The Priory Hospital Middleton St George

Updated 18 March 2024

The Priory Hospital Middleton St George is a 104-bed hospital that provides 24-hour support 7 days a week for people aged 18 years and over with mental health problems, personality disorders or both.

Patient accommodation comprises of:

• Birch ward – psychiatric intensive care unit for men (10 beds)
• Chester ward – psychiatric intensive care unit for women (10 beds)
• Oak ward – acute admission ward for women (12 beds)
• Sycamore ward – acute admission ward for women (15 beds)
• Thoburn ward – acute admission ward for both women and men (22 beds)
• Dalton ward –Longer Term High Dependency Rehabilitation Unit for women (13 beds)
• Hazelwood ward – Highly Specialist Inpatient Rehabilitation Unit for women (10 beds)
• Linden ward – Longer Term High Dependency Rehabilitation Unit for men (12 beds).

The hospital director is the registered manager and has been in post since February 2020. The hospital is registered with the Care Quality Commission to provide the following regulated activities:

• assessment or medical treatment for people detained under the Mental Health Act 1983
• treatment of disease, disorder or injury.

There have been 13 inspections carried out at the Priory Hospital Middleton St George in the previous 11 years.

The most recent inspection was in May 2021, following which, the hospital was rated good overall and under each of the key questions we ask.

We undertook a Mental Health Act monitoring visit of Birch and Chester wards in September 2023. We found the following issues:

• patients currently in seclusion did not have seclusion care plans in place and advanced practitioner nurses were carrying out seclusion reviews that were meant to be done by a qualified doctor.
• there were blanket restrictions in place which were disproportionate to the risk identified.

What people who use the service say

We spoke with 25 patients using the service and 3 carers. This included 13 patients on the rehabilitation wards and 12 on the acute and PICU wards. Most patients told us staff treated them in a kind, caring and respectful way. Two patients on Sycamore ward did not always feel listened to and told us some staff did not always respond to them appropriately.

Patients and carers told us they were involved in decisions about care and treatment and were able to give feedback about the service. They knew how to complain and were aware of advocacy services that could support them and speak on their behalf. Patients said there was always someone they recognised and felt able to speak with.

Patients said they felt safe, and they were supported to keep in touch with family and the local community. They used the site shuttle bus and staff supported them to spend time away from the service.

Patients said they were a long way from home. Patients understood the restrictions and why these were in place and said they had access to advocates and could raise concerns through regular community meetings.

Updated 18 March 2024

The Priory Hospital Middleton St George is a 104-bed hospital that provides 24-hour support 7 days a week for people aged 18 years and over with mental health problems, personality disorders or both.

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

• We inspected both of the location’s two core services: the long stay and rehabilitation wards and acute wards and psychiatric intensive care units.
• We rated the acute wards and psychiatric intensive care units requires improvement under the Safe and Well Led key questions and the service as requires improvement overall. We rated the long stay and rehabilitation wards as good under each key question and the service good overall.
• When the ratings were aggregated, the overall rating for the location is requires improvement.

We rated The Priory Hospital Middleton St George as requires improvement because:

• During our inspection visits, system, and resources to enable the provider to monitor the cleanliness and safety of some wards were not fully effective. We found the service was not clean or well maintained in some areas.
• We had identified, during our Mental Health Act review in September 2023, that fully effective operating systems, to ensure seclusion processes within the service were in line with the Mental Health Act Code of Practice, were not place. This was because medical reviews had been carried out by advanced practitioner nurses and not responsible clinicians or duty doctors as stated in the Code of Practice. Following internal staff discussions, the provider had agreed they would cease this practice and had plans in place for how this change would be implemented.
• Nurses did not always complete nursing reviews in line with the requirements of the Mental Health Act Code of Practice. We reviewed 10 seclusion records, pertaining to 7 patients, and founds shortfalls in record keeping that could indicate poor practice, potential risk and that national guidance was not adhered to.
• Some of the nursing staff we spoke with were unable to demonstrate their understanding of the Mental Health Act, Mental Capacity Act and duty of candour.

However:

• The rehabilitation wards provided safe care and the wards had enough nurses and doctors. Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.
• The ward environments on Linden and Hazelwood were clean and well maintained.
• Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. 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 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.
• Staff planned and managed discharge well and liaised well with services that would provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason. Staff delivered a recognised model of mental health rehabilitation.

Updated 18 March 2024

Updated 18 March 2024