Here at Priory Group we set out to deliver the highest quality care and support to those people who are residents or patients in our homes, hospitals and schools. We expect all of our colleagues to deliver the highest standards of support, care and treatment. We help our colleagues to do this by facilitating a culture of transparency and openness, evidence-based practice and enabling continuous learning and improvement opportunities.
Our services are effectively regulated by our internal divisional teams, our corporate teams and of course by our external regulators, commissioners and stakeholders. We also use the feedback from those who use our services to make improvements.
We measure progress by providing objective, quantitative and auditable data that measures outcomes, effectiveness and service user experience. A uniform approach across Priory Group is ensured through our divisional management structure, whereby each of our three divisions has its own chief operating officer (COO) and senior management team. Our corporate teams are there to support our divisional teams in delivering the safety, quality and compliance agenda.
Focus on safety
Our commitment: Our absolute priority is to make sure we operate safe and effective services 24/7 and that all staff understand what is required of them to make that happen. We recognise that a strong safety culture is needed at all levels.
At site level: Regular governance meetings are held at site (daily, weekly, monthly depending on the nature of the meeting) to ensure appropriate information sharing and management of risk and we have a comprehensive suite of over 300 policies to ensure staff are working together in the right way. These are easily accessible on our intranet and kept-up-to-date by a dedicated team to reflect developments in law and practice: staff receive training, coaching and support when new versions are issued.
At board level: There is a comprehensive review each month by the operational board and its sub-committees of all safety and risk matters. Structured reports in agreed formats are generated so that information and decision-making is consistent. We have a robust escalation and reporting culture: all incidents are required to be reported within 24 hours up to CEO level and immediate steps taken to manage risk and/or improve patient, staff or environmental safety where needed.
Advice and Support: Services are fully supported to ensure staff are delivering safe and effective care 24/7. We invest over £8m annually in our internal team of over 100 auditors and quality leads who regularly visit over 450 services to assess safety and drive quality improvements. Our audit teams mirror what CQC, Ofsted, HSE and other regulators do - they inspect against exactly the same standards to ensure consistency. Action plans are drawn up quickly and support provided until improvements are embedded.
Investigation Team: We also have a dedicated, independent team that investigate all very serious incidents and we aim to circulate serious incident reports to families and statutory agencies within 60 days. We meet with families throughout investigation processes and encourage them to make comments on our reports. We will address any of their further concerns not covered in the report. We co-operate fully with all enquiries from the police, safeguarding, commissioners or regulators as appropriate following a serious incident. Lessons learned from all incidents are shared between staff and sites on a regular basis and improvements monitored and audited.
Third Party Support: We also invest in partnerships with third party providers where additional expertise is needed. For example, we engage Ashtons to make sure drugs and medicines are delivered and administered to patients in a safe way. Frequent audits of our pharmacy services are carried out and training provided to our staff where needed.
Shift Cover: We strive to ensure each ward or site has the right amount of staff and the right skill and seniority mix for each shift. Our staffing ratios accord with best practice or national guidance (for instance, our CAMHS units are staffed in accordance with QNIC guidelines) and there are clear escalation and support procedures where staff call in sick to ensure appropriate cover. We have a wide pool of talent to draw on consisting of both permanent employees and bank staff and only use agency staff where there is no alternative: we only use trusted agency suppliers with proven track records who contract on our own terms and conditions.
Reducing Agency Usage: We strive constantly to improve our recruitment and retention of nurses and other healthcare staff and reduce the level of agency staff, recognising that positive, therapeutic, long-term relationships between patients and staff are at the heart of safe and effective care. We have invested in 10 additional Workforce Co-ordinators in services with the highest agency staff usage to re-double our efforts to ensure shifts are staffed with permanent or bank staff (who can easily book shifts via their phone using the app have developed internally). The national benchmark for agency usage is between 30%-50% compared to Priory agency usage which runs at 11-13%.
Career Development: We also recognise that staff work best when they have opportunities to progress and develop themselves and 2018 saw the launch of our “Career Pathways” project. All staff are automatically enrolled onto a pathway which outlines their possible career progression routes. To date we have also accessed £2.5m of funding from the Apprenticeship Levy to support staff development.
Training: We also invest over £2.5m a year in training and all staff have access to our Academy platform which allocates a unique learning and development programme to each individual depending on their role. Training completion rates are frequently monitored to ensure compliance rates are as high as possible. All staff need to attend certain mandatory modules such as emergency first aid at work training.
Safe Buildings and Equipment
Investment: We invest significant amounts in our facilities to ensure they are well-maintained, fit for purpose and accord with regulatory requirements and expectations. Between 2016 – 2017 we spent nearly £160m on maintaining, developing, re-positioning and refurbishing our facilities with the focus always on making sure our units are safe.
Specifications: We have no dormitory accommodation in our hospitals. All our new builds are built to a specification that includes en-suite bedrooms and wards with suitable spaces (such as activity rooms and therapeutic space). Any new builds also incorporate requirements to comply with national guidance on mixed sex accommodation. The requirement for gender separation is taken into account for any refurbishment, or any service change.
Safer Rooms: In the last few years, regulators and commissioners have become much more focussed on ensuring fixed-point ligature risk is managed appropriately. In addition to our policies and training, we have developed our own “safer room” specification for all hospitals with a view to ensuring as many fixtures and fittings as possible conform to an agreed reduced-ligature specification (for example, push button taps). By August 2019, we will have converted all 240 of our CAMHS bedrooms to this specification at a cost of up to £25,000 per room.
Care Protect: We have also installed the Care Protect monitoring system across all our CAMHS services and some of our adult services. This is a sensor-based patient monitoring system to support risk management and observation procedures by staff. Qualified independent third parties monitor recordings in real-time and send immediate alerts to site staff where self-harming or other risky behaviour is observed. The system is still relatively new but patients have provided positive feedback about its use and it helping to keep them safe on a constant basis.
Modernising: We have also undertaken large-scale refurbishment works at sites where regulators have raised concerns about ward layouts in our older buildings. For example, at Roehampton, we have spent nearly £6m to re-position wards and communal areas to improve sightlines and reduce blindspots. Similarly with new services: Priory has recently invested in, and opened, a psychiatric intensive care unit for children and young people at a cost of £3.6m. The unit design conforms to the NAPICU specification as well as incorporating safety features from the “safer room” specification referred to above.
Our Estates Team: We also invest over £1m per year in our estates team to ensure each facility is compliant with all relevant environmental regulations (including in relation to fire) and that all building works for new and existing facilities are safely carried out and completed in accordance with all planning and building regulation requirements. The estates team also ensures that all equipment (such as fire extinguishers, taps and water outlets, hoists and electrical equipment) is tested regularly and replaced where needed. A dedicated 24/7 helpline ensures essential maintenance is carried out quickly and thoroughly by approved contractors.
Safety First: Throughout each year, there are any number of operational initiatives some of which stem from regulatory requirements and some are generated internally in line with our commitment to continuous improvement. We are always thinking about and looking for ways to make patients safer or to make services more patient-centred. Each month we have a “Safety First” bulletin which focuses on a particular aspect of patient care.
Reducing restrictive practice: This initiative is led by professionals from our clinical network and has been a focus particularly in forensic services. We have participated in the NHSE CQUIN for the last three years and have met all of the CQUIN indicators each quarter. In addition, over the last year we have been moving all staff from MVA physical intervention techniques to PMVA and there has been a reduction in recorded prone restraint in these sites of 76% between Q1 and Q3 2018.
Working with NHSE: This year we have agreed with NHSE to focus on Positive & Proactive Care by undertaking a project led by experts by experience, conducting focus groups with staff and patients in all of the forensic units. This involved 65 wards and 130 focus groups. This was a fantastic opportunity for learning. A key objective for us this year and next is the development of Safewards. We are aiming that by end of 2020, Safewards will be referenced in 60% of all inspection reports.
CQC Initiatives: Our sexual safety working group was launched in 2019 and has produced a sexual safety policy and identified training and support needs for our frontline staff. We are currently developing our approach to assessing sexual safety on our wards for patients, through individualised risk assessment. Our objective is to ensure that all patients receive an assessment of their sexual safety on admission to our wards.
Technology: The development of new technology is also a priority for us as we recognise the role this has to play in keeping people safe from harm. We are currently piloting a new system for observations on wards to improve monitoring and audit of procedures using electronic forms. Subject to a successful trial, we intend to roll this out across all services. We are also developing a mobile app for parents and carers of in-patients in Priory services to improve communication and give greater visibility of day-to-day activities and progress with treatment.
NHS Monitoring: Priory and other providers are subject to the same efficiency measures, pricing controls and quality improvement measures as NHS trusts. The same data sets are submitted as part of the standard national contract and public and independent providers are regulated in the same governance system: they are subject to the same level of scrutiny, reporting, and accountability. All Priory hospital services are visited and inspected by NHS case managers on a regular basis.
