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Broadmoor hospital rated inadequate by watchdog Broadmoor hospital rated inadequate by watchdog
(about 5 hours later)
Broadmoor high-security hospital, which houses notorious criminals including Peter Sutcliffe, the Yorkshire Ripper, has been rated inadequate, with concerns raised about patients being physically restrained too often. Broadmoor high-security hospital has been rated as inadequate, with concerns raised about excessive use of restraint and seclusion of patients.
Inspectors from the Care Quality Commission said they did not see convincing evidence that seclusion and restraint were only being used in cases when it was deemed absolutely necessary. Inspectors from health regulator the Care Quality Commission (CQC) highlighted staffing shortages and poor morale as contributing to problems at the Berkshire hospital, which houses notorious criminals including the Yorkshire Ripper, Peter Sutcliffe.
The withdrawal of extra pay for some staff working at Broadmoor hospital in Crowthorne, Berkshire, has also led to problems recruiting people to work there, the watchdog said. The report, published on Wednesday, said: “At Broadmoor the staffing levels did not reduce safety but impacted on access to association time, therapeutic and leisure activities and resulted in restrictive practices being used for longer periods of time than might otherwise be needed.”
Issues over staffing levels do not pose a threat to security at the West London Mental Health NHS trust unit, but they raise concerns around cancelled activities and patients spending too much time in their rooms, the report said. West London Mental NHS trust, which is responsible for Broadmoor, as well as 24 other main sites with a total of about 33,000 patients, received an overall rating of “requires improvement”. The most pressing problems were identified in its forensic services, which cater for people with a mental health problem who have been arrested, are on remand or have been convicted of a crime.
The trust, which covers a wide range of services including community-based and specialist provision for more than 33,000 people, received a “requires improvement” rating in relation to being safe, effective and well-led, following the five-day inspection in June. The trust was rated as good for being caring and responsive, with staff at Broadmoor singled out for praise for showing genuine concern for patients individually and a desire to help them recover. But the CQC said that the withdrawal of extra payments for working in highly secure units had contributed to staff shortages at Broadmoor by hampering recruitment.
Recommendations include ensuring seclusion facilities are in good condition, making sure staffing levels are sufficient to guarantee patient and staff safety, and better staff engagement to make sure employees feel their input is always valued. Dr Paul Lelliott, the deputy chief inspector of hospitals and lead for mental health, said: “Staffing shortages and difficulties with recruitment at West London Mental Health NHS Trust are having a noticeable impact on the quality of some services. In the forensic services, this is compounded by low morale. As well as affecting the quality of care, there is the risk that staff might not show the openness, transparency and honesty that are essential to provide safe care.
Inspectors rated the trust as good for being caring and responsive, and said staff at Broadmoor in particular were seen to show “real concern for patients on an individual basis and a desire to see them progress towards recovery”. “We were concerned at the apparent overuse of physical restraint, and the failure to keep proper records. Staff must use restraint only as a last resort, and minimise the use of restraint in the prone (face-down) position. They must record the use of all types of restrictive intervention.”
The trust’s chief executive, Steve Shrubb, welcomed the positive rating for staff but recognised the need to cut down on the frequency of patients being restrained, and said conditions for staff must be improved. The NHS is in the middle of a two-year programme to reduce restrictive practices such as seclusion and restraint and to put an end to deliberate face-down restraint.
He said: “We need to speed up the work the leadership team is undertaking to create the conditions for our staff to be the best they can be. This includes increasing staffing, improving staff engagement and morale and reducing the use of restrictive practices including restraint and seclusion.” Sophie Corlett, the director of external relations at mental health charity Mind, said: “Physical restraint can be humiliating, terrifying, dangerous and even life-threatening and Mind has been campaigning for a reduction in how much it is used, even in secure facilities.
Dr Paul Lelliott, the deputy chief inspector of hospitals and lead for mental health, said staff shortages in the trust were having a noticeable impact on the quality of some services. “Face-down restraint, when a person is pinned face-down on the floor, can be particularly dangerous ... Every trust in England should now be implementing new policies and retraining their staff in alternative techniques so that restraint is only ever used as a last resort.”
“In the forensic services, this is compounded by low morale. As well as affecting the quality of care, there is the risk that staff might not show the openness, transparency and honesty that are essential to provide safe care. There were 37 people in seclusion at Broadmoor at the time of the regulator’s five-day inspection in June. The CQC said that some segregation rooms at the hospital were located so other patients could see in, which was an affront to the dignity and privacy of those under seclusion.
“We were concerned at the apparent overuse of physical restraint, and the failure to keep proper records. Staff must use restraint only as a last resort, and minimise the use of restraint in the prone (face-down) position. They must record the use of all types of restrictive intervention. They must also make the necessary physical health observations to ensure the safety of patients who have been given an injection to manage disturbed or distressed behaviour.” It also said some segregation rooms were dirty or needed maintenance and that records were not fully completed, which meant it was not always possible to know if patients had received appropriate medical and nursing monitoring during their time in seclusion.
He added: “West London Mental Health NHS trust is a large organisation with many parts. Despite the problems described above, our inspectors visited other services where staff were positive about the work of the trust and where care was delivered by hard-working, caring and compassionate staff.” As well as recommending improvements to seclusion facilities and staffing levels, the regulator said staff should be made to feel their input and engagement is valued.
The trust’s chief executive, Steve Shrubb, said the CQC “recognised our staff’s hard work and compassion, many of our services were found to be good, and all of our services were found to be caring and staff should feel rightly proud of this”.
“However, we know that we have more work to do and need to deliver improvements if we are to deliver consistently high-quality care to every single patient.”