Mental health services for children and young people at a hospital have been criticised following a watchdog inspection. Care for children and young people at Cheadle Royal Hospital, also known as the Priory Hospital Cheadle Royal, has been rated 'inadequate' following an inspection by the Care Quality Commission (CQC).
Hospital bosses said they were 'disappointed' at the rating, which they insisted 'does not accurately reflect the quality of... child and adolescent mental health services at Cheadle'.
"We have disputed the factual accuracy of many aspects of the report," they added in a statement.
The regulator carried out an unannounced inspection amid ‘concerns about safety’. The inspection followed the deaths of three young women within weeks of each other at the Priory Hospital Cheadle Royal, but it is not known if it was triggered by them.
Mental health blogger Beth Matthews, 26, Lauren Bridges, 20, and Deseree Fitzpatrick, 30, all died at the psychiatric hospital last year - although their deaths are not thought to be linked.
READ MORE: Join the FREE Manchester Evening News WhatsApp community
During the January inspection, breaches were found in relation to the 'safe care and treatment'; 'premises and equipment'; 'systems'; and 'staffing' categories at child and adolescent mental health (CAMHS) services. The findings, published on Friday, reveal that high levels of restraint were being used at the facility, that the health of patients was not being monitored after tranquilisation, nor were side-effects of medications being looked at.
Cheadle Royal, run by Affinity Healthcare Limited, is a 150-bed hospital with 13 wards which provides care to people with ‘diverse nursing needs’, says the CQC. That includes adults with acute and psychiatric intensive care needs, personality disorders, eating disorders and adults requiring long stay rehabilitation.
This inspection was carried out on three CAMHS wards – Woodlands, Orchard and Meadows.
Alison Chilton, CQC deputy director of operations in the north, said: “When we inspected mental health services for children and young people at Cheadle Royal Hospital, we found standards of care were well below those people have a right to expect.
“The child and adolescent mental health (CAMHS) wards weren’t well-led and information systems didn’t ensure that wards ran smoothly. We found ward environments weren’t always well maintained.
“On Meadows for example, people had graffitied doors, on Woodlands there were rooms with broken windows, although there was no safety risk from broken glass, they didn’t provide a therapeutic environment for people to live in. Also, on Orchard we saw several bedrooms either without curtains or they were too short, although the provider informed us curtains were on order.
“People shouldn’t have to live in an environment with these poor conditions and the provider must address these issues as a matter of priority. Also, young people couldn’t easily access the outside space which is really important to help them live healthier lives.”
Inspectors revealed that:
Staff assessed and managed risk well but did not always update risk assessments after incidents
The service recorded high levels of restraint and seclusion. However, staff used restraint and seclusion only after attempts at de-escalation had failed
Staff did not ensure that physical health monitoring took place after every incident of rapid tranquilisation. They did not always ensure that medication side effects were monitored
Young people and their families told us they were not always involved in investigations
Managers did not ensure that staff received training, supervision and appraisal. Mandatory training, supervision and appraisal figures were below the provider’s target
Discharge planning was generic and only developed as children and young people approached discharge
Competency checklists and agency profiles outlining staff training were not always available so managers could not reassure themselves the agency staff working were suitably trained
Young people did not have easy access to outside space
However, the CQC did find that the service ‘provided a range of treatments suitable to the needs of the children and young people and in line with national guidance about best practice’, and that ‘the ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare’.
“Additionally, the wards had high vacancy rates and were reliant on agency and bank staff. Some young people told us that agency staff didn’t always treat them with dignity and respect,” continued Ms Chilton.
“Some carers told us they didn’t feel supported, and communication from staff wasn’t always good. It was concerning that they weren’t informed about any incidents which had taken place, or supported when their loved ones were on home leave, which must be addressed.
“However, it was promising that ward teams had access to the full range of specialists required to meet the needs of the children and young people on the wards.
“Following the inspection, we provided feedback to the leadership team who must address our concerns. We will continue to monitor the service closely and if we’re not assured improvements have been made and embedded, we will not hesitate to use our enforcement powers to keep people safe.”
