The Priory Hospital North London

Updated 8 September 2023

We carried out a comprehensive inspection of the child and adolescent mental health service (CAMHS) because the service had not been inspected since 2019. We wanted to check on improvements made since this inspection. We had also received a complaint from a family member which gave us concerns about the safety and quality of the service.

This was an unannounced inspection.

During this inspection, we inspected and rated all the key questions for the CAMHS ward; safe, effective, caring, responsive, and well-led.

Priory Hospital North London has one ward for children and young people: Birch Ward. This is an 8-bed ward for both males and females with acute mental health problems up to 18 years of age. During the inspection, hospital leaders informed us they had closed 1 bed to new admissions due to the high acuity and challenging behaviours of young people. In the lead up to the inspection, several staff had been assaulted by young people and required treatment.

The NHS commissions beds for children and young people at The Priory Hospital North London. The hospital has two pathways; one with the local collaborative and another with the national Priory referrals NHSE team. As such, the hospital accepts and reviews referrals of children and young people based locally as well as out of area. At the time of our inspection there were 3 out of area young people on Birch Ward.

The provider is registered to provide the following regulated activities:

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

Treatment of disease, disorder or injury.

There was a registered manager in post.

We last conducted a comprehensive inspection of The Priory Hospital North London in October 2019. At that time we rated the hospital as requires improvement for safe, and good for effective, caring, responsive and well-led. We rated the hospital as good overall. In February 2022 we conducted a focused inspection of the two acute wards for adults of a working age and psychiatric intensive care units. These wards were rated as good in all 5 key questions.

Following the 2019 inspection, we issued a requirement notice on the provider concerning Regulation 18 (Staffing) of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This action related to the CAMHS wards, of which there were two at the time. We also issued a number of actions we felt the provider should take to improve. During this inspection we found the provider had improved in some areas, but there were still some actions that were yet to be established.

What people who use the service say

We spoke with 6 young people and 6 family members. Overall, young people spoke positively about staff, in particular the ward manager, clinical psychologist and education team. Young people were generally happy with the education and therapy offering, and they received copies of their care plans. However, some young people told us they were bored on weekends because there were no trips. They also shared negative feedback about some maintenance issues such as the washing machine and living room environment.

Overall, parents of the young people we spoke with were positive about the care their children had received. Parents were very pleased with the levels of communication from staff. However, most parents did not know how to make a formal complaint and there was not a formal way for them to feedback on the operation of the hospital.

Updated 8 September 2023

Priory Hospital North London is an independent hospital which provides care and treatment to young people and adults with mental health problems and substance misuse problems. There are 2 adult wards and 1 ward for young people. Birch Ward treats children and young people with acute mental health problems and has 8 beds.

Our rating of this service for children and young people went down. We rated it as requires improvement because:

• We rated the service as requires improvement for safe and well-led. When aggregated with the previous ratings for the acute adult wards this means the overall rating for the hospital is now requires improvement.
• Staff did not always monitor young peoples’ physical health in line with the provider’s Standard Operating Procedure (SOP) or national guidance after they had received medicines via rapid tranquilisation. This meant young people may be at potential risk of harm. The provider’s SOP more closely mirrors national guidance for rapid tranquilisation monitoring in adults than the national guidance for children and young people.
• The ward environment required improvement. The medicines trolley in the clinic room was not clean, and young people reported ongoing issues with the effectiveness of the ward’s washing machine. The environment was not suitable for young people admitted with autism spectrum disorder.
• Medicines management required improvement. For example, two staff did not always sign the controlled drugs book in line with the provider’s policy. Liquid medicines were not always labelled with the dates they were opened or when they were due to expire. Staff did not make it clear what had happened to medicines stored in the fridge after the fridge temperate had exceeded the recommended temperature. This meant staff could not be sure medicines administered to young people were suitable for use.
• Some parents felt concerned staff did not encourage their children to engage with the education or therapy on the ward, or to eat a balanced diet.
• Young people and carers were still not yet formally involved in the operation of the hospital. Young people had weekly community meetings and carers felt able to contact managers with any concerns but plans to involve service users on interview panels or in clinical governance meetings were yet to be implemented.
• Our findings from the other key questions demonstrated the governance processes needed strengthening. For example, improvements were needed with oversight of medicines management issues, ensuring post-rapid tranquilisation physical health monitoring was completed appropriately, and ensuring actions from audits were addressed. Managers did not always have access to accurate data, for example on incidents, to enable good oversight of the service.

However:

• We rated the service as good for effective, caring and responsive.
• Staff assessed and managed most risks well and followed good practice with respect to safeguarding. They knew the young people and their individual risks well. Young people were kept separate from adult service users. Staff used restraint only after attempts at de-escalation had failed. Where managers had concerns about the safety and quality of care of a young person, they had engaged other stakeholders and considered alternative care options.
• Staff developed holistic, recovery-orientated care plans informed by comprehensive assessments. Staff used the positive behavioural support (PBS) model to understand young peoples’ behaviours which challenge.
• The team included or had access to a range of specialists required to meet the needs of young people and worked well together. Managers supported staff to complete their training, appraisals and supervision.
• Staff treated young people with compassion and kindness and understood their individual needs. They actively involved young people, and their carers where appropriate, in decisions and care planning. Staff provided carers with daily updates about their child’s wellbeing and care. Young people had regular access to an independent advocate.
• Staff planned and managed discharge well. Young people had access to high-quality education throughout their time on the ward. The on-site school was rated as ‘Outstanding’ at their last inspection in March 2023.
• Leaders were visible and approachable to young people and staff. Staff felt respected, supported and valued.

Updated 8 September 2023

See summary above.

Updated 10 January 2020