The Chief Inspector of Hospitals, Ted Baker, is placing Priory Hospital Arnold into special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate overall or for any key question or core service, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.
Priory Hospital Arnold is provided by Priory Healthcare Limited and registered with the CQC 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
• Diagnostic and screening procedures
The hospital offers two acute mental health wards for men and women on Newstead and Bestwood Wards and a psychiatric intensive care unit on Rufford Ward for women and for men on Clumber Ward. Rufford Ward opened in May 2020 and Clumber Ward opened in November 2020.
There were 16 beds on each of Bestwood and Newstead Wards which were commissioned by Nottinghamshire Healthcare NHS Foundation Trust and 10 beds on Rufford Ward. There were 10 beds on Clumber Ward, five of which were commissioned by Forward Thinking Birmingham and the other five beds could be spot purchased.
There have been 16 previous inspections to Priory Hospital Arnold. The latest was a follow up inspection in October 2020 following information of concern about Newstead and Bestwood Wards. We only looked at parts of the Safe and Well led key questions and did not rate the hospital. We last rated the hospital following our inspection in October 2019 as requires improvement overall, inadequate for safe and requires improvement for effective, caring, responsive and well led.
Before this inspection we received information of concern from anonymous contacts about Rufford and Clumber Wards and complaints raised by patients on Rufford Ward. We were told that inappropriate restraint and seclusion was used, staff were not clear about how to report safeguarding concerns and felt scared to report, the staff alarm system was not working and the maintenance and cleanliness of wards was poor.
We visited Rufford and Clumber Wards unannounced on the evening of 9 March 2021. We spoke with patients, their carers, and staff by telephone from Rufford and Clumber Wards between 10 to 12 March 2021 and visited Newstead and Bestwood Wards unannounced on 16 March 2021.
This was a focussed inspection and we inspected the Safe and Well led key questions only.
We rated Safe as Inadequate and Well Led as Inadequate and Priory Hospital Arnold as Inadequate overall.
At this inspection we found:
- The wards were not safe, clean, well equipped, well-furnished or well maintained.
- The provider had not ensured all staff were confident to use the alarm system to summon help in an emergency. This meant some staff did not respond to the alarms or did not know the type of incident they were responding to.
- The service did not have enough nursing staff, who knew the patients well.
- Staff did not always follow the providers infection control procedures.
- Staff did not always assess and manage risks to patients and themselves well. The provider had not fully assessed ligature risks and taken action to reduce them.
- Leaders did not demonstrate they had the skills to perform their roles and ensure the safety of patients and staff.
- Our findings from this inspection demonstrated that governance processes did not operate effectively at ward level and that performance and risk were not well managed.
However:
- All staff including agency staff received basic training to keep patients safe from avoidable harm.
- Staff used restraint and seclusion only after attempts at de-escalation had failed.
- Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
- Staff had access to clinical information on the providers electronic records system and verbally handed over information about patients risks between each shift.
- Staff recognised incidents and reported them appropriately.
- The majority of staff told us they could raise concerns without fear of retribution and would do so.
- Some staff told us they felt respected, supported and valued.
Following the inspection on 9 March 2021 we served an enforcement notice requiring the provider to take urgent action to keep patients safe. We required action to ensure infection control processes were in place to minimise the risks of cross infection and to assess and reduce ligature risks across the hospital.
Following the inspection on 16 March 2021 we imposed conditions to prevent admissions to the hospital and required the provider to take action to assess and reduce ligature risks. The provider responded to these within the required timescales. The provider also made a decision to close Clumber Ward temporarily which increased the staffing on the other three wards.