• Hospital in Nottinghamshire, run by St Andrew’s Healthcare, has been rated “inadequate” by the CQC 
  • The hospital, which provides inpatient services for patients with learning disabilities and autism, was also placed into special measures
  • Serious concerns over the hospital’s use of seclusion rooms, including failing to respond to patients wanting food or to use the toilet

A major provider of inpatient learning disability and mental health services has had one of its hospitals placed into special measures by the Care Quality Commission, which raised concerns staff failed to respond to urgent requests from patients in seclusion.

In a report published today, the CQC has rated a hospital in Nottinghamshire, run by St Andrew’s Healthcare, as “inadequate”.

During a visit in September 2018, inspectors found staff were breaching the Mental Health Act, including one ward which allowed patients to vote on whether to end the seclusion of another patient.

Inspectors also found staff did not always respond to the requests of patients who were in seclusion, including one instance where a patient soiled themselves after repeated requests to go to the bathroom.

St Andrew’s Healthcare is a major provider of inpatient units for mental health, learning disability and autism services. Its hospital in Mansfield provides 66 inpatient beds for men with learning disabilities and/or autism.

The CQC’s inspection was prompted after it was alerted to concerns over the provider’s services. Its report also found:

  • Staff were not responding to patients’ requests when they were in seclusion. This included requests for food, to go to the toilet, to use the shower, for medicines and blankets;
  • Patients on some wards reported that staff “took a punitive approach and spoke to them in a disrespectful way”; and
  • Managers and staff did not ensure environments were safe and there was a failure to identify ligature points and seclusion rooms with blind spots.

The hospital was rated “inadequate” for safety, care, and leadership. It was rated “good” for responsiveness and “requires improvement” for its effectiveness.

The provider’s latest rating is a considerable deterioration on its 2015 inspection report, when it was rated “good” overall.

The latest report comes after high profile media reports of a 17-year-old who has been in seclusion at another unit run by St Andrew’s Healthcare in Northampton for at least 21 months.

Following the reports, health and social care secretary Matt Hancock commissioned the CQC to carry out a thematic review of the use of prolonged seclusion and segregation on patients within inpatient wards.

In relation to the practices identified on Thoresby Ward, where patients voted on whether to end the seclusion of another patient, senior managers told the CQC this was normal practice for this ward which is classed as a “therapeutic community model”.

But the CQC said patients had not given consent for this and added: “Patients voting to end other patients’ seclusion introduced a significant risk that people would be held in seclusion longer than required… This was a breach of the Mental Health Act code of practice, which states ‘seclusion should immediately end when a multidisciplinary team review, a medical review or the independent multidisciplinary team review determines it is no longer warranted’…

“The code further states that only the following persons can authorise seclusion; a psychiatrist, an approved clinician who is not a doctor or the professional in charge (for example, a nurse) of the ward.”

A St Andrew’s Healthcare spokeswoman said: “We deeply regret that in a number of instances the care provided to patients at Mansfield fell below our expected standards. As soon as the CQC raised concerns we acted decisively, closing the hospital to new admissions. We are now undertaking a clinical review and strengthening operational oversight under new management.

“We regret that in a small number of cases, care of those in seclusion fell short of the high standards we strive for.”