Priory Healthcare - Quality Accounts
2009/10
Table of Contents
Part 1
Statement on quality from the Board of Directors
3
Statements of assurance from the board
4
Part 2
6
Quality Standards and Processes
Business Overview
6
Leadership, Governance and Accountability
6
The Quality and Safety Team
8
Consultation processes
9
Part 3
Priority 1 -
Five Quality Priorities
Compliance with CQC Regulation and Standards
10
10
Priority 2 Providing Safe Services
AIncident Rates
BSerious Incidents
CMedication Management Audit
13
13
14
15
Priority 3 Patient Involvement and Service User Experience
APatient Opinion Surveys
BComplaints
16
16
18
Priority 4 Staffing
AColleague Opinion Survey
BLearning and Development
19
19
20
Priority 5 Effective Services
AEating Disorders
BChild & Adolescent Mental Health Services (CAMHS)
CSecure and Complex Care
DRehabilitation: Priory Hospital Highbank
21
21
22
23
24
Annex
Statement from lead purchaser
25
Page 2 of 25
Part 1
Statement on quality from the Board of Directors
Priory Healthcare’s objective is to offer safe, effective and welcoming services for
people with a variety of mental health and neurological problems, enabling them to
maximise their potential and to make as full a recovery as possible. This report sets
out the evidence for Priory’s commitment to providing safe services that are effective
and offer high levels of customer care.
This is the first year in which quality accounts have been published under the
guidance issued by the Department of Health, in which independent providers to the
NHS are expected to comply with the same guidance as NHS Foundation Trusts.
Priory welcomes this development and is publishing as full an account as possible in
this first year with the intention of moving towards third party assurance of the data
in 2010-11. To this end we have been working with PricewaterhouseCoopers to
ensure that our processes and outcomes are available for independent audit.
Priory’s financial year does not correspond to the public sector financial year, our
quality accounts align to the NHS reporting year rather than our financial reporting
year so that appropriate comparisons can be made where possible. Therefore the
information presented in this document relates to April 2009 – March 2010. While
there remains debate about what contents are appropriate for quality accounts in
mental health services, the board of Priory has taken the view that it is right to
publish as much material as might be readily understood by a non-specialist audience
and the company hopes that this may inform the ongoing debate and encourage
other organisations in all sectors to publish similar information.
In the opinion of the board this first report demonstrates that our services are well
governed, with appropriate accountability being taken at board and site level. The
award of the ISO 9001:2000 accreditation at the end of 2009 provided a strong
external benchmark of the quality of our internal governance processes. We believe
that the extent of quantitative data available to managers at Priory is unusually high
for a mental health service.
Key points from this year’s accounts are
•
High levels of compliance with CQC regulations during the year
•
High levels of compliance with incident reporting, with low levels of serious
incidents, a profile consistent with a risk-vigilant and safe service
•
High levels of outcome reporting from all sites, with a growing acceptance of
the usefulness of structured outcome reports
•
High levels of patient satisfaction with the services offered
•
High levels of colleague satisfaction with Priory as an employer using the
equivalent answers from NHS Mental Health Trust employees as a benchmark
•
High levels of compliance with mandatory learning and development modules,
using an award winning, e learning system – ‘Foundations for Growth’
•
The implementation of a state of the art service to identify and reduce
medication errors in prescribing and dispensing
Page 3 of 25
Statements of assurance from the board
During 2009/10 Priory Healthcare provided NHS mental health services in 23 sites
across England and Scotland.
Priory Healthcare has reviewed all the data available to them on the quality of care in
all of these NHS services.
The income generated by the NHS services reviewed in 2009/10 represents 100% of
the total income generated from the provision of NHS services by Priory Healthcare
for 2009/10.
During 2009/10 one national confidential enquiry (Suicides and Homicides by People
with a Mental Illness) covered NHS services that Priory Healthcare provides, and
Priory Healthcare participated in it. Priory Healthcare also participated in the audit of
adult inpatient wards and in the quality networks operated by the Royal College of
Psychiatrists: QNIC – The Quality Network for Inpatient CAMHS units and QNFMHS The Quality Network for Forensic Mental Health Services.
Reports of the quality networks are regularly reviewed and action plans are set by
each unit to improve against the set standards, progress being reviewed by the
appropriate service line quality network.
Reports of hospital clinical audits were regularly reviewed by the provider in 2009/10
and action plans progressed and monitored in real time as described above.
A proportion of Priory Healthcare’s income in 2009/10 was conditional upon achieving
quality improvement and innovation goals agreed between Priory Healthcare and NHS
commissioning bodies through the Commissioning for Quality and Innovation payment
framework. Further details of the agreed goals for 2009/10 and for the following 12
month period are available on request by contacting jacobhollis@priorygroup.com.
Sites which operate as part of Priory Healthcare are fully registered with the Care
Quality Commission. During 2009/10 the registration framework was the national
minimum standards, under which each site has different specific conditions on
registration, such as the age range, and the number of beds. These are available on
request.
