You may choose to look the other way…

It’s my birthday today (thank you for the tweets and messages) and last night I heard a rumour that St Andrew’s Healthcare were going to get a roasting from CQC about their services in a report published today. For those not in the know St Andrews, or St Arseholes as Mark Neary coined them perhaps somewhat more aptly, run warehouses for people with learning disability, autism or mental ill-health. A large number (most?) of the people that they call patients are under section of the Mental Health Act and therefore are incredibly vulnerable. St Andrew’s claims to be a charity, and they (like many other so called charities) run services that they charge the NHS a huge amount of money for. This doesn’t seem to really bother NHS England, local CCGs, the Charity Commission, anyone really. The days of the long stay institution are meant to be done and dusted but they’re alive and well and you never go long without a new turf tossing ceremony for yet more buildings at this so called specialist provider.

So did the CQC deliver me the birthday present I was hoping for. Yes and no. The report published this morning shows that St Andrews Adolescent services aren’t fit for purpose.

‘I am placing the service into special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate overall or for any key question or core service, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration’.

I tweeted the low lights of the report here if you want to see them. It’s so grim, these are adolescent services for young people hundreds of miles from home, held under lock and key.

Seclusion rooms without basic furnishings. People shown no kindness.

This was a particular low light in the summary section:

Seriously, over half of shifts, 47% of provision provided by temporary staff. I mean on one hand you understand it, who would want to work there, but on the other how dangerous is it to the patients, supposedly ‘complex’ and extremely vulnerable young people, hundreds of miles from home, in rooms with no furniture, fed through hatches etc etc etc and half the time, literally half the time, staff didn’t know them. Add to that the staff shortages resulting in the only single bit of respite, the only chance to get out of that hell hole being stopped, because there aren’t enough staff on.

The bit that really put me off any sense of birthday celebration though was this:

CQC, the healthcare regulator, had raised the issue of inappropriate and unsafe use of seclusion and long term segregation on 12 separate occasions. 12 times they’d been warned of the same problem. The fact that St Andrews had done nothing to address that is pretty strong indication if you ask me that they’re beyond arrogant, they’ve no concerns about people’s safety, they’ve no regard for the regulator, they’re obviously confident that commissioners the country over will keep coughing up the dosh regardless. I don’t really want to get into a discussion now about the cost and effectiveness of this provision, suffice to say it aint cheap (we’re talking thousands of pounds per person per week) and there’s very little (any?) evidence that being locked away in these places does anything except traumatise people and isolate them from their families and communities.

I had a quick nosey at St Andrews other provision and their CQC reports this evening. They’ve not had a comprehensive inspection since September 2014 (report published in February 2015). This comprehensive inspection found that St Andrews required improvement in the safety domain then. Almost 5 years ago.

How can a provider require improvement for safety for five years and not be shut down? Do we literally have to wait for people to die (I know people have already) and the resultant prosecution? At what stage do CQC say enough is enough? How can you be allowed to require improvement in safety and still be allowed to take new patients/not be required to support your existing patients to leave?

If you look at the CQC page for St Andrews Healthcare there are 9 services listed. I’ll quickly run through them to save you having to do the leg work, to give an overview of their safety standing. Done chronologically.

So September 2014 (4yrs and 9mths years ago) we know St Andrews overall requires improvement in safety.

There’s one service that St Andrews have acquired called Broom Cottage. It hasn’t been inspected since they took it over so we really don’t know how it’s doing. It was good when it was last inspected in April 2016. Let’s be fair though, in terms of safety, it’s performance now is unknown.

Then the next inspection was of St Andrews Neuropsychiatry Service. It took place in May 2017 and they found that it’s record on safety was good. That’s positive.

St Andrews Essex was inspected the following month, June 2017 and its safety was found to require improvement.

There were high levels of the use of prone restraint across the hospital, particularly in the psychiatric intensive care services. Whilst the provider had set out measures to reduce levels of seclusion and restraint these measures had not yet had significant effect.

How do women fare at St Andrews? St Andrews Womens Service was inspected in May and June 2017, with a report published in October 2017. The service was rated as requires improvement for safety. Inspectors reported that:

We inspected this key question for forensic services and the learning disabilities service. We also identified some issues in other services that we did not plan to inspect in this key question.

