Child and adolescent mental health (CAMHS) services at an under-fire private hospital in Cheshire have been rated 'inadequate' following an unannounced inspection by the health care regulator.
The Care Quality Commission (CQC) inspected the CAMHS wards at Cheadle Royal Hospital in January in response to reported concerns about safety.
At this inspection breaches were found in relation to safe care and treatment, premises and equipment, governance and staffing, though the hospital's management hotly disputed some of the findings and the CQC's rating.
The 150-bed, 13-ward at Cheadle Royal Hospital is run by Affinity Healthcare Limited (Priory Group) and provides care to people with diverse nursing needs. This CQC inspection only looked at three CAMHS wards – Woodlands, a female-only 10-bed low secure ward; Orchard, a 15-bed mixed sex ward offering acute services; and Meadows, a 10-bed mixed sex ward for children and young people requiring psychiatric intensive care.
Following this inspection, CQC's rating for this service has dropped from 'good' to 'inadequate', and it has also gone from 'good' to 'inadequate' for being safe. Well-led has dropped from 'requires improvement' to 'inadequate'. Being effective and responsive has declined from 'good' to 'requires improvement' and caring remains rated as 'good'.
The CQC said the service will be kept under close review to ensure people's safety and will be re-inspected to assess whether improvements have been made. The hospital was not placed in special measures, despite earlier reports.
However, as previously reported by the BBC, three women died at Cheadle Royal Hospital within a 2-month period last year. One of the women, Beth Matthews, 26, died after swallowing a toxic substance in front of staff, and her care was severely criticised in a Coroner’s inquest in to her death, which concluded she died from suicide contributed to by neglect, while there have also been whistle-blower reports in relation to staffing shortages and care concerns.
Standards of Care well Below What is Expected
Commenting on the latest CQC inspection of the hospital, Alison Chilton, CQC deputy director of operations in the north, said: "When we inspected mental health services for children and young people at, we found standards of care were well below those people have a right to expect.
"The child and adolescent mental health (CAMHS) wards weren't well-led and information systems didn’t ensure that wards ran smoothly.'"
She said that inspectors found that ward environments weren't always well maintained. "On Meadows for example, people had graffitied doors, on Woodlands there were rooms with broken windows, although there was no safety risk from broken glass, they didn’t provide a therapeutic environment for people to live in. Also, on Orchard we saw several bedrooms either without curtains or they were too short, although the provider informed us curtains were on order. People shouldn't have to live in an environment with these poor conditions and the provider must address these issues as a matter of priority. Also, young people couldn't easily access the outside space which is really important to help them live healthier lives."
Additionally, Ms Chilton noted that the wards had high vacancy rates and were reliant on agency and bank staff.
"Some young people told us that agency staff didn't always treat them with dignity and respect. Some carers told us they didn't feel supported, and communication from staff wasn't always good. It was concerning that they weren't informed about any incidents which had taken place, or supported when their loved ones were on home leave, which must be addressed," she said.
There were some positive findings too, Ms Chilton acknowledged, saying it was promising that ward teams had access to the full range of specialists required to meet the needs of the children and young people on the wards.
Disputing the Findings
In a statement issued in response to the CQC's findings, Priory CEO Rebekah Cresswell, said: "We are disappointed with the CQC's overall (CAMHs) rating which does not accurately reflect the quality of our child and adolescent mental health services at Cheadle, and have disputed the factual accuracy of many aspects of the report. Our responsibilities are first and foremost to our patients and their families, and while we take the report very seriously and remain committed to addressing any issues raised, the misrepresentation of our service is unhelpful both to them, and to our dedicated and hard-working staff."
She said the report included many positive aspects found by inspectors, including that "'all wards were safe, clean, well-equipped, well-furnished and fit for purpose', patient incidents were managed well, our staff were 'discreet, respectful, and responsive when caring for children and young people,' and that patients felt our staff were 'supportive, kind, respectful and caring'. They state we had enough nursing and support staff to keep patients safe. They stated our care was 'personalised, holistic and recovery-orientated' and 'staff from different disciplines worked together…to make sure children and young people had no gaps in their care'".
Ms Cresswell also pointed out that there has been significant investment in the hospital in the last couple of years, with agency staff use down by two-thirds since the inspection, and 99 new permanent staff have been recruited at Cheadle this year alone.
"We are concerned that this kind of rating, when care has been highlighted as good, gives the wrong impression and could exacerbate the very problem the regulator appears to want to address, namely staffing. This inspection happened five months ago, and we were working on increasing our permanent staffing levels long before this, which is why we have already seen an increase in them."