The Care Quality Commission has taken enforcement action against one Priory
Healthcare site during 2009/10. It was deemed that Chadwick Lodge was not
processing ligature removal rapidly enough following the results of an internal audit.
The notice was lifted before these accounts were prepared.
Priory Healthcare sites are subject to yearly self assessment by the Care Quality
Commission and are inspected at their discretion according to their risk adjusted
processes. Further details of CQC inspections that have taken place during this year
are included later in this quality account. Priory Healthcare has not been requested to
participate in any special reviews or investigations by the CQC during the reporting
period.
Page 4 of 25
Priory Healthcare was not requested to submit records during 2009/10 to the
Secondary Uses service for inclusion in the Hospital Episode Statistics which are
included in the latest published data.
As part of a previous successful application to join the N3 secure network Priory
Healthcare has previously used the information governance toolkit to demonstrate
compliance with NHS data standards, however as an independent sector provider
Priory was not required to repeat this exercise in 2009/10. It remains compliant with
the standards.
As a provider of mental health services Priory Healthcare was not subject to the
Payment by Results clinical coding audit during the reporting period by the Audit
Commission.
Priory provides services to a large range of NHS commissioning bodies, the greatest
volume of which is derived from consortium of 3 Kent PCTs purchasing Secure and
Complex Care services. We have therefore sought review and comment from the Kent
consortium in accordance with their legal obligation. Comments are included in the
annex.
To the best of my knowledge and belief the information in these accounts is accurate
PROFESSOR CHRIS THOMPSON MD FRCP FRCPSYCH MRCGP
Chief Medical Officer - Priory Group
on behalf of the board
Page 5 of 25
Part 2
Quality Standards and Processes
Business Overview
Priory Group is an Independent Sector Company providing a wide range of services
funded by public bodies, private medical insurance and clients themselves. Priory
Group specialises in clients with mental health problems, developmental disorders,
and neurological or rehabilitation needs, often with complex specialist needs relating
to challenging behaviour and physical illness.
The group’s services are divided into three broad sectors: Healthcare, Care Homes
and Education. There are close working relationships between the sectors, fostering
innovation and efficiency.
These quality accounts relate to both the NHS and private activity of the Healthcare
segment of Priory’s operations where hospital level data is concerned, since no
distinction is drawn between NHS and private provision in the company’s quality
structures. However two service lines are entirely privately funded and are therefore
excluded from service line outcome data in the NHS accounts. These are general adult
psychiatry and addictions. Further information is available on request.
Leadership, Governance and Accountability
The Board
The operating company board includes the chief executive (CEO), the chief financial
officer (CFO), the chief operating officer (COO) and the chief medical officer (CMO)
and is chaired by a representative of the main shareholder. The CMO is the board
member with primary responsibility for quality and safety but all board members
recognise their responsibility to support and enhance the quality and safety of services
in the Group. The agenda for each board meeting contains a section on quality at
which the CMO presents an overview of the latest group data, together with any areas
of risk identified since the previous meeting. The COO, CMO and CFO work closely
together under the leadership of the CEO to ensure that investment is aligned with
quality as well as commercial requirements.
Site Management
Each site has a registered manager who is accountable for all on-site activity including
quality. Corporate policy requires the hospital director to convene clinical governance
and health and safety committees on a regular basis to review quality and safety on
the site. The main agenda items of these Committees are set by the Central Quality
and Safety Forum (see below) to ensure that mission critical items are always covered
- but with variation allowed for initiative in finding local solutions. To deliver the
quality objectives the hospital director works with a senior management team, which
includes a medical director, a director of clinical services and a site services manager.
There is also a regional management structure to assist the hospital directors. The
Medical Director is responsible for all medical activity on site including consultant
appraisal and discipline, and for representing the views of the Medical Advisory
Committee to the Hospital Director. The Medical Director reports operationally to the
hospital director but professionally to the Chief Medical Officer of the company.
Page 6 of 25
The following tables map service lines onto provided hospitals for the period 2009/10.
Acute hospitals provide one or more of four types of service, adult mental health,
addictions, adolescent inpatient units and eating disorder inpatient units. Some
hospitals also provide slow stream inpatient rehabilitation. Most acute hospitals also
provide day care and outpatient therapy services to reduce the need for admission
and to reduce the length of stay by providing high intensity after-care following
discharge. Consultant outpatient clinics also operate out of the acute hospitals and at
two satellite sites - Edinburgh (operated from Glasgow hospital) and Canterbury
(operated from Ticehurst).
Acute Hospitals
Hospital
Roehampton
North London
Chelmsford
Southampton
Brighton and Hove
Bristol
Woking
Nottingham
Glasgow
Altrincham
Preston
Hayes Grove
Woodbourne
Ticehurst
Highbank
Adult
mental
health inc
therapy
services
x
x
x
x
x
x
x
x
x
x
x
x
x
Adolescent
tier 4 and
high
dependency
Addiction
Treatment
programme
Eating
disorder
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
Other specialties
Rehabilitation
Rehabilitation
Rehabilitation
Adult Aspergers syndrome
Rehabilitation
Neurological rehabilitation
Secure and Complex Care sites operate a range of long stay services at various levels
of security. The Grange sites (Sturt, Hemel, Heathfield, Bristol, Potters Bar and St
Neots) care for patients with various diagnoses but all with, physical, mental health
and security needs and often with marked challenging behaviour.
