Admissions to Priory Hospital Blandford, which caters for children and young people with a learning disability or autism as well as mental health problems, have been suspended until further notice after an inspection in May identified several serious quality and safety issues.
“Young people used phrases such as feeling degraded, that they were not caring”
Meanwhile, Kneesworth House in Hertfordshire, which provides inpatient care and other services for people with mental health problems, including some with a learning disability, has been told to make urgent improvements by the Care Quality Commission following inspections in March and April.
Dr Paul Lelliot, the CQC’s deputy chief inspector for hospital inspection and lead for mental health, said the care provided at both hospitals “fell well below the standard that people should expect”.
The CQC’s findings come amid mounting concern about the quality of care for inpatients with learning disabilities nationally with a number of independent settings run by other providers recently rated “inadequate” and placed in special measures.
An independent review into the way specialist learning disabilities hospitals are regulated – to be led by eminent psychologist Professor Glynis Murphy – is due to take place after abuse at Whorlton Hall in County Durham was exposed by BBC Panorama.
Priory Hospital Blandford was issued with a warning notice immediately after being inspected due to concerns about the safety of young people.
Inspectors found staff did not have the experience and skills to manage the complex needs of the young people in their care and at the time of the inspection there were just two registered nurses in place with two waiting to start.
“The hospital had found it difficult to recruit permanent staff and there was therefore a heavy reliance on agency workers many of whom had little knowledge or experience of working with young people who had learning disabilities and autism and complex needs,” said the inspection report.
“This also impacted on the continuity of care being delivered. Not all agency staff received appropriate training or regular supervision,” the report added.
According to the report the hospital “was failing to adequately assess and manage young people’s risks” and wards were “unsafe for young people and staff”.
There had been a number of incidents where young people had assaulted or were bullying each other and “a high number of assaults on staff”.
“Staff did not report all incidents, particularly around physical assault and racial abuse”
In the garden for one of the wards “there were loose bricks and nails that young people had made attempts to use as weapons or could use to harm themselves; staff had restrained young people to prevent potentially dangerous situations occurring”.
Young people told inspectors that staff did not treat them well or behave well towards them.
“Young people used phrases such as feeling degraded, that they were not caring, that there was no compassion and that they felt distressed at their treatment,” said the report.
One young person felt the hospital had not helped them, and staff “had left them alone to look after themselves”.
“Young people said that staff stayed in the office and they could hear staff talking about their care. Another felt staff were not interested in them,” said the report.
Families who spoke to inspectors said services were disorganised and “appalling” and “different staff told them different things”.
Incident reports showed “inappropriately high use of physical restraint as an intervention”.
The report reveals there were 138 restraints out of 250 incidents involving eight different young people over a three-and-a-half-month period.
“Staff did not report all incidents, particularly around physical assault and racial abuse and the quality of reports were poor. This meant that incidents could be missed and therefore not escalated to external bodies such as safeguarding or CQC,” said the report.
Inspectors also found a lack of support for staff.
“The ward staff did not feel supported by the leadership team, they said they did not feel safe, listened to or supported by managers following incidents. They felt that concerns raised around staffing and support around care for specific young people were not listened to,” said the report.
At Kneesworth House, which is run by Partnerships in Care – part of The Priory Group, inspectors raised particular concerns about the forensic service.
“In the forensic service, staffing levels were not sufficient to ensure that patients had access to the whole ward,” said the report
Staffing shortages also meant ward activities and patients’ leave was cancelled.
According to the report, some staff in the forensic service were “uncaring”.
“We take the CQC findings extremely seriously and are making immediate changes”
“Seven patients we spoke with commented that a few staff were rude, unfriendly and did not listen to them or antagonised patients. One patient said a member of staff had mocked them over a private issue,” said the report.
Inspectors also found “an example of negative and judgemental language about a patient in a seclusion record”.
Patients told the inspection team that some staff on one of the forensic wards “used a key to prod their feet if they did not get up in the morning”.
“Some patients altered their sleeping position or wore trainers in bed to prevent this happening,” said the report.
When staff secluded patients, they did not always follow hospital policy or the Mental Health Act Code of Practice, inspectors found.
“Some medical and nursing reviews had not been completed within timescales, seclusion care plans were poorly recorded and in three examples of prolonged seclusion, did not make it clear why seclusion needed to continue,” said the report.
Inspectors found some clinic rooms at the hospital were disorganised and some ward areas were dirty and in need of repair and redecoration.
This included stained and dirty toilets and inspectors noted “an unpleasant smell” on two of the wards.
Priory healthcare said it had taken immediate action in light of the two CQC reports.
“We take the CQC findings extremely seriously and are making immediate changes at Blandford which has suffered from being unable to attract suitably-qualified nurses and clinicians with the expertise to meet the needs of this complex patient group,” said a spokesman.
“This reflects a national picture, with staffing problems particularly acute where sites are rural, and service users require high levels of specialist input and round-the-clock care,” he added.
At Kneesworth he said “a major investment plan” was under way to improve the environment.
“While we accept the forensic service fell below expected standards, the CQC rated the hospital’s acute mental health and rehabilitation services, which make up the greatest proportion of patients, as ‘good’, and said that, overall, the hospital was ‘good’ for being effective and responsive,” said the spokesman.
“Our immediate priority is to address the issues raised by the regulator to ensure good practice is replicated throughout,” he added.