• NHSE asked hospital with “voluntary” ban on admissions to admit patient
  • Later the same month, CQC put legal restriction on admissions at facility
  • Provider says clinical team approved the “exceptional case”
  • NHSE says it “work[ed] with [patient] and their family” before admission

NHS England asked an “inadequate” hospital for people with learning disabilities and autism to admit a patient, despite the service having a “voluntary” ban on admissions in place — and shortly before inspectors decided to impose a legal restriction.

The provider said it was an “exceptional case”, where the individual “had several failed placements”, and had stayed at the hospital — Jeesal Cawston Park in Norfolk — “in the past”. 

However, it appears to highlight the shortage of good quality accommodation and placements available and pressure on commissioners to make use of “inadequate” facilities.

The Care Quality Commission rated the hospital “inadequate” in July last year, and had agreed with commissioners a self-imposed “voluntary embargo” on admitting new patients.

In November, the CQC visited again and, during that month, used its legal powers to prevent admissions to the hospital without the CQC’s specific prior approval.

However, just days before the CQC took this enforcement action, NHSE asked Cawston Park to admit one patient, the provider said.

In its report on the November inspections, published last week, the CQC said it still had “significant concerns” about Cawston Park, a 57-bed hospital for adults with learning disabilities and autism, who “have complex needs associated with mental health problems and present with behaviours that may challenge”. The CQC did note some improvements at the facility, which currently has 10 NHS patients, including on discharge planning.

CQC findings in November included:

  • Short-staffed wards and general observations not always being completed when there were a high number of incidents. During the inspection, one patient, who had their observations reduced due to lack of staff, broke a toilet seat and swallowed a screw. 
  • An unbagged stool sample was left in a medication fridge for more than two months. Managers checked the fridge on 10 October, but had not spotted the issue.
  • Lack of staff training meant inspectors were not assured the quality of clinical observations was consistent.

Jeesal said its “voluntary embargo” would remain in place until Jeesal “and key stakeholders” were confident in the services. It said a new chief operating officer was leading an action plan.

A spokesman said: “We were asked by NHS England in November 2019 to admit a patient who had several failed placements and had been with us in the past. The clinical team agreed the admission was in the best interest of the patient. The board approved the admission based on the clinical team’s advice.

“We see this as an exceptional case and we have continued to date with our voluntary embargo on new admissions.” 

An NHSE spokesman said: “When deciding where to place a patient, NHS England and NHS Improvement always works with them and their family to decide on the most appropriate place for their needs, and continues to work with them on an ongoing basis.”

The CQC’s November inspection report said it had reviewed the “care and treatment plans” of this particular patient, and that “a discharge planning support plan had been initiated with outcomes and success measures in place”.

Cawston Park becomes the latest hospital where the CQC has restricted admissions — similar action was taken at Cygnet Acer Clinic in Chesterfield in November, but this enforcement action has now been lifted.

A CQC spokesman said: “The latest inspection (into Jeesal Cawston Park) did find areas of improvement, but it also identified issues affecting patient safety. That is why we now require this provider to not admit any patients without prior written agreement from CQC.”

Major problems in LD and mental health inpatient services have increasingly come under the spotlight over the past year or so. In October, NHSE chief executive Sir Simon Stevens indicated there should be development of more NHS facilities, squeezing out a “sometimes-inappropriate” level of private provision.

The Patient Safety Congress

The Patient Safety Congress, taking place on 13-14 July 2020, brings together more than 1,000 people with the shared aim of transforming patient safety. It draws together contributions from patient speakers, safety experts from healthcare and other safety critcal industries, and frontline innovators, to challenge and drive forward on patient safety. You will be part of influential conversations with those responsible for driving the new national strategy on patient safety and take away real solutions that you can adopt to improve outcomes where you work.