Page 7 of 25
Secure and Complex Care
Hospital
Thornford Park
Chadwick Lodge and
Eaglestone View
Farmfield
Medium
Secure
Low
Secure
Womens
services
X
X
X
X
X
X
X
X
Sturt House
Hemel
Heathfield
Potters Bar
Bristol Grange
St Neots
Personality
Disorder
Step down
and
complex
care
X
X
X
X
X
X
X
X
The Quality and Safety Team
The CMO is in overall strategic control of the quality and safety system which is
designed to ensure that sites, and the service lines within them, can be held
accountable for their quality using data that is valid and reliable.
Ms Sally Carmody, the director of quality and safety, reports to the CMO and is
responsible for the effective operation of the central Quality and Safety team. The
team has three functions
a) Compliance Management; A team of four compliance managers visit each site
at least twice a year to carry out a full audit against the minimum standards of
the CQC, health and safety and environmental health regulations. They review
evidence and report on every standard. They are also available for advice to
hospital directors. They revisit as necessary to ensure the required
improvements have been carried out.
b) Policy and Regulation; A central group that ensures that all Priory policies are
reviewed regularly, remain current and that they are compatible with national
guidance.
c) Clinical Risk Management: A group that investigates complaints that have not
been resolved at hospital level, and undertakes reviews of serious untoward
incidents, liaising as necessary with the company insurers and legal advisers.
Page 8 of 25
Consultation processes
The quality and safety team has a Company-wide consultation meeting every 3
months – the Quality and Safety forum – which is chaired by the CMO, and attended
by the central team, regional managers and specialist directors including HR, Learning
and Development, Estates and IT. This forum reports to the board. The forum has
subcommittees, called specialist networks, for each service line – i.e. addictions,
eating disorders, adolescents, general psychiatry and therapy, secure and step down.
Two medical directors committees, one for acute and one for secure, also report to
the forum.
The culture of quality is strong within Priory. Accountability is a strong theme and a
proportion of bonus for senior managers is awarded only after achievement of agreed
quality objectives.
Page 9 of 25
Part 3
Five Quality Priorities
Priorities for Improvement
The DH guidance requires at least three priorities to be identified for improvement.
We have chosen five broad areas on which to report as described below.
1. To provide services that comply with regulatory standards as set by the CQC,
Health and Safety Executive, Environmental Health, Data Protection,
professional regulators, and all other regulators impacting on our work
including those in Scotland, Wales and Northern Ireland.
2. To provide safe services. The evidence presented derives from our incident
reporting system. We aim to have a high rate of incident reporting while
maintaining a low rate of serious incidents using NHS Mental Health Trusts as a
benchmark.
3. To provide welcoming services, giving choice, dignity and high levels of
customer service to our clients and patients. As measured and reported
through a programme of patient satisfaction surveys collected and analysed
independently of Priory.
4. To be a good employer so that staff members are trained, educated and
motivated to provide the best available service. Employee satisfaction is
measured through our annual colleague opinion survey, with key points
benchmarked against equivalent NHS mental health staff satisfaction data.
Levels of achievement of mandatory training assignments are reported to
demonstrate commitment to maintaining levels of fitness to practice for all
grades of staff.
To provide clinically effective services ensuring the best possible opportunity for
recovery and to evidence our success rates using recognised outcome measures,
appropriate to each service line.
Priority 1 - Compliance with CQC Regulation and Standards
For the period covered in these accounts the minimum standards as set out in the
Care Standards Act 2000 remained the benchmark and it is therefore not possible to
make comparisons between Priory and NHS providers. In addition, since the CQC
relies on a risk adjusted self assessment process many of our sites have not been
visited in the recent past as they have been deemed low risk. The chart below details
sites that have been inspected by the CQC during 2009/10, and the number of
requirements identified. Sites not listed here were not deemed to require inspection,
based on their self assessments. Each requirement relates to one of the 441
standards, and the low number of requirements therefore shows a high level of
compliance.
Progress on the action plans created to achieve the standards where a requirement
was indicated is tracked internally to ensure rapid resolution of the issue. This is
followed up with a site visit by the internal compliance managers to ensure that the
Page 10 of 25
reported actions have been carried out. Management is therefore confident that the
requirements identified by CQC have been resolved at the time of this report.