Serious concerns were raised by coroners after the deaths of three women last year. Beth Matthews, originally from Cornwall, was a blogger with a 'massive' online following. An inquest concluded that neglect by staff at the hospital contributed to her death by suicide.
She died on March 21, 2022 after ingesting a poisonous substance she ordered online. She had collapsed in front of staff members at the hospital, where she was a patient after being detained under the Mental Health Act. She had told them it was protein powder.
Just weeks before, on January 23, Deseree Fitzpatrick, another patient at the Cheadle Royal Hospital, died after being found unresponsive in her room. She had been admitted just days before due to risks of self-harm and for alcohol detoxification.
The 30-year-old had been living in sheltered accommodation after being the victim of domestic violence and was diagnosed with Emotional Unstable Personal Disorder (EUPD). Deseree was taking a number of medications from her GP, but was then prescribed a number of additional drugs, the majority of which had a central nervous depressant effect.
The five-day inquest before HM Coroner Andrew Bridgeman found she had choked in her sleep after being given inappropriate medication which had caused 'significant sedation'. The coroner said there was insufficient consideration of 'polypharmacy' and that the medication regime was inappropriate.
The inquest also heard there were missed opportunities for a review of that regime and that she was given so much medication that it resulted in profound sedation and the loss of her gag reflex.
A spokesperson for the Priory apologised following Deseree's death.
A month later, on February 24, Lauren Bridges also died. From Bournemouth, she was a patient on a secure ward at the Stockport hospital after needing to be transferred to a ‘more secure’ unit. Her mum Lindsey paid tribute to her 'beautiful and brave' daughter, detailing 'significant concerns' about her care as she claimed her daughter was 'failed by a system that should have helped and supported her'. Those coronial proceedings are ongoing.
The CQC's overall rating is 'requires improvement'. It has also gone from good to inadequate for its level of safety.
The service’s well-led rating has dropped from requires improvement to inadequate. For CAMHS, the rating has dropped from good to inadequate, it has also gone from good to inadequate for safety. 'Well-led' has dropped from requires improvement to inadequate. Being effective and responsive has gone from good to requires improvement, while and caring remains 'good'.
"The service will be kept under close review by CQC to ensure people’s safety and re-inspected to assess whether improvements have been made," says the CQC.
What the hospital says
Priory CEO Rebekah Cresswell said: "We are disappointed with the CQC’s overall (CAMHs) rating which does not accurately reflect the quality of our child and adolescent mental health services at Cheadle, and have disputed the factual accuracy of many aspects of the report.
"Our responsibilities are first and foremost to our patients and their families, and while we take the report very seriously and remain committed to addressing any issues raised, the misrepresentation of our service is unhelpful both to them, and to our dedicated and hard-working staff.
"The headlines of the CQC’s press release fail to identify many positive aspects found by inspectors, including that ‘all wards were safe, clean, well-equipped, well-furnished and fit for purpose’, patient incidents were managed well, our staff were ‘discreet, respectful, and responsive when caring for children and young people,’ and that patients felt our staff were ‘supportive, kind, respectful and caring.’ They state we had enough nursing and support staff to keep patients safe.
"They stated our care was ‘personalised, holistic and recovery-orientated’ and ‘staff from different disciplines worked together…to make sure children and young people had no gaps in their care’.
"To meet increasing national demand, we have invested £360,000 this year in refurbishing Orchard ward as a high dependency care ward for young people with additional support for disordered eating.
"This was already planned for 2023. And since January 2022, almost £2m has been invested overall in services at Cheadle Royal Hospital. We remain totally focused on reducing agency use, which is down by two-thirds since the inspection, and recruited 99 new permanent colleagues at Cheadle this year alone, which includes nine new nurses and 46 healthcare assistants, with a further 13 new nurses and 37 healthcare assistants in the pipeline.
"We are concerned that this kind of rating, when care has been highlighted as good, gives the wrong impression and could exacerbate the very problem the regulator appears to want to address, namely staffing. This inspection happened five months ago, and we were working on increasing our permanent staffing levels long before this, which is why we have already seen an increase in them."
Read more of today's top stories here
READ NEXT:
