A Northampton hospital has been graded by inspectors as ‘requires improvement’, a report reveals today, after they found it had failed to meet some management and safety standards and restrained children too often.
The Care Quality Commission visited St Andrew’s Hospital, (as well as other sites run by parent charity St Andrew’s Healthcare) in September and has since rated the effectiveness, responsiveness and levels of care as ‘good’.
However, they were criticised in the areas of both ‘safe’ and ‘well-led’, gaining ‘requires improvement’ ratings.
The team of 70 inspectors found that a face-down restraint was being used on children (known as prone restraint), which medical experts and the Government have said should be used only as a last resort because of the danger of compressing the patient’s airways.
The report said that, in relation to prone restraint, the hospital “does not have a robust system in place to learn from incidents and ensure that the risk of harm is minimised.”
Dr Paul Lelliott, CQC’s deputy chief inspector of hospitals, said: “Many of the children and young people admitted to St Andrew’s Healthcare have severe mental health problems and have a history of behaviour that has put themselves or others at risk.
“Despite that, we were surprised at the number of occasions when staff had resorted to physical restraint.
“The staff at St Andrew’s Healthcare must ensure that when restraint is used it is by the safest means to minimise the possibility of harm to the patient.”
Inspectors also criticised the private hospital, which is based off Billing Road, for using high numbers of agency staff because of the negative effect on continuity of care.
“St Andrew’s Healthcare has had difficulty recruiting nursing staff and many posts were vacant. It has been relying heavily on the on the use of agency and bank nurses.
“The service has given us assurances that it is making the necessary improvements and we have already witnessed some of these in action.
He added: “People deserve to be treated in services which are safe, caring, effective, well-led, and responsive to their needs and this is what we look at when we carry out our inspections.
“We will continue to monitor this service closely and this will include further inspections.”
St Andrew’s Healthcare is one England’s largest charities providing specialist mental health care and facilities for children, young adults, women, men and older people.
The charity also provides private therapy services for GP referred patients.
It has eight registered locations serving mental health and learning disability needs, including four hospital sites in Northampton, Birmingham, Nottingham and Essex.
The service has been told that it must take action to improve in the following areas:
- The provider must ensure that care in the adolescent service is planned in accordance with children’s rights.
- Care and risk must be assessed, planned and managed based on individual needs.
- All care and treatment options must be discussed and explained in a way the patient understands, particularly in the learning disability and children and adolescent mental health services.
- Patients and their family or carers should always be involved in their care planning and risk assessments.
-The provider must ensure that the Code of Practice for the Mental Health Act 1983 is always adhered to when necessary.
-The provider must ensure that all accommodation is in line with best practice guidance for same sex accommodation. There were no clear arrangements for ensuring same sex accommodation in the older adult’s service adhered to guidance from the Department of Health and the MHA Code of Practice, to protect the safety and dignity of patients.
-The provider must ensure that patients who are deaf or have hearing loss are cared for by staff able to communicate with them effectively.
Across the service, the inspection team found areas of good practice. These included:
-Inspectors spoke with patients in the children and adolescent’s mental health service who spoke of the support provided to them and how staff had continued to work with them when other people had let them down.
-Practice in the older person’s service incorporated the latest research and evidenced-based guidance to ensure the most effective care was being provided.
-A strong model for future plans in the neuropsychiatry service meant that at a strategic level it was clear how developments were to be implemented.
Gil Baldwin, who took over as Chief Executive Officer at St Andrew’s in July last year, said: “The timing of the visit from the CQC team was really helpful for the Charity as we continue to plan for the future.
“It has confirmed that we are right to have confidence that our services are effective, caring and responsive - which were all rated as ‘good’.
“The inspection has highlighted aspects which can be improved and this resonates with the things we have already identified for improvement in our immediate and future plans.
“As part of the CQC’s pilot programme for its new-style inspection approach, we have been very happy to volunteer to have our ratings published as part of our commitment to transparency.
“We will continue to work with the patients, families and carers, the CQC, Healthwatch and NHS England on an immediate action plan to address those really important points that have been raised and this will complement our longer term plans, which I look forward to announcing shortly.”
Manjit Darby, director of nursing at NHS England said: “We welcome the CQC’s report into St Andrew’s Healthcare. We have been working actively with St Andrew’s and its health partners to ensure improvements to services and are pleased to note the areas of good practice and progress made to date.
“As the CQC identifies, there are some areas still requiring improvement and will continue to work with St Andrew’s and [the watchdog] Healthwatch Northamptonshire to address these for the benefit of patients.”
CQC inspectors will return to the service in due course to check that the required improvements have been made.