Priory Site
No of Requirements
Date of Inspection
Bristol
4
25/11/2009
Chadwick
8
15/06/2009
Chelmsford
1
01/03/2010
Farmfield
3
21/10/2009
Glasgow *
4
16/06/2009
Thornford
7
19/01/2010
*Inspection carried out by Healthcare Commission Scotland
In addition to the CQC visits our Compliance Managers carry out
unannounced Regulation 26 visits every 6 months, independently of site
management. In contrast to the CQC inspections these review all 441
standards against an audit template. The number of requirements at each
site is shown below for the 2 visits in 2009/10. The low numbers of
requirements across all sites and the generally stable numbers provide
assurance that sites are well managed and compliant with regulation.
Priory Site
Inspection 1
2009/10
Inspection 2
2009/10
Altrincham
5
6
Brighton & Hove
5
7
Bristol
9
11
Canterbury
4
1
Chadwick
7
4
Chelmsford
5
7
Farmfield
6
5
Glasgow
7
10
Hayes Grove
2
7
10
14
Hemel
5
4
Highbank
4
3
North London
7
7
Nottingham
8
7
Potters Bar
5
4
Heathfield
Preston
4
4
Roehampton
8
7
Southampton
9
5
St Neots
6
6
Sturt
9
3
Thornford Park
5
2
Ticehurst
9
13
Woking
3
6
Woodbourne
6
8
Page 11 of 25
QNIC Standards in Adolescent Units
All adolescent units are registered with the Royal College’s QNiC system of standard
monitoring and are reviewed yearly by visiting teams, providing a level of servicespecific standards that goes beyond the CQC requirements. Our own teams also take
part in visits to other providers. The results for the most recent round of visits are
presented below. Each hospital has an action plan to improve the results for the next
visit and these have been reviewed by the specialist network.
The Roehampton result is influenced by the fact that it had recently opened. Vigorous
action was taken to resolve the issues identified to the satisfaction of the QNiC
executive team and commissioners and management are confident that the 2010/11
visit will show improved compliance.
Altrincham
Bristol
Chelmsford
Hayes Grove
North London
Roehampton
Southampton
Ticehurst
Woodbourne
0
10
20
30
40
50
60
70
80
90
100
% of Criteria Met
CARF Accreditation at Priory Highbank
The Priory Highbank is currently CARF accredited. CARF (Commission on
Accreditation of Rehabilitation Facilities) is an internationally respected accreditation
and standard setting organisation based in USA. Highbank achieved a 3 year
accreditation decision in 2008 and are due to undertake a further survey in June
2011.
Page 12 of 25
Priority 2 - Providing Safe Services
First it is necessary to have a robust means of reporting and acting on incidents,
categorised according to their seriousness. This report begins with the results of the
Priory reporting system for the period 1st of April 2009 – 31st of March 2010.
Second some avoidable incidents have been targeted for elimination or significant
reduction by public health authorities and these have received special attention in this
report.
Third, near misses should be collected where possible. This year Priory developed a
system with our partners, Ashton’s Pharmacy in which medication near misses were
recorded independently by visiting pharmacists. The early results of this system are
reported.
AIncident Rates
Incident reporting is encouraged in Priory and the comparative rates for each hospital
and each service line, month by month are fed back to clinical teams. Trends are also
analysed across the company at the specialist networks. Patient and staff incidents
are rated on a 1-8 scale according to the degree of harm that occurred: Where more
than one individual is involved in an incident it counts as one incident per individual.
Severity level 8 includes a range of serious, or potentially serious events such as
death, serious injury resulting in brain damage, loss or impaired use of limb, a serious
suicide attempt (excluding repeated self harm), an infection control breakdown, an
outbreak of infectious disease, absconding of a detained patient or a minor, any
involvement of the police, a serious medication error, a POVA event, a Child
protection event, a fire, or any RIDDOR reportable events.
The remaining definitions are as follows: level 7 Broken bones; 6 Prolonged hospital
stay; 5 Hospital overnight; 4 Hospital visit; 3 Small Injury – not referred to hospital; 2
Minor Injury – No loss of work; 1 Minimum Harm – No injury
Levels 7 and 8 are classified as high level, 4-6 as medium and 1-3 as low. All high
level incidents are subject to a serious incident review carried out either by the
hospital director, or where considered necessary by the central quality team.
The total number of incidents reported in the period was 19.68 per 1,000
occupied bed days. For comparison all NHS Mental Health Trusts returning
data to the National Patient Safety Agency showed an average incident rate
of 12.00 per 1,000 occupied bed days. Priory therefore reports roughly
twice the number of incidents of all grades. This is interpreted as a positive
result, showing a risk aware and therefore relatively safe environment.
The next section details only the more serious incidents of a type targeted by the NHS
for elimination or marked reduction in incidence.
Page 13 of 25
B-
Serious Incidents
Deaths - One patient took their own life unexpectedly whilst an inpatient. This case
has been reported to the relevant authorities including the coroner. The incident is
subject to a Critical Incident Investigation which is presently underway. No inpatients
committed a homicide during this period. 17 other deaths occurred due to natural
causes. These were not unexpected because of the nature of the patients’ physical
illness but they were nevertheless subject to independent review.
