UK Health Regulators Identify Mental Health Facilities Rated Inadequate--Why is This Not Done in the US?

June 22, 2023

The United Kingdom’s Care Quality Commission (CQC) inspects health and social care settings - including mental health centres and hospitals - to ensure standards, giving each a rating of outstanding, good, requires improvement or inadequate.

An inadequate rating is given when the service is “performing badly” and the CQC has “taken action against the person or organisation that runs it.”

In total there are currently 12 mental health hospitals that have been given a rating of inadequate, as shown in the map above. They are:

• Montague Court, Birmingham
• Moorlands Neurological Centre, Staffordshire
• Willows Green Hospital, Manchester
• Taplow Manor, Berkshire
• St Andrew’s Healthcare, Essex
• Ivetsey Bank Hospital, Staffordshire
• Priory Hospital Arnold, Nottingham
• Ashwood Court Nursing Unit, Cheshire
• Priory Hospital East Midlands, Nottingham
• Woodbourne Priory Hospital, Birmingham
• Eleanor, Manchester
• Sherwood Lodge Independent Healthcare, Somerset

Dr. Sean O’Kelly, the chief inspector of hospitals, placed Montague Court, run by Options for Care Limited, into special measures following inspections on 15 and 16 February this year.

Services placed in special measures were due to be inspected again within six months.

The CQC said “the hospital did not provide an environment which was safe, clean, well equipped, well furnished, well maintained and fit for purpose.”

However it noted that, “We spoke with four patients, all said staff worked with and supported them. Throughout the inspection we saw that staff treated patients respect, offered choice of food and drinks. We observed staff were responsive when caring for patients. We saw evidence that staff sought feedback from patients on the quality of care provided in the ‘house’ meeting minutes which were held on a weekly basis.”

Moorland Neurological Centre, run by Elysium Healthcare (Acorn Care) Limited,  was kept in special measures and rated inadequate following inspections on 13 and 14 December 2022.

The CQC said “this was a focused follow-up inspection of Moorlands Neurological Centre, previously known as The Woodhouse Independent Hospital.

“At the time of our inspection, Moorlands Neurological Centre continued to provide a service to people with a learning disability or autism.

“We carried out this inspection to follow up on enforcement action we issued at our most recent inspection in February 2022, where we asked the provider to make significant improvement to its services.

“In February 2022, our inspection of The Woodhouse Independent Hospital identified significant concerns that rated the service inadequate and applied Special Measures.

“Since that inspection, the provider had commenced transformation of the hospital from one that provided a service to people with a learning disability or autism to one that provided a service to patients with an acquired brain injury.”

It added: “However, although the name of the hospital had changed, patients with an acquired brain injury had not yet been admitted. Because this inspection focused only on the concerns raised at our previous inspection and the Warning Notice issued following it, we did not change our rating.”

“The previous rating of inadequate remains because we did not have enough evidence to rerate the key questions of safe and well led.”

Willows Green Hospital, run by Willows Green Healthcare Limited, was rated inadequate maintained following inspections on 1, 2 and 9 March.

The CQC said this was because “the provider had failed to provide a stable management team with four managers in less than a year as well as a changing multi-disciplinary team which had resulted in no continuity of improvement from the last inspection.”

Taplow Manor, run by Active Young People Limited, was rated inadequate and placed into special measures following inspections on 13 and 14 December.

The hospital provides specialist mental health services to children and young people aged 12 to 18.

It was rated inadequate because its “Tamar ward remained unfit for purpose.

“This had been a concern in the last 3 inspections. The provider had developed a feasibility study and were submitting a planning application so a new purpose built ward could replace it. However, there had been little progress to mitigate the immediate concerns about the ward environment and it was not well maintained.”

St Andrew’s Healthcare, run by St Andrew’s Healthcare, was rated inadequate following an inspection on 14 June 2022.

This was because “the service did not always provide safe care. Patients had no access to nurse call systems so that patients could summon help if required.

