Special measures for hospital where patients had to 'lie on floor'

The Care Quality Commission has rated St Andrew’s Healthcare’s mental health hospital for children and adolescents in Northamptonshire “inadequate” overall and within the safety, caring and well-led categories. The hospital has been temporarily closed to admissions.

In particular, the CQC found patients in seclusion were left to sit or lie on the floor in rooms with no chair, bed, pillow, mattress or blanket.

Another instance of poor practice, which inspectors labelled “uncaring, undignified and disrespectful”, involved staff changing a female patient with a male staff member present.

According to the report, staff had also imposed blanket restrictions on patients “without justification”. For example, patients were restricted to specific snack and drink times, and, on one ward, were not allowed to wear shoes.

Last year, St Andrew’s Healthcare’s Northamptonshire service faced fierce public scrutiny over the seclusion of a 17-year-old girl with autism, called Bethany, who had been in seclusion at the hospital for almost two years.

The reports prompted the CQC to inspect the provider. In a focused report, published in February, the regulator raised concerns over the use of repeated and prolonged segregation. However, as this was a focussed inspection, the hospital was not rated at this time.

The hospital is the second of St Andrew’s Healthcare’s services to be placed in special measures in less than six months. In February, the independent provider’s Nottinghamshire Hospital was also rated inadequate. Among the inspectors’ concerns was one ward on which patients were allowed to vote on the length of other patients’ seclusion.

The provider has seven other services rated by the CQC, with five rated “good” overall, and two “requires improvement”.

Other findings from the most recent inspection at Northamptonshire include:

• A high number (326) of episodes of seclusion over six months across all wards;
• Staff not following best practice when using seclusion – for example, medical reviews had not taken place within the first hour in six episodes;
• Managers not filling 13 per cent of shifts in March 2019 and using bank and agency staff to cover 47 per cent of shifts; and
• Staff shortages sometimes resulting in staff cancelling escorted leave, appointments or ward activities.

Commenting on the most recent CQC report, Katie Fisher, chief executive of St Andrew’s Healthcare said it highlighted challenges with the “variability” of the service’s care. She noted the watchdog had cited several examples “where we are getting care right”. The service received “good” ratings in the effective and responsive domains.

However, she continued: “With particular reference to processes surrounding seclusion and long-term segregation, we accept that we should have done better by our patients. We need a bigger rethink of our seclusion and long-term segregation process, so have begun a charity-wide review. This will ensure that, when safety concerns make it necessary to seclude or segregate a patient, the facilities provided and monitoring undertaken are consistently safe and robust.”

She added the provider will be appointing an improvement director to oversee the work around seclusion and has sought advice from an unnamed outstanding-rated CAMHS provider.

The CQC’s rating comes following the watchdog’s interim report on the use of restraint and seclusion in mental health services. In response to the report, health and social care secretary Matt Hancock announced a review of every patient held in long-term segregation.