Non-fatal serious incidents - There were 196 serious (level 7 and 8) incidents. 18
of these involved a patient assaulting staff members. Across all hospitals there were
1,220 episodes of control and restraint involving a recognised hold technique. Of
these episodes 37 resulted in reported incidents at level 4 to 8 inclusive. The injuries
were always sustained as part of the incident occasioning the control and restraint,
rather than being a result of the hold.
Age Inappropriate admissions - No patient under 18 was admitted to an adult
general psychiatry ward in Priory during the period. Priory operates a large number of
inpatient adolescent beds registered up to the age of 18 and a bed in these units is
always available.
Absconsions - Many Priory acute beds are occupied by voluntary adult patients so
the concept of absconsion is not relevant. This report is therefore restricted to those
that involve a minor (adolescent under 18) or a detained patient. An absconding
incident is reported at level 8 even if no harm occurred to the patient or the public.
During this period an absconsion of a minor was reported even if the patient only left
the confines of the adolescent unit but not the grounds of the hospital, regardless of
the perceived level of individual risk. This is a very wide definition of absconsion and
contributed to the apparently high level experienced in the units. For future reports
the definition will be modified by the individual risk score and restricted to those that
leave the grounds.
In total there were 86 absconsions which fell into 3 categories.
• Adolescents – 45 incidents of absconding (including 8 detained adolescents).
• Adults - 23 detained at an acute site and 4 detained at a Grange (controlled
access facilities)
• Secure - 14 detained patients. There were no incidents of a patient on transfer
from prison absconding from inside the security perimeter of the hospital (this
is important as it is an event that should never occur according to the NSPA).
No incident of absconding was associated with harm occurring to the patient a
member of staff or the public.
Gender appropriate accommodation - Priory hospitals have no mixed sex
accommodation and therefore all accommodation is gender appropriate. All patients
have their own bedroom (with en-suite facilities) which they can use for quiet time
during the day. There are also day rooms and outdoor areas which can be used for
socialising in single or mixed sex groups. All adult patients sign an agreement on
admission to respect others personal space and confidentiality and this is enforced by
ward managers and nurses.
Page 14 of 25
CMedication Management Audit
No incidents during the year occurred as a result of a prescribing or drug
administration error. However, prescribing is a potentially high risk activity and Priory
has therefore undertaken a review of medication management using specialist mental
health pharmacists who visit each ward weekly and review medication charts,
providing an independent audit of prescription card errors. These are reported back to
Hospital Directors, the clinical governance committees, the central medical directors
committee and the quality and safety team. The chart shows the overall number (%)
of errors in 2009/10 for each hospital. During this period 7,500 prescription cards
were reviewed by the pharmacists, scrutinising 62,000 prescribed items. The errors
shown are largely administrative issues. Over the four quarters of the audit the
number of red categories reduced from 9 to 2.
An E-learning training module has been produced to support nurses and medical staff
to reduce these error rates. In the attached chart each clinical area is coloured to
indicate the percentage of errors, clear for less than 5%, orange for 5 - 10% and red
for greater than 10% of errors.
The audits used 4 standards:
•
•
•
•
Mental Health Act compliance - prescriptions should correspond with MHA forms (T2 or T3)
Prescription writing - prescriptions should be signed dated & have all required details
Administration errors - nurses should have signed for the correct administration, with no gaps on charts
Patient details - all required fields such as Patient Name, DOB and Allergy Status should be stated
Results requiring attention are highlighted in ORANGE and those of concern in RED
Hospital Altrincham Brighton & Hove Bristol Acute Bristol Grange Chadwick Lodge Chelmsford Farmfield Glasgow Hayes Grove Heathfield Hemel Hempstead North London Nottingham Potters Bar Preston Roehampton Southampton St Neots Sturt House Thornford Park Ticehurst House Woking Woodbourne MHA Compliance Number (%) 7 (0.4) 0 (0) 23 (2) 39 (4) 171 (6) 4 (0.4) 177 (9) 38 (4) 23 (2) 9 (1) 8 (1) 2 (0.5) 0 (0) 5 (1) 1 (0.3) 73 (1) 0 (0) 5 (1) 24 (6) 119 (5) 36 (2) 0 (0) 5 (0.4) Prescription Writing Number (%) 239 (2) 5 (0.1) 345 (4) 188 (1) 525 (2) 528 (8) 335 (2) 325 (4) 227 (3) 76 (1) 106 (1) 502 (7) 167 (12) 54 (2) 45 (1) 1883 (5) 159 (2) 186 (1) 28 (1) 310 (1) 712 (4) 188 (3) 398 (4) Medication Administration
Number (%) 270 (2) 61 (0.1) 639 (6) 161 (1) 218 (1) 399 (6) 1257 (7) 1246 (16) 871 (11) 645 (6) 192 (1) 166 (2) 41 (3) 68 (2) 94 (2) 1204 (3) 229 (4) 267 (1) 70 (2) 283 (1) 842 (5) 10 (0.2) 215 (3) Patient Details
Number (%) 80 (4) 4 (1) 25 (2) 27 (3) 61 (2) 151 (11) 49 (2) 30 (3) 57 (4) 35 (4) 3 (0.2) 51 (4) 15 (6) 1 (0.3) 21 (4) 186 (3) 23 (3) 7 (0.4) 30 (7) 37 (2) 135 (8) 34 (4) 43 (3) Page 15 of 25
Priority 3 - Patient Involvement and Service User Experience
APatient Opinion Surveys
Priory has been systematically collecting service user views of their experience for 6
years using an independent polling organisation, HWA. The results are analysed every
3 months for acute hospitals and yearly for longer stay services. Because of the
different characteristics of the patient groups we have designed specific
questionnaires and delivery methods for Adult Inpatients, Therapy and Day Services
and Secure and Complex Care Services. Under each heading there were several
questions but only the average number of responses and % satisfaction for the
domain is reported here.
