An under-fire mental health hospital in Bolton has been threatened with closure if it does not make "rapid, widespread improvement" to its services, while the maternity service at Royal Bolton Hospital has also had its ratings downgraded by the Care Quality Commission (CQC).
The Breightmet Centre for Autism, an independent hospital run by ASC Healthcare Limited, which provides support to adults with a learning disability or autistic people, was previously rated ‘inadequate’ and placed in special measures following a CQC inspection in March 2022.
After a follow-up inspection in December, the hospital, which was caring for 12 patients at the time, has been rated 'inadequate' overall for a second consecutive time, and also rated 'inadequate' for being safe, effective, caring and well-led.
The CQC is now taking further enforcement action, and if there is not rapid, widespread improvement will start the process of preventing the provider from operating the service.
'Disproportionate Level of Restraint'
Debbie Ivanova, CQC's director for people with a learning disability and autistic people, said: "Much like the findings from our previous inspection, we still didn't see enough significant improvement to reassure us that leaders at Breightmet had turned things around. More worryingly, we witnessed incidents that gave us real concerns about people's dignity and their experience of using this service.
"We witnessed staff using a disproportionate level of restraint, and care plans weren't followed in ways such as helping people who needed it to eat and drink.
"We also saw staff laughing at the people they were supposed to be looking after, and that people spent most of their time alone in their rooms. People also told us staff could be loud at night time and disrupt their sleep, and their preferences such as to be supported by carers of a specific gender wasn’t always being respected. Vulnerable people were relying on all staff members to act as their advocates, to help them live their best lives and it is unacceptable the people they relied on were treating them this way.
"However, we did see some small improvements since the previous inspection in how the service was handling complaints and working well with services that provide aftercare to ensure people received the right care and support when they went home."
'Improvements are Being Made'
In response to the CQC’s findings, the Breightmet Centre for Autism issued the following statement to Medscape News UK: "We are passionate about delivering high quality care to our service users and their safety and wellbeing is our number one priority. The Breightmet Centre for Autism is a small community hospital for adults with Autism and/or Learning Disability and has an ethos of least restrictive practice and enabling community care for our patients with positive outcomes.
"The new management team at the Breightmet Centre for Autism is working constructively with the CQC and other external stakeholders such as NHSE and our focus is on making ongoing sustained improvements for our service users and families.
"The CQC has acknowledged that improvements had been made at the time of inspection in December 2022 and we are further confident that further sustained improvements continue to be made as we continue to work collaboratively with all external stakeholders."
Deterioration in Care at Royal Bolton’s Maternity Service
Meanwhile, the CQC has downgraded the rating of maternity services at Royal Bolton Hospital, from 'good' to 'requires improvement' overall following an inspection in November.
The inspection at the trust, which is run by Bolton NHS Foundation Trust, was carried out as part of CQC's national maternity services inspection programme.
As well as the service’s overall rating declining, it has also dropped from 'good' to 'requires improvement' for being safe and well-led. It will continue to be monitored closely by the CQC to see if the required improvements have been made.
Carolyn Jenkinson, CQC’s deputy director of secondary and specialist healthcare, said: "When we visited maternity services at Royal Bolton Hospital, we found a deterioration in the standard of care being provided across the areas we looked at. However, there had been recent changes in the leadership team, who had started to make some improvements.
"There were issues around staffing levels which led to frequent closures of the birthing centre and midwifery led hospital unit. This reduced the birthing options available to women and birthing people.
"Additionally, during the inspection one of the postnatal wards was closed due to staffing issues, which caused delays transferring people from the labour ward. This situation was regularly assessed by leaders who moved staff around to ensure women and birthing people received appropriate care.
"However, inspectors found staff supported and involved women and birthing people, families and carers to understand and make decisions about their care and treatment."
'Safety is Our Priority'
In response to the CQC’s findings, Bolton NHS Foundation Trust said a number of improvements to its maternity services was well underway.
Tyrone Roberts, chief nursing officer at Bolton NHS Foundation Trust said: "Our priority will always be the safety of our patients and ensuring that we consistently deliver the high-quality care our communities expect and deserve.
"It's been a difficult couple of years, and like other NHS organisations we are experiencing challenges when it comes to addressing workforce gaps in maternity services.
"The CQC highlights the areas we already knew needed improving and this will enable us to accelerate our plans. The report acknowledges the scale of the improvement work we are doing and the changes we have already made and our focus now is to truly embed them across our service and sustain them."