St Andrew’s hospital under new management after going into Special Measures

St Andrew's hospital in Nottingham has been placed in Special Measures by the CQC

St Andrew’s Hospital in Mansfield, Nottinghamshire has been closed to new admissions and placed under new management after being put in Special Measures by the CQC.

The charitable hospital said it had taken decisive action to strengthen operational oversight and was a conducting clinical review following the regulator’s call for ‘urgent improvements’ at the 66-bed secure facility.

In a damning report, the regulator said patients’ basic needs were not always met and that staff at the hospital did not protect patients from avoidable harm or abuse.

Ligature points were identified on one ward while out of date ligature assessments were found on another. Staff were also criticised for failing to respect patients’ privacy and dignity, including ignoring patient requests to use the shower or toilet when they were in seclusion.

The hospital, which provides services for men with learning disabilities and autism spectrum disorders who are detained under the Mental Health Act, was previously rated ‘Good’ by the CQC following an inspection in 2015. However, it was the subject of a focused inspection in September 2017 after concerns were raised about service provision. Although it was not rated, the CQC found a number of breaches of regulation, including those regarding seclusion records and ligature assessments.

Following the latest inspection in October, the hospital was rated ‘inadequate’ on the questions of whether services are safe, caring and well-led. Although, inspectors rated the hospital ‘good’ in terms of whether services are responsive, it was deemed ‘requires improvement’ on the question of whether they are effective.

The CQC’s deputy chief inspector of hospitals and lead for mental health, Dr Paul Lelliott, said: ‘Our return to St Andrew’s Nottinghamshire showed there had been a real deterioration in the service being delivered…Inspectors highlighted a number of serious issues. These included that people were not protected from the risks of harm.’

He said staff did not always adhere to the Mental Health Act Code of Practice when using seclusion and had used inappropriate and disrespectful language in a patient’s record.

‘While some patients said that staff were friendly and approachable, others told us that staff ignored them, took a punitive approach and spoke to them in a disrespectful way. These findings are troubling.  We have told St Andrew’s Healthcare that they must take immediate action to address the problems that our inspectors identified,’ he added.

The service has been given six months to make improvements, including ensuring compliance with Mental Capacity Act and with the Mental Health Act Code of Practice in relation to seclusion practices.

It has also been told to ensure all environments is safe and introduce governance processes to identify and address areas of poor practice. In addition, the CQC said staff must receive specialist training in relation to restraint and therapeutic communities, and treat patients with kindness and respect.

The hospital will be reinspected later this year and the CQC could take action to stop the charity operating the service if improvements have not been made.

‘We will continue to monitor the service closely and this will include further inspections,’ added Lelliott.

St Andrew’s said it deeply regretted that the hospital had fallen below its expected standards in a number of instances and would continue to work with staff, patients, families and the CQC to promptly address concerns.

A spokesperson for the charity said: ‘The CQC’s concerns relate to the care and monitoring of those in seclusion – a measure that we very much consider to be a last resort. We regret that in the small number of cases, care of those in seclusion fell short of the high standards we strive for…We will welcome the CQC back to Mansfield to review improvements within the next six months and are confident this will result in an improved rating for the hospital.’