CQC Monitoring: All Priory services are also regularly scrutinised by the CQC and assessed against their standards. We understand the importance of working closely with the CQC and are very much aligned with their focus on improving patient safety and quality of outcomes. All providers – NHS or independent – rightly place great emphasis on their CQC ratings, which provide a fair reflection of a facility’s safety and quality performance from an independent regulator applying consistent, rigorous standards.
Our ratings: As a result of the hard work and commitment of all our staff teams across all our 84 CQC-registered hospitals, 87% of our sites are “good” or “outstanding”, compared to 78% in the NHS or other independent providers. We are proud of this achievement which is a testament to our unrelenting focus on safety and quality.
Our care and support teams are supported by a corporate assurance function that includes an internal inspection team. This enables our services to be safe and effectively regulated and enhances the effectiveness and delivery of high quality treatment, care and education.
Achieving positive outcomes, coupled with the experiences of our service users and colleagues, are at the heart of everything that we do. This approach is also reflective of the national agenda for quality.
Our priorities for driving quality within Priory are to:
- Exceed national standards of care
- Improve outcomes for both our adult and adolescent service users
- Deliver safe and secure services
- Ensure a positive experience of care for all who use our services
- Invest in our colleague through education and training
- Ensure that our policies and procedures are up to date, evidence-based and take into consideration regional variations i.e. Wales, Scotland, Northern Ireland and England
Priory has a strong track record of delivering high quality care, treatment, and education which is supported by robust outcome data made available to all of our stakeholders.
All providers of health and specialist services, education and social care have a core responsibility to strive for excellence in the services that they provide and to continually identify areas for improvement. The care, treatment and education that we provide is subject to regulation by the individual bodies operating across England, Wales, Scotland and Northern Ireland. We welcome all such inspections knowing that these again give us the opportunity to learn and improve.
Priory ensures that services are compliant by:
- Having in place an internal compliance team, led by the director of compliance. The team comprises inspectors with expertise in their particular fields and use consistent inspection tools to assess compliance with the appropriate regulations
- Similarly a health and safety team is in place. Like the compliance team, this is a centrally managed team and is responsible for undertaking frequent audits all of our homes, schools and hospitals with reference made to matters such as food safety, fire safety and colleague welfare
- Our reporting structures and quality monitoring procedures – each service has a monthly clinical governance meeting that has a standardised agenda mapped against the regulators required outcomes
- Our senior divisional colleagues also attend a monthly Quality Review Meeting where data is scrutinised and performance measured and considered
- Quality and safety dashboards are in place and these enable divisional and corporate oversight of all of our individual services and these link quality, HR and finance indicators together. These are produced monthly and tracked for trends with remedial action taken where necessary
- Audit – a divisional audit calendar is in place as well as a minimum of 3 audits per year that are bespoke to their requirements with clear action-planning requirements and evidence of change reported to the head of quality
- Action-planning for improvement and securing improvements is the responsibility of operational colleague
Delivering the best possible outcomes for the people who use our services is about more than simply satisfying the requirements of the regulators, it’s about leading for improvement. Our commitment to the people who use and come into contact with our services is nothing less than to be a trusted provider which makes a positive difference to people’s lives.
Priory is committed to effectively safeguard and protect all vulnerable individuals supported by our services from any form of abuse. We will always aim to ensure best practice and partnership working in relation to safeguarding.
We firmly believe that safeguarding is everyone’s responsibility throughout our organisation.
We strive to maintain a transparent and open culture where everyone feels safe and able to raise and share concerns. Concerns relating to safeguarding are always listened to and taken very seriously.
Priory has a robust structure both locally and nationally for managing safeguarding. Safeguarding across Priory Group has a voice at board level through the executive lead for safeguarding. We also have regional safeguarding leads who ensure best and safe practices.
Every service has a designated safeguarding officer trained to a high level of competence in understanding safeguarding adults, young people and children and ensuring that safeguarding supervision is always in place.
Clear policies and procedures are supported by a commitment to deliver high quality safeguarding training to all colleagues working in our services on an ongoing basis. Robust monitoring processes ensure that this policy is applied and that practice is regularly evaluated.
Working in partnership
We work in partnership with key agencies involved in safeguarding to ensure information sharing and the best possible provisions and outcomes in relation to safeguarding are in place, as well as working in partnership with local authorities to ensure we understand local procedures and that best practice is shared.
Robust recruitment procedures comply with all safeguarding requirements and recommendations, and our colleagues receive regular supervision in accordance with regulatory requirements.
For further information please contact David Watts, Director of Risk Management: telephone 020 7605 0923 or email firstname.lastname@example.org.
Get in Touch Today
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