery.
• Staff planned and managed discharge well and liaised with services that would provide aftercare. Staff supported patients to use local services, demonstrating the recovery ethos and emphasis on living in the community. There was good participation with other services and the community that was central to care planning and recovery. As a result, discharge was rarely delayed for other than a clinical reason.
• The service was well-led, and the governance processes mainly ensured that ward procedures ran smoothly. There was an ethos of joint decision-making. Patients were actively involved in developing the service. This meant that patients were involved in all aspects of service planning and delivery, via a range of meetings from ward community meetings, the patients’ council and governance.

However:

• Some governance processes were not effective. For example, managers did not ensure fire evacuation procedures were carried out according to policy. Some restrictive practices, such as opening mail in front of staff and the practice of selecting patients to be searched in the rehabilitation service, were not individually risk assessed. Some governance documents were not dated.

• There were no risk assessments on Hindsford ward for patient steps without handrails, and no means for patients to call for assistance in one of the communal bathrooms on Lever ward.

• Some medicines on Hulton ward were out of date, and fridge temperatures were not always taken and logged as required.

• On Hulton ward, required checks were not always completed and documented in line with national guidance following the use of rapid tranquilisation.

• Pharmacy visits did not take place consistently and in accordance with contractual arrangements.

• Furnishings on some of the wards were damaged and in poor condition. The communal shower on Hulton ward was in a poor state of repair and did not ensure patients' privacy and dignity.

• Some patients’ advanced statements were not reflective of their current wishes and preferences.

• Patients did not always have access to snacks between meals. Some patients were not happy with the food choices and portion sizes available at mealtimes.

Updated 6 December 2022

Our rating of this service went down. At this inspection we rated it as good because it was effective, caring, responsive and well led but safe required improvement.

Updated 6 December 2022

We did not rate this core service at the last inspection.

At this inspection we rated it as good because it was safe, effective, caring, responsive and well led.

The rehabilitation mental health wards for working age adults were a small proportion of hospital activity. The service provided high dependency rehabilitation and recovery for men aged 18 years and over who had complex mental health issues. It focused on reducing challenging behaviours and supporting patients to engage with their families and communities.

The main service was forensic in-patient or secure wards. Where arrangements were the same, we have reported findings in the forensic in-patient or secure wards section.

Updated 6 December 2022

The psychiatric intensive care unit was a small proportion of hospital activity. The main service was the forensic inpatient or secure wards. Where arrangements were the same, we have reported findings in the forensic inpatient or secure wards section.

We did not rate this core service at the last inspection.

At this inspection we rated safe as requires improvement.