The service also did not “ ensure staff had easy access to resuscitation equipment. We were not assured that staff could access resuscitation equipment in a timely way in an emergency.”

Ivetsey Bank Hospital, run by Active Young People Limited, was rated inadequate following inspections from 14-22 November.

This was because of a number of reasons, including:

• Not all areas of all ward were clean, and all furniture was not wipeable to meet infection control needs.
• The service governance processes did not always ensure that ward procedures ran smoothly. The processes in place did not always identify gaps in recording, gaps in patient checks and whether risk management plans had been updated after incidents had occurred.
• The service audit systems in place did not identify if all young people with a dual diagnosis had a positive behaviour support plan in place.

Priory Hospital Arnold, run by Partnerships in Care Limited, was kept in special measures and rated inadequate following inspections on 2, 3 and 4 August.

The CQC said it rated the hospital inadequate because “we have not seen sufficient improvement to the safety of patients since a previous inspection published in March 2020, where the rating for safe has remained inadequate.

“The governance processes and the way the service was consistently led did not always ensure that patients remained safe.  The provider did not always deliver safe care to patients.”

Ashwood Court Nursing Unit, run by Making Space, was rated adequate following an inspection on 14 September.

One of the reasons why the CQC gave this rating was because “policies, processes and other documentation were not robust enough to ensure the service was able to provide safe and consistent care.”

“Mandatory training compliance figures did not always meet the required standard for all modules,” it added.

“First aid training was 44 per cent and manual handling of people training was 65 per cent. Some staff had been booked onto this training in the weeks following the inspection.”

Priory Hospitals East Midlands, run by Partnerships in Care Limited, was rated as inadequate following an inspection on 30 August.

This was because, among other reasons, “staff had reported numerous medicines errors through the providers internal electronic incident reporting system.

“A visiting community pharmacist had identified recent medicines errors. The provider had not identified these independently due to a lack of oversight around medicines management.

“Doctors had not always ensured medicine charts were clear and concise, which increased the risks of errors.”

Woodbourne Priory Hospital, run by Priory Health Limited was rated inadequate following inspections on 31 August and 1 September.

The CQS said this was because “the service did not ensure that the ward had enough suitably qualified staff to meet the needs of all children and young people.”

It added: “The service did not ensure that risk assessments were always updated following incidents which indicated a change to risk factors.

“The service did not ensure that there was an effective system in place to manage the use of agency staff. The service did not ensure that staff received adequate support following incidents.”

Eleanor, an independent mental health service, was rated inadequate following an inspection on 22 July.

The CQC found that “the service was not safe. It did not have enough staff to provide care for the patients. Staff did not manage risk well.

“Permanent and agency staff did not have the same level of training to ensure they could work together to restrain a patient.”

It added: “Risk assessments had been completed but were not reflective of patient risk or up to date. For example, we found these to either not reflect incidents that had occurred before the assessment or had not been updated following incidents. There was no evidence that the multi-disciplinary team had met to review and discuss newly presenting patient’s risk.

“Staff did not know about risks to each patient and how to act to prevent or reduce risks. Staff did not have access to consistent risk documentation for example, briefing documents contained conflicting advice on the risk’s patient presented with.”

Sherwood Lodge Independent Healthcare, an independent mental health service, was rated inadequate following inspections on 24 May and 1 June 2022.

Several reasons were given by the CQC for the rating, including: “The environment and equipment were not well maintained. There was broken furniture and other damaged items throughout the premises. The clinic equipment was overdue calibration and a service. Staff had not completed comprehensive assessments of patient needs to ensure the suitability of the environment and allocation of upstairs bedrooms.”

Source: Matt Mathers, “Mapped: All the mental health hospitals rated inadequate; Twelve mental health providers are rated inadequate,” The Independent, June 20, 2023, URL: https://www.independent.co.uk/news/uk/home-news/mental-health-hospitals-inadequate-map-cqq-b2360777.html