"Inadequate" celebrity mental health clinic ordered to make improvements

A private mental healthcare clinic that treated celebrity patients such as Lily Allen, Johnny Depp and Amy Winehouse has been ordered to make improvements amid concerns for the safety of patients at risk of suicide or self-harm.

The Priory hospital, in Roehampton, south-west London, is occupying a Grade II-listed building and is known as Priory Healthcare group’s “first and most well-known hospital”.

The hospital is best known for treating celebrities, particularly for drug addiction, and has been described as the British equivalent of the Betty Ford Clinic in the US.

The list of well-known patients includes songwriter Pete Doherty, former footballer Paul Gascoigne and Lloyds Banking Group chief executive António Horta-Osório.

The Priory treats a wide range of mental health problems including depression, anxiety and addictions. Some of the facilities on offer to private patients include an on-site restaurant, a gym with a personal trainer and housekeeping for a number of the private en-suite rooms.

But the Care Quality Commission (CQC) gave the hospital a rating of “requires improvement” following an inspection. The regulator issued the provider with a warning notice after inspectors rated the hospital as “inadequate” for providing safe care.

But Priory Healthcare, which runs the hospital, said it was “disappointed” the regulator decided to re-inspect its facility in the middle of a £1.2m improvement programme.

The CQC argued that the hospital was not providing safe levels of staffing to meet the needs of their patients.

The inspection report reads: “There remained high vacancy rates for nurses across the hospital and particularly on the eating disorder service. This resulted in high use of bank and agency staff and there were also a significant number of shifts with below safe staffing levels.

“Records indicated that there were more incidents on shifts with insufficient staff on Priory Court, the eating disorders unit for children and adolescents. There had been 95 incidents on Priory Court in the six months prior to the inspection.

“Following the inspection the provider sent us revised figures indicating a higher level of staffing than indicated at the time of the inspection. We undertook enforcement action against the provider, serving a warning notice regarding staffing levels.”

The regulator launched a re-inspection of the premises in October last year after it highlighted concerns during a visit in March 2016.

It said that in addition to concerns about staffing levels, inspectors concluded that the hospital environment, particularly on the acute wards, remained unsafe for patients at risk of suicide or self-harm.

Inspectors rated the trust as “good” for being effective and caring but “requires improvement” on being responsive.

Dr Paul Lelliott, the CQC’s deputy chief inspector for mental health, said: “When we inspected the Priory Hospital in October 2016, we were very concerned about the safety of patients at risk of suicide or self-harm.

“The hospital must ensure it can meet the needs of patients they choose to admit whilst improvements to staffing and the environment take place.

“We did however find some improvements and noted that the provider had implemented a pre-admission risk assessment.

“The wards also provided a comprehensive range of psychological therapies, including dialectical behavioural therapy, mindfulness, and family therapy. Occupational therapists and dietitians facilitated activities and discussion groups.”

Commenting on the inspection, Dr Sylvia Tang, chief executive of Priory Healthcare, said: “Roehampton is a safe hospital providing high quality care and treatment and we remain fully committed to making improvements for the benefit of all of our patients.

“Our £1.2m improvement programme at Roehampton is being led by a new management team and includes trialling a state-of-the-art patient monitoring system.

“It is disappointing that we have been re-inspected part-way through this programme when there were works in progress which have now been completed.

“Similarly, we question CQC’s findings in relation to staffing: our rotas show that appropriate staff-patient ratios have been maintained and, over the last year, we have reduced the vacancy rate for nurses by more than 50%, despite a national shortage of nurses.”

In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14.

"Inadequate" celebrity mental health clinic ordered to make improvements

Andrew Marr says new stroke treatment brings "subtle" improvements

Broadcaster Andrew Marr said a new treatment he received after having a stroke has resulted in subtle changes, but not the “dramatic improvements” he hoped for.

The BBC presenter, who had a stroke almost four years ago and remains semi-paralysed on his left side, travelled to Florida to try a new anti-inflammatory drug called Etanercept.

Marr, who had described the treatment – which involved having the drug injected into the spinal fluid while hanging upside down – as a Christmas present to himself, said he will now work to build on the small changes he has seen.

Marr said in a statement: “Although I haven’t seen the dramatic improvements that I hoped for, there have been subtle and useful changes which I am going to work on through physiotherapy and exercise over the coming months.

“It hasn’t been ‘pick up thy bed and walk’ but it hasn’t been nothing, either. We will tell the fuller story in a BBC documentary scheduled to be broadcast in January.”

Marr’s stroke in January 2013 left him spending two months in hospital and undergoing extensive physiotherapy to help him walk.

In a piece for the Spectator recently, talking about the new treatment, he detailed some of the effects of the stroke.

He wrote: “I’m not complaining too much: I can work, drink, see friends, paint, listen to music and irritate my children like before. I’m a lucky fellow.

“But I can’t run or cycle or swim, and I walk very unsteadily and slowly. I drop things and take ages to get dressed.”

Andrew Marr says new stroke treatment brings "subtle" improvements

Hospital improvements ought to inspire our GPs

There have been some welcome developments in the NHS this week. Jeremy Hunt, the Well being Secretary, has sought to create on improvements in hospital care procedures following the Mid Staffs scandal by insisting upon greater transparency. Trusts are to be rated on the extent to which they motivate open and honest reporting of bad practices that could be putting sufferers at threat.

This is the initial nationwide physical exercise of its type in the planet, though it takes a lead from American hospitals, in which a better willingness to acknowledge the quantity of so-called “patient safety alerts” has resulted in a marked reduction in fatalities. Counter-intuitively, the much more a hospital is prepared to be open about its failings, the safer it gets. Slowly, for that reason, our hospitals are turning out to be cleaner, significantly less susceptible to superbugs and more compassionate. Latest surveys have witnessed a marked jump in men and women reporting that they would truly feel secure in a hospital if they have been sick believe in boards are now far more probably to commit their time talking about safety than about money and although a lot more than a dozen trusts remain in “special measures” following inspections, the path of travel for in-patient hospital care is encouraging.

The very same are not able to be stated, nevertheless, for major care. At the annual conference of the British Health-related Association yesterday, the chairman of its GPs’ committee, Dr Chaand Nagpaul, mentioned solutions had been on the verge of “imploding”. Sufferers have been currently being positioned at risk, he stated, by “brutal disinvestment”, typically possessing to wait two weeks for appointments.

There is no doubt that loved ones medical doctor companies are facing an unprecedented challenge brought on by fast demographic adjustments. The variety of people above 70 will develop by a lot more than a million in excess of the subsequent twenty many years, with all the attendant wellness troubles this will bring. To cope with this, it is essential that the GP and social care methods work seamlessly with each other. It is also essential that family members medical doctors show higher versatility and imagination. Not only is the appointments method farcical in some locations, but sufferers only get 10 minutes with their medical professionals, which indicates serious troubles are going undiagnosed. And if there are two-week waits for appointments, as Dr Nagpaul said, that might have anything to do with how GPs organise their practices, with few surgeries open in the evenings or at weekends.

As is occurring now in our hospitals, surgeries that perform effectively require to spread the greatest practices all around the country. And rather than ceaselessly pointing out problems, the BMA should come up with some good ideas for addressing them.

Hospital improvements ought to inspire our GPs

End of daily life care demands "widescale improvements", report says

Fewer than half of NHS sufferers who have been in their final hrs or days were told that they have been dying by hospital workers, in accordance to a vital report from the Royal College of Doctors (RCP), while a important amount of households and family members are left feeling they have no emotional help.

The report also highlights the continued lack of specialist palliative care at weekends, ten many years on from Nice suggestions that it need to be offered 7 days a week.

Complaints by households that dying family members had been not offered fluids were a single of the chief spurs to an investigation and later on withdrawal of the Liverpool Care Pathway – a protocol meant to help men and women to die properly. The RCP audit, which incorporated some who have been on the Pathway and others who have been not, located that 59% of sufferers were assessed to see whether or not they required fluids through a drip – but conversations about thirst have been held with only 17% of individuals and 36% of family members and pals.

The report, which investigated six,580 deaths in 149 hospitals during May possibly final yr, concludes that broad-scale enhancements are required to make certain that care and support for the dying is persistently very good.

Half of individuals dying spend their last days in a hospital, but the RCP’s inquiry suggests some hospitals are a far better location in which to die than other people.

“The fundamental dilemma is about regardless of whether this is a national priority and no matter whether this is an NHS priority,” explained Dr Kevin Stewart, chair of the RCP’s audit steering group. “We never think this location has been offered adequate prominence.”