Acute Adult Inpatients (2009)
Your Admission (Excellent+Very Good)
Your Medical Care (Yes)
Your Therapy Programme (Excellent+Very Good)
Accommodation (Excellent+Very Good)
Catering (Excellent+Very Good)
Going Home (Excellent+Very Good, Yes)
Nursing (Excellent+Very Good)
Consultant/Doctor (Excellent+Very Good)
Would You Recommend us to a Friend (Yes)
Opinion of Overall Quality (Excellent+Very Good)
Average N
740
692
666
781
772
595
774
767
766
777
Average %
66%
73%
72%
75%
66%
78%
86%
85%
95%
79%
Secure Service Users (2009)
Communications (Good+Average)
Accommodation (Good+Average)
Catering (Good+Average)
Comfort (Good+Average)
Personal needs (Good+Average)
Medical and therapeutic needs (Good+Average)
Health professional skills (Good+Average)
CPA meetings (Yes)
Average N
145
147
150
147
143
146
141
135
Average %
77%
87%
80%
83%
80%
78%
84%
75%
Complex Care Service Users (2009)
Communications (Good+Average)
Accommodation (Good+Average)
Catering (Good+Average)
Comfort (Good+Average)
Personal needs (Good+Average)
Medical and therapeutic needs (Good+Average)
Health professional skills (Good+Average)
CPA meetings (Yes)
Average N
98
97
97
99
95
91
89
85
Average %
83%
91%
83%
91%
88%
79%
87%
72%
Therapy and Day Services (2009)
Assessment and first day care attendance (Excellent+Very Good, Yes)
Regarding your therapy treatment (Excellent+Very Good, Yes)
Groups (Excellent+Very Good, Yes)
Environment and services – Attitude of Staff, facilities & Cleanliness
(Excellent+Very Good)
Would You Recommend us to a Friend (Yes)
Opinion of Overall Quality (Excellent+Very Good)
Average N
455
441
362
Average %
76%
78%
71%
370
79%
462
467
98%
88%
Page 16 of 25
Adolescent service user feedback is incorporated in the QNiC Routine Outcome
Measurement suite of outcomes and is therefore analysed separately. Response rates
were fairly low with 43 surveys being completed and recorded on the QNIC ROM, this
represents roughly 10% of discharges in the period. This has been identified as an
area for improvement and we hope to publish data based on a greater number of
responses in next year’s quality accounts.
Child & Adolescant Mental Health Services (2009/10)
Communication & Advice (Very Happy + Happy)
The Effectiveness of the Service (Very Happy + Happy)
Comfort & Practicalities of the Service (Very Happy + Happy)
Discharge & Follow Up (Very Happy + Happy)
Overall opinion of Service (Very Happy + Happy)
Average N
43
43
42
42
43
Average %
61%
56%
51%
55%
74%
In viewing the above results it is worth considering that the respondents had a
tendency to select the middle of the 5 options (titled Mixed), and very few answers
indicated overt dissatisfaction. This might be considered to be indicative of the nature
of the patient group, finding new and improved ways to obtain the views of young
people remains an ongoing undertaking in Priory Healthcare services.
Page 17 of 25
BComplaints
Priory’s complaints reporting system is approved by the CQC and has three levels.
Most complaints are dealt with informally in the hospital and are not logged centrally.
Formal complaints can be registered either verbally or in writing and most are dealt
with at the hospital level. If the patient is not satisfied they may escalate to stage two
where an independent investigator from within the group takes on the management
of the complaint. If that does not resolve the issue there is the further opportunity to
take the complaint to the health service ombudsman (for NHS patients). The numbers
include both private and NHS patients.
Formal Complaints by Hospital 01/04/2009 – 31/03/2010
Hospital Type
Acute
Secure & Complex Care
Total
Hospital
Altrincham
Brighton & Hove
Bristol
Chelmsford
Glasgow
Hayes Grove
Highbank
North London
Nottingham
Preston
Roehampton
Southampton
Ticehurst House
Woking
Woodbourne
Chadwick
Farmfield
Grange Heathfield
Grange Hemel
Grange Potters Bar
Grange St Neots
Sturt House
Thornford Park
Complaints
38
6
6
13
11
15
10
21
3
3
40
1
11
9
16
90
45
9
11
7
6
5
40
Complaints per
1000 Bed Days
2.79
1.45
0.33
1.11
1.41
1.39
0.50
1.56
0.78
0.65
1.63
0.12
0.68
1.30
1.28
3.01
2.59
1.01
0.95
0.28
0.46
0.80
0.99
416
1.26
Of these formal complaints 8 were escalated to Stage 2 and were either resolved by a
Priory Group investigator or continue to be investigated and one was referred to stage
3.