They identified 13 headline failings on safety issues including insufficient staffing and medical cover. Problems with seclusion, smelly and dirty bed linen and concerns about tranquillisation.

On my birthday last year, a report was published on St Andrews Mens Service following an inspection in March 2018. It required improvement in safety, well actually it required improvement overall but we’ll just focus on safety for now. There were 17 safety failings highlighted, this being the first.

Seclusion practices were not compliant with the Mental Health Act code of practice. Medical and nursing reviews had not taken place as required in 36% of records checked. Staff had not completed seclusion care plans for patients in 70% of records checked.

St Andrews Birmingham were inspected in June last year with a report following in August 2018.I reckon you might guess what follows, inspectors rated the service as requiring improvement in safety. There were a number of safety failings, this being the first:

The seclusion room on Speedwell ward had recently been damaged and therefore was not in use. Hurst seclusion room was not in use due to the air conditioning not working. If patients needed seclusion they would have to use the facility on another ward. Moving distressed patients through wards and corridors to alternative seclusion rooms carried a risk of harm to patients and staff. The provider had arranged repairs to both seclusion facilities but staff had been waiting for over a month for repairs to be carried out.

An unannounced inspection of Winslow in August last year, reported the following month, found that safety required improvement. The headline message being that the service was not consistently safe.

In February this year a report was published about St Andrews Nottinghamshire. For the first time CQC rated a St Andrews service as inadequate overall and put it into special measures. Its safety measures were of course, unsurprisingly at this stage, inadequate. You can read a thread I posted this morning with some of its failings here. Just your average abuse and neglect really, with the first failing being that staff didn’t protect patients from abuse and harm. How could they?

So there we have it, enough to put anyone off their birthday cake. 9 services run by St Andrews and when it comes to safety 1 is apparently good, 1 we just don’t know, 5 require improvement and 2 are in special measures and inadequate.

Given St Andrews last had a comprehensive inspection almost 5 years ago and they required improvement in safety then…. I’m left wondering when they’ll have another and how anyone with that track record on safety can be considered anything but inadequate across the board.

I’m going to finish this post with a direct quote from Mr Justice Stuart Smith’s sentencing remarks at the HSE prosecution of Southern Health last March:

It is a regrettable fact that it took a time consuming and punishing campaign on the part of Connor’s mother and stepfather, Dr Sara Ryan and Dr Richard Huggins, and TJ’s husband, Mr Roger Colvin, and others to uncover the serious systemic problems with the Trust’s health and safety management arrangements that underpin this prosecution. Those systemic problems lasted for years from well before the death of TJ until well after the death of Connor. The existence of those problems is now fully acknowledged by the Trust, as I shall detail later. However, it is clear on the evidence that Dr Ryan in particular faced not merely resistance but entirely unjustified criticism as she pursued her Justice for LB campaign – LB being short for “Laughing Boy”, which was Connor’s widespread and affectionate nickname. It is right that I should pay tribute to those who campaigned but in particular to Dr Ryan at the outset of these sentencing remarks. It is also right that I should record the Trust’s public statement that:

“The Trust fully acknowledges that Dr Sara Ryan has conducted herself and the JusticeforLB campaign in a dignified, fair and reasonable way. To the extent that there have been comments to the contrary by Trust staff and family members of staff, these do not represent the view of the Trust and are expressly disavowed.”

When the systemic problems were finally recognised, a welcome realism entered the Trust’s appreciation of what had happened. The Trust indicated its intention to plead guilty to these two charges even before proceedings were issued. Appropriate credit will be given for that early indication in due course. The Trust has also made it completely clear that it does not attempt to shift or deflect responsibility for what went wrong onto individuals in its employment.

It shouldn’t take the deaths of people in ‘care’ to bring about change. Families and advocates and allies should not have to campaign for accountability. It shouldn’t take years for healthcare providers to ‘recognise’ their failings.

This case is concerned with deep rooted systemic failings directly affecting the safety of vulnerable and disadvantaged patients. They were patients who were in the Trust’s care and who needed, above all else, the Trust to protect them.

How long before we see the same sort of judgement, following the same failings at St Andrews, or maybe, just maybe, action could be taken to prevent the loss of lives given the multiple well documented failings in safety that exist.

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