According to the findings, physicians and nurses had recognised that most of the individuals (87%) were in the last days of their life, but talked about it with much less than half (48%) of these who were regarded as capable of getting the discussion. In 93% of circumstances, however, they advised relatives, on regular 31 hours ahead of the death.

Most sufferers had been prescribed medicine when they essential it for the 5 important signs skilled at the end of daily life – ache, agitation, noisy breathing, problems breathing and nausea and vomiting. Not all required the drugs, but in the ultimate 24 hrs 44% had been given pain relief and 17% medication to help with shortness of breath.

3-quarters of the 858 bereaved family members members questioned felt they had been involved in choices about the care and treatment of their dying relative – but a quarter did not and 37% thought the emotional support given to them by the healthcare group was only fair or poor.

The report also located there was really tiny coaching for hospital personnel in the care of the dying, in spite of nationwide suggestions -– it was necessary for doctors in only 19% of Trusts and for nurses in 28%. Virtually half (47%) of Trusts did not have a named board member with responsibility for care of the dying.

“A core job of any hospital is to care for the dying, however this audit displays this care is nevertheless not currently being prioritised,” said Dr David Brooks, president of the Association for Palliative Medication (APM).

“10 many years on from Wonderful recommending that professional medical and nursing providers must be obtainable seven days a week in palliative care, only a fifth of hospitals are in a position to provide this level of care.”

In the light of the Francis Inquiry and the “More Care Less Pathway” report by Lady Julia Neuberger into the Liverpool Care Pathway, “we locate this extremely troubling”, mentioned Brooks.

“Despite the fact that we all face dying at some point, there isn’t ample education and accessibility to professional support in the majority of hospitals to ensure all dying individuals obtain the care they deserve every time they require it,” he extra.

“It should be a basic entitlement for a dying man or woman to have substantial top quality, compassionate end of daily life care. This needs individuals caring for them to have satisfactory fundamental instruction and access to expert support when required, irrespective of in which they are in the country.”

Dr Stewart stated that even though some aspects of care are great in hospitals in England, “I am deeply concerned that some hospitals are falling short of the outstanding care that must be presented to each dying people and these critical to them. In distinct, communication with individuals and their families is usually poor. It is disappointing that hospitals never look to recognise this as an crucial issue, not just for people experiencing this in their very own lives, but for the wider public.

“Everybody would like to know that if they are in the identical circumstance, their requirements and people of their families, pals and people important to them will be met, with clinically suitable treatment, sensitivity and compassion.”

Professor John Ellershaw, director of the Marie Curie Palliative Care Institute in Liverpool, stated: “It is unacceptable in the recent day and age that hospitals are failing patients, and their families, in the care they get at the end of their daily life. Also several sufferers are dying badly in our hospitals when we know how to care for them properly.”

Richard Berman, a advisor in palliative care medicine at the Christie Hospital in Manchester, knows his patients are going to die. They have terminal cancer. But when they are in their last days of life, he will tell them only as considerably as they want.

“It really is not something that you have to let everyone know. The better way of putting it is that the patient should be offered the chance to discover about what is taking place to them,” he mentioned.

He – or someone else on the palliative care group – will request a broad question in as sesnsitive way as feasible, this kind of as “How do you feel things are going?”. The patient might respond, “I’m not confident they are going quite well”, which provides the medical doctor the chance to inquire, “Would you like me to explain more about what’s going on?”.

It truly is a phase by stage approach, explained Berman. “There is by no means the bombshell question that they are not expecting,” he mentioned. “Not each patient wants to hear a lot more – in which situation, the conversation stops there.

It’s difficult to have hard and quick principles about how you do this,” stated Berman. “Everyone is different and has a distinct personality and different culture and background. There need to be a very versatile method.”

Even some people who do want open and frank discussions can get upset, “but the majority know anyway that things weren’t going so properly and just want confirmation of that”.

“Often sufferers are poorly or may become poorly speedily and you may miss the opportunity to have these discussions.” Conversations with family members and pals and support for them are also essential. “This is a extremely sensitive, distressing and hard time for them. They require to be stored concerned in discussions and up to date with what is going on,” he explained. At the Christie, they really get handful of complaints, but “emotions run higher. If family members are distressed and angry and upset, the way forward is to sit them down and explore why. Often it is anything that is reasonably effortlessly resolvable. It is all about sensitive and open communictaion.”

End of daily life care demands "widescale improvements", report says