Page 18 of 25
Priority 4 - Staffing
Priory recognises that Human Resource Management is critical to the success of a
healthcare organisation. Two indicators are reported this year.
A-
Colleague Opinion Survey
Once a year Priory carries out a colleague opinion survey to test the views of the
workforce and these are fed back to hospitals and the staff forum. Below are the key
questions compared with the equivalent NHS results from the most recent survey
available (2008).
Priory (2009)
Priory Staff Survey 2009
Positive
%
Negative
%
NHS (2008)
Positive
%
Negative
%
You have adequate materials, supplies and equipment to do your work
57
25
59
23
The people you work with treat you with respect
81
10
79
6
You always know what your work responsibilities are
82
10
75
12
Your immediate manager gives you clear feedback on you work
65
20
61
17
There are enough staff at your unit for you to do your job properly
46
37
34
41
Your training/learning/development has helped you do your job better
61
17
70
9
You are able to do your job to a standard you are personally pleased with
You are satisfied with the quality of care you give to
patients/residents/students
Your manager helps you find a good work-life balance
76
12
63
20
74
13
70
6
65
16
61
14
You have clear planned goals and objectives for your job
68
16
66
13
You are able to contribute to the success of your team
89
5
52
17
What is your
What is your
colleagues
What is your
skills
What is your
manager
What is your
72
14
72
10
82
7
78
6
64
17
67
15
69
17
66
14
overall opinion of the amount of responsibility you are given
overall opinion of the support you get from your work
overall opinion of the opportunities you have to use your
overall opinion of the support you get from your immediate
40
36
33
32
What is your overall opinion of the recognition you get for good work
overall opinion of the way the company values your work
52
28
49
24
Would you recommend Priory as a good place to work
69
31
49
17
Do you think you will still be working for Priory in 12 months
48
14
21
54
Key
Priory better by at least 10%
Priory better by less than 5%
Priory better by at least 5%
Priory worse by less than 5%
Priory worse by more than 5%
Page 19 of 25
B-
Learning and Development
Priory has a bespoke learning and development program that won the e-learning
award for the Best e-learning Project Securing Widespread Adoption (2006), the
South East National Training Award (2007), and the Institute of IT Training “elearning project of the year” (2007). It continues to be developed to meet the
changing needs of the business. The system uses a blended learning approach to
ensure that the delivery method is always appropriate to the subject. It incorporates
feedback on completion of modules that can be fed into the appraisal and assessment
of staff. The chart below shows the completion rates for all training modules in all
hospital units.
Complete
Thornford Park
Expires Soon
Late or Not Complete
AssignmentRequired
18.50%
9.20%
72.20%
Chadwick Lodge
75.20%
8.90%
15.40%
St Neots
74.50%
10.10%
15.50%
Sturt
Hemel Hempstead
8.30%
19.90%
71.80%
Potters Bar
87.90%
Heathfield
88.50%
6.30% 5.30%
8% 3.20%
Brighton
67.30%
6.80%
20.60%
Woking
66.30%
8.90%
18.40%
Preston
Hayes Grove
Roehampton
Highbank
Chelmsford
72.40%
71.20%
73.40%
69.20%
76.30%
74.10%
6%
8.30%
83.80%
Farmfield
Ticehurst House
10%
6.40%
83.60%
20.60%
5.20%
21.50%
7.20%
17.40%
8.90%
15.80%
13.20%
15.70%
6.30%
14.70%
9.40%
North London
76.90%
7.90%
14.60%
Altrincham
77.20%
8%
14.80%
Glasgow
79.50%
Woodbourne
80.40%
6.50%
13.20%
Bristol
80.80%
6.10%
12.70%
Southampton
79.90%
7.70%
12.30%
Nottingham
81.20%
5.70%
9.70%
11.10%
7.80%
Page 20 of 25
Priority 5 - Effective Services
A-
Eating Disorders
All Eating Disorder units provide treatment according to standards set in the Priory
Eating Disorder Care packages which are audited annually to ensure that their
consistency and quality is maintained. To measure the outcome of the standard
package Priory partnered with the University of Stirling to examine in detail the
outcomes at the Priory Hospital Glasgow for a consecutive series of patients admitted
with Anorexia and Bulimia Nervosa. This is the largest single outcome study of
inpatient treatment outcomes for eating disorders (In Press as “The Effectiveness of,
and Predictors of Response to Inpatient Treatment of Anorexia Nervosa” European
Journal of Eating Disorders). In future, similar data will be available from all sites.
