The Care Quality Commission
  • Mental Health
  • Independent mental health service

The Priory Hospital Southampton

Overall: Good read more about inspection ratings

Marchwood Park, Marchwood, Southampton, SO40 4DA (023) 8098 5648

Provided and run by:
Priory Healthcare Limited

Important: This service was previously registered at a different address - see old profile

All Inspections

18 and 19 April 2023

During a routine inspection

Our rating of this service improved. We rated it as good because:

  • The service provided safe care. The ward environments were safe and clean. The wards had enough nurses and doctors. Staff assessed and managed risk well. They conducted emergency scenario simulations to ensure that staff became accustomed to responding to unexpected events. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.
  • 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 and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • 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 these staff received training, supervision and appraisal. 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.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
  • The service managed beds well.
  • The service was well led and the governance processes ensured that ward procedures ran smoothly.

However:

  • The hospital used a high number of agency staff.
  • Patients and staff raised concerns over the competency of new agency staff working on an eating disorder ward.
  • Nurses did not complete the safety checks consistently on Skylark ward.
  • Not all staff knew where both ligature cutters were located on Skylark ward. Not all staff knew where the potential ligature points were around the ward.

26 to 27 July & 8 August 2022

During an inspection looking at part of the service

We undertook this inspection as part of a random selection of services which have had a recent Direct Monitoring Approach (DMA) assessment where no further action was needed. This inspection was to seek assurance about this decision and to identify learning about the DMA process.

We focused on two key questions during this visit. Was the service safe? And was the service well-led?

Our rating of this service went down. We rated it as requires improvement because:

  • There were not always enough staff on the wards. The provider was not always able to fill vacant shifts with bank and agency staff, which had put patients and staff at potential risk of harm.
  • Some staff had not completed their required mandatory training, which included the provider’s in house restraint training. In addition, some staff had not received regular 1:1 supervision or annual appraisals. This meant the provider could not be assured staff had the right skills, knowledge and experience to perform their role safely.
  • Staff on the adult acute ward did not always manage risk consistently or in line with patient care plans. Safeguarding alerts were not always raised when needed.
  • On Starling ward, we found staff had not always attempted to complete the required physical health observations after patients had received medicines by rapid tranquilisation. The provider’s policy and national guidance requires staff to closely monitor the physical health of these patients because they are at heightened risk of physical health deterioration.
  • Some governance processes and local policies were not well implemented. For example, safeguarding alerts were not always shared with the relevant stakeholders.
  • There had been two incidents where staff on other wards had not readily responded to Skylark’s emergency alarm when required. A protocol was in place but staff had not followed this.
  • Leaders had not always managed risks well and could potentially impact patient safety. This included concerns raised by staff about site security, although actions and plans were being discussed.
  • Staff did not always feel they were listened to by senior leaders and raised some concerns about the culture.

However:

  • All three wards we visited were clean, well equipped, well-furnished and well maintained.
  • Clinic rooms were fully equipped, with accessible resuscitation equipment and emergency drugs that staff checked regularly.
  • Patients said they were treated with compassion and kindness and felt respected.
  • Staff used restraint only after attempts at de-escalation had failed.
  • Incidents were reported and investigated. At ward level we found staff implemented learning following incidents.
  • Staff knew and understood the provider’s vision and values and how they applied to the work of their team.
  • Managers engaged with local health and social care providers to help meet the needs of patients and plan services. Managers from the service participated in the work of the local transforming care partnership.
  • Leaders were aware of most operational challenges and had plans in place to address them. For example, the provider was aware of staffing pressures and reviewed staffing levels regularly. New staff were being recruited and vacancy rates across the hospital were reducing.
  • Skylark ward had gained accreditation with the Royal College of Psychiatrists’, Quality Network for Eating Disorders (QED).

6 October 2020

During an inspection looking at part of the service

We carried out a focused inspection of Kingfisher ward, the child and adolescent mental health ward at the Priory Hospital Southampton in 6 October 2020

As this was a focused inspection, we did not cover all key lines of enquiry and therefore we did not re-rate the service during this inspection. Therefore the ratings from the previous inspection in 2019 remain the same.

Kingfisher ward is a 12 bedded mixed-gender ward for young people aged between 12 and 18 years old.

The service is registered to provide the following regulated activities:

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

We inspected the ward due to an increase in serious incidents and concerns that the service was potentially admitting young people whose risks were higher than a general child and adolescent mental health ward can manage. Throughout August 2020, there had been a significant increase in serious incidents reported to the Care Quality Commission compared to previous months. The incidents included repeated occurrences of self-harm, predominately by swallowing foreign objects, and young people absconding from the ward.

During the inspection we looked at relevant aspects of the key questions, are services safe, effective and well-led. We focused our attention on how the service managed incidents, how it learnt from incidents, and how it was meeting the needs of all people who use the service.

We found that:

  • Staff assessed and managed risks to patients and themselves well in anticipating, de-escalating and managing challenging behaviour. Staff used restraint only after attempts at de-escalation had failed. When incidents had occurred, staff held debriefs with the young person(s) involved.
  • Staff managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service.
  • The ward teams included or had access to the full range of specialists required to meet the needs of young people on the wards. Managers ensured that these staff received training, supervision and appraisal.
  • The service had been recognized by a provider collaborative governance operational and assurance committee for ensuring that all staff during the peak of the pandemic still received regular supervision.

However:

  • Although nursing staff developed a care plan for each young person that met their needs, they were not holistic as they did not include the input from the multidisciplinary team or agreed interventions. These were recorded elsewhere in the young person’s care and treatment record.
  • The provider’s admission, transfer and discharge policy did not contain a clear acceptance and exclusion criteria. This may lead to inappropriate admissions to the ward.
  • Although staff and young people confirmed debriefs occurred following an incident, it was rarely documented. This means that it wasn’t clear that young people had received a debrief or check-in following an incident. A young person also commented that staff only debrief the young person(s) involved in an incident and not others on the ward who may have been negatively affected.

25 and 26 June and 12 July 2019

During a routine inspection

Our rating of this service stayed the same. We rated The Priory Hospital Southampton as good because:

  • The service provided safe care. The ward environments were safe and clean. The wards had enough nurses and doctors. Staff assessed and managed risk well. They minimised the use of restrictive practices and followed good practice with respect to safeguarding.
  • Staff developed holistic care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • 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 these staff received training, supervision and appraisal. 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.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. There were mutual expectation meetings with staff and patients and young people to improve understanding between them. They actively involved patients and families and carers in care decisions. The staff on Skylark ward shared research with the patients to improve their understanding of their treatment. Staff on Skylark had arranged a carers education day aimed at helping them to support the patient on discharge.
  • The service managed beds well so that a bed was always available locally to a person who would benefit from admission and patients were discharged promptly once their condition warranted this.
  • The service was well led and the governance processes ensured that ward procedures ran smoothly. Leaders tested staff knowledge at daily flash meetings. Senior managers offered mentoring to staff to help develop future leaders.

However:

  • The systems and processes in place for managing medicines were not robust on the acute ward and on the child and adolescent mental health ward  ward.
  • Staff on the acute ward did not assess and clearly record mental capacity on a decision specific basis for patients who might have impaired mental capacity.
  • Care plans were not consistently recovery focused and personalised to each patient.
  • Young people told us that there was not enough activity at the weekends.
  • Not all staff understood young people’s right to leave the ward.