8 March to 9 March 2023
During a routine inspection
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.