The chart shows the change from admission to discharge in the body mass index (a
negative number when the patient has gained weight). Almost all patients achieved
their target weight at a non-anorexic level of BMI = 18. This mixed sample included
some patients with multi-impulsive Bulimia who were at a normal weight on
admission, hence the small numbers to the right of the chart who did not gain weight.
The length of admission was correlated with greater increase in BMI showing that on
average the length of stay was appropriate (chart not shown).
The attitudes to eating shown by these same patients also improved as shown in the
second chart, demonstrating that weight gain was accompanied by psychological
improvement.
Page 21 of 25
B-
Child & Adolescent Mental Health Services (CAMHS)
During 2009/10 CAMHS outcome measurement was handled as part of the QNIC
routine outcome measurement (ROM) programme. Several outcome measures were
used as part of clinical practice in Priory CAMHS units and the results of these
measures were submitted to QNIC via their outcome measurement system.
Completion rates of CAMHS outcomes where not as high as had been hoped, this was
attributed in part to trying to deliver too many measures in what is a fast paced and
challenging environment.
Going forwards we have identified key measures which we will focus on recording,
these are HoNOS-CA (clinician rated), and CGAS. In addition to these a special version
of HoNOS-CA, rated by the young person themselves will also be administered across
Priory CAMHS units.
The below chart shows the HoNOS-CA and CGAS results for 76 patients. Both
assessments were administered at admission, at regular intervals throughout the
episode and at discharge. The change between the first and last assessment is shown
below, note that an increased CGAS score shows improvement whilst with HoNOS-CA
improvement is demonstrated by lower scores.
HONOSCA CHANGE
CGAS CHANGE
80
Pre/Post Change in CGAS/ HoNOSCA Score
60
40
20
0
-20
-40
-60
Page 22 of 25
C-
Secure and Complex Care
In Priory secure hospitals HoNOS-Secure, a specialised version of the Health of the
Nation Outcome Score, is used to assess patient’s mental health and their specific
needs relating to security. This is administered on admission and at 6 monthly
intervals, as well as on discharge. At the same time the risk of violent behaviour
occurring is assessed for every patient using HCR-20. Both HoNOS-Secure and HCR20 are recognised and validated measures, and their use is often monitored under
NHS contracts.
During 2009 secure patient’s HoNOS-Secure and HCR-20 scores were recorded and
evidenced as part of their Care Programme Approach review meetings, but due to IT
system changes results were not centrally recorded. During 2010/11 Priory Healthcare
will commence systematic, centralised recording of HoNOS-Secure and HCR-20 which
will enable us to report on aggregate results across sites.
Because of the nature of Complex Care patients, standardised outcome measures are
often difficult to apply effectively. The HoNOS scores of many Complex Care patients
will deteriorate even in the best circumstances, due to the degenerative nature of
some of the presenting problems. HoNOS is nevertheless administered to most
Complex Care patients as it is required under the contract, although it is generally
accepted that the results in many cases do not necessarily reflect the success of care
for the individual patient.
Priory is therefore currently developing a bespoke measure, based on setting priority
objectives that we hope to meet for each patient. We feel this is the best way to
demonstrate where we are successful in maintaining and improving areas such as
quality of life which are traditionally difficult to quantify. This new measure will be
piloted during 2010/11 in all Priory Grange sites.
Page 23 of 25
D-
Rehabilitation: Priory Hospital Highbank
The outcome tool used for Neurological rehabilitation at Highbank is called FIM FAM, a
combination of the Functional Independence Measure and the Functional Assessment
Measure. The total score from the combined 30 scales of the FIM FAM is a recognised
measuring instrument in rehabilitation services.
The FIM FAM results of all service users, funded on a full neuro-rehabilitation
placement at Highbank during 2009 are presented below. This includes adult service
users on Walmersley/ Walmersley Transitional Living Unit plus 1 child who received
rehabilitation on our Children’s Continuing Care Unit.
FIM FAM results were obtained from 27 service users on rehabilitation placements.
Two service users suffered acute illness and passed away and one suffered a further
severe brain injury and had to be discharged to acute services.
Of the 24 remaining service users, 23 (96%) showed an increase in total FIM FAM
score, as demonstrated below:
Highbank 2009 FIM FAM Study by Change in Total Score
Increase of 50 to
99 Points
3 (13%)
Increase of 100
to 150 Points
4 (17%)
Increase of 1 to
49 Points
16 (66%)
No Change
1 (4%)
Increase of 1 to 49 Points
Increase of 50 to 99 Points
Increase of 100 to 150 Points
No Change
Page 24 of 25
Annex
Statement from lead purchaser
NHS Medway on behalf of and for Eastern and Coastal Kent PCT and West Kent PCT
has reviewed Priory quality accounts and in light of our commissioning experience I
can confirm that Priory Quality accounts are correct although they have not been fully
audited by NHS Medway.
Alexandra Thurlby, Contracts Manager (Placements), NHS Medway
Page 25 of 25