- Six mental health hospitals admitting people with learning disabilities or autism drop at least two ratings since May
- Includes one which was rated “outstanding” seven months before receiving “inadequate” rating
- CQC says it is “strengthening our assessment of these types of hospitals” and reviewing methods
- Also says more people have come forward with information
The Care Quality Commission has rated six mental health hospitals “inadequate”, just months after describing them as either “good” or “outstanding”, since the Whorlton Hall scandal was revealed.
HSJ analysis shows that of the 13 mental health hospitals admitting people with learning disabilities or autism which have been rated “inadequate” by the CQC since May this year, six of them dropped at least two ratings in a short space of time.
The six hospitals which dropped at least two ratings include Whorlton Hall — the County Durham hospital closed following a BBC Panorama report in May showing residents being mistreated — which the CQC rated as “good” in December 2017 before revising this to “inadequate” in May.
The BBC investigation prompted the CQC to investigate all similar mental health hospitals run by Cygnet, which took over the running of Whorlton Hall in January 2019.
Cygnet Newbus Grange in Darlington — which was rated “outstanding” in a report published in February 2019 – was judged “inadequate” by September, while Cygnet Acer Clinic in Chesterfield fell from “good” in November 2018 to “inadequate’ in a report published 12 months later.
The other three hospitals were:
- The Breightmet Centre for Autism in Bolton, run by ASC Healthcare, which was rated “good” by the CQC in August 2018, before being judged “inadequate” in a report published in October the following year;
- Kneesworth House in Hertfordshire, run by Partnerships in Care Ltd, which was rated as “good” in February 2018, before dropping to “inadequate” in a report published in July this year; and
- The Woodhouse Independent Hospital in Staffordshire, run by Elysium Healthcare, which was given a “good” rating in December 2017, before being graded “inadequate” in September.
It comes as the CQC prepares to publish independent reports on its role in relation to the Whorlton Hall scandal. The reports were due to be published earlier this month, but were delayed because of the pre-election Purdah period. NHS England — one of the commissioners, along with local authorities and clinical commissioning groups, of learning disability inpatient care — also last month initiated a “taskforce” on the issue.
The CQC has acknowledged it needed to “strengthen” its assessments of this type of care and said it had begun to do so, and was reviewing them further “from a human rights perspective”.
Asked by HSJ why the ratings had changed in such a short space of time, it said it had revisited all the similar Cygnet hospitals in the wake of the Whorlton Hall findings, said the quality of care at this type of hospital “can change quickly”, and said it was also “strengthening” its assessments.
Ted Baker, CQC chief inspector of hospitals, also said more people had contacted the CQC following the Panorama programme, who “have helped inform our monitoring and regulatory action, including focused inspections”.
Professor Baker said: “We are currently strengthening our assessment of these types of hospitals and have provided inspectors and their managers with new supporting information about how to identify and respond to ‘closed cultures’ in services.
“We have started a longer-term review of our methodology from a human rights perspective. We are committed to working closely with people who use services, families and professionals to develop this. This will include implementing any recommendations from the independent reviews that we have commissioned into our regulation of Whorlton Hall.”
The regulator’s State of Care report, published in October, said there had been deterioration in care for people with a learning disability or autism, said it was “not acceptable”, and in particular highlighted concerns about inpatient wards where residents often lived a long way from their family and community, and prolonged use of segregation.
One leading learning disability expert who has worked in senior NHS positions, who asked to remain anonymous, suggested to HSJ how the CQC could further improve inspections: “There is a missed opportunity to involve clinicians who don’t work in the mental health or learning disability sector in inspections.
”They can often see things those more culturated in those settings might not recognise. They should be an addition to the inspection team… Inspection teams need to look for soft indicators of problems, and if they find soft indicators they need to dig deeper.”
The source added: “If inspections are announced clearly providers will put on their best face for the inspections. We need some more unannounced inspections.”
Rachel Power, chief executive of the Patients Association, said: “We would like to see further explanation from CQC about why these institutions’ ratings changed within the space of two years.”
Learning disability charity Mencap said the CQC’s focus on “appalling human rights abuses” in inpatient units for people with a learning disability or autism “is welcome, but long overdue”.
Dan Scorer, Mencap’s head of policy and public affairs, said: “Whoever ends up with the keys to Number 10 must commit to implementing the recommendations of Parliament’s joint committee on human rights report, setting up a specialist unit to tackle transforming care [the NHS England programme seeking to cut the number of people with learning disabilities who are in inpatient units] and fund social care for all working aged disabled adults who need it. This human rights scandal has to end.”
The CQC has commissioned two independent reviews into Whorlton Hall, on how it dealt with concerns raised about the hospital in 2015 by a former inspector and on its regulation of the facility between then and 2019.
What the CQC found on its more recent inspections
- During the inspection at Newbus Grange, carried out in May 2019, the CQC found some patients were “routinely denied access to their own possessions” and there had been “a very substantial increase in the use of restraint since 2016”. Inspectors also found “the interior of the building was worn and tired in places and some rooms smelt of damp or urine”.
- Cygnet Acer Clinic’s inspection in August, in response to information received by the CQC, found it was “not safe”, with self-harming incidents among patients increasing significantly in the three months leading up to the inspection, and that more than 75 per cent of nursing staff were unqualified.
- An inspection of the Breightmet Centre for Autism in June found the “care premises, equipment and facilities were unsafe,” “substantial or frequent staff shortages” and patients’ privacy and dignity were not respected and found two dressed in soiled clothing.
- The CQC inspection of Kneesworth House found it “had not kept patients safe from improper treatment and some staff were uncaring and disrespectful,” and areas of the hospital were dirty. Since the inspection in April, the regulator has conducted three responsive inspections and taken urgent enforcement action.
- Inspectors found Woodhouse Independent Hospital was not adequately staffed and patients’ physical health was not being monitored consistently.
Cygnet told HSJ the change in the ratings of its services in such a short time was surprising and “difficult to understand” and said its “firm commitment remains to enhance the care of those placed with us”.
A Cygnet spokesman said: “The CQC inspections happened some months ago, thereafter further inspections have taken place indicating a sustainable improvement of those services. We expect those ratings to be published shortly.”
A spokesman for The Priory Group, which is Partnerships in Care’s parent company, said: “At Kneesworth, a major investment plan is underway to ensure the environment is improved, and while we accept the forensic service fell below expected standards, the CQC rated the acute mental health and rehabilitation services — which make up the greatest proportion of beds — as ‘good’, and overall the hospital was rated as ‘good’ for being ‘effective’ and ‘responsive’.”
Elysium Healthcare said it has put in place an immediate action plan following the inspection and it takes the health and wellbeing of its patients “extremely seriously”.
A company spokeswoman said: “We are pleased that the CQC noted that the staff treat patients with compassion and kindness. They also noted that staff respect patients’ privacy and dignity.”
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CQC reports, information supplied to HSJ