SICKENING: East Lancashire secure unit strongly condemned by health watchdog in shocking report

The Care Quality Commission highlighted serious failings including excessive use of physical force to restrain vulnerable patients.

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The report into the Calderstones Partnership NHS Foundation Trust also criticised dirty and unsafe wards, poor storage of food and medicines, and inadequate staffing.

Leading charity Mencap said it painted ‘a sickening picture’ of conditions at the Whalley-based trust, which provides secure, hospital and community care for vulnerable adults.

The government inspectors criticised the trust for ‘serious deficiencies in the quality of care it provides’ including over-use of physical restraint, including holding patients face down to the floor, seclusion and segregation.

KEY CQC CRITICISMS

• Overuse of physical restraint including 479 episodes in six months where patients were held face down onto the floor contrary to national safety guidance
• Excessive resort to the seclusion and segregation of patients including one kept in a flat on their own for six weeks
• Dirty and unsafe wards and rooms including a case where faeces were left on the floor for six hours
• Poor staffing levels with one ward often staffed by temporary nurses and inadequate night time cover on others
• Rooms used unsupervised by patients with paint where a ligature could be attached raising the risk of self-harm
• Poor infection control and hand-washing facilities on wards
• Use of out of date medicines sometimes administered by staff without appopriate qualifications
• Poor practice on the storage and date labelling of food
• 43 per cent of patients had been in the hospital for more than five years.

The trust, which also has sites in Rochdale and Lancaster, has 210 patients with learning disabilities or autism mainly referred from the courts, prisons and high-security mental hospitals for offences including murder, rape, arson and violence.

Many also suffer from mental illnesses including severe schizophrenia and psychosis and 30 per cent of those held in secure accommodation at the trust have additional restrictions placed on them by the Ministry of Justice.

JanTregelles, chief executive of the leading learning disability charity Mencap, said: “The CQC findings paint a sickening picture of what is happening inside a hospital trust providing care for people with a learning disability.” Ribble Valley MP Nigel Evans described the report as ‘an appalling catalogue of what should not happen to a human being’.

Pendle MP Andrew Stephenson said the report was ‘deeply concerning’ and Blackburn’s Jack Straw described it as ‘very serious’.

Calderstones chief executive Mark Hindle said since the July inspection he had already instituted an action plan to address the failings including appointing a new associate medical director and taskforce to tackle the problem of overuse of physical restraint.

He highlighted praise in the report from patients for the safe and caring environment at the trust, the pride and enthusiasm of staff and the efficient procedures for dealing with complaints.

Mr Hindle said: “The inspection was an important snapshot at that time and disappointingly it highlighted a number of unacceptable and inadequate areas of process and service delivery, which we acknowledge and have taken immediate steps to improve.”

Following the routine four day inspection by the CQC, Calderstones faces repeat and unannounced return visits and could face serious sanctions if its action plan fails to meet the inspectors recommendations.

They could include a legal notice to improve, placement in ‘special measures’ and instalment of new management or, as a last resort, closure.

The trust is already responding to an enforcement notice issued by health service regulator Monitor in January over its care of a resident at its Scott House unit in Rochdale The July inspection report found 1,661 episodes of physical restraint in the previous six months.

These included 479 where patients were held face down onto the floor contrary to the latest national safety guidance, mostly involving just six of the patients cared for by the trust.

In once case a patient was held down with leg straps despite advice stating this form of restraint was ineffective in his case.

It also criticised excessive resort to the seclusion and segregation of patients (333 incidents in six months) including one kept in a flat on their own for six weeks.

Some of the wards and seclusion rooms that inspectors visited were dirty or were unsafe. One had faeces left on the floor for six hours.

The report also highlighted deficiencies in infection control procedures, incorrect labelling and use of sharps containers, poor food labelling and storage, lack of suitably qualified, skilled and experienced staff - particularly at night, and slow discharge of patients with 43 per cent at the hospital for more than five years.

It found places where unsupervised patients could attach a ligature or cord, to harm themselves.

Dr Paul Lelliott, CQC’s deputy chief inspector of hospitals, said: “The conditions that we found on some of the wards were unacceptable.

“It should go without saying that a hospital ward should be clean.

“Many of the people admitted to Calderstones have severe mental health problems and have a history of behaviour that has put themselves and/or others at risk. Despite that, we were surprised at the number of occasions when staff had resorted to physical restraint.

“I would urge the trust to work tirelessly to find alternative ways of helping the people they care for to gain control over their more risky behaviours.

“The staff at Calderstones must also ensure that when restraint is used it is by the safest means and that there is proper medical back-up to minimise the possibility of harm to the patient.”

Mencap’s MsTregelles said: “The inspectors have found serious deficiencies in the quality of care, including dirty and unsafe wards and seclusion rooms, inadequate staffing, frequent use of physical restraint and seclusion, including face down restraint, and failures in relation to the Mental Health Act.

“This shows the urgent need to end the unacceptable culture of sending people away to inpatient units such as those run by Calderstones. These are not places where families would ever want to send their loved ones.”

Mr Hindle said: “Since the visit from the Care Quality Commission in July, we have been working closely with them in order to learn from the visit which was carried out under the pilot scheme for the new-style CQC inspection regime. “There are challenges in supporting people with extremes of behaviour, where because of their learning disabilities, many have committed crimes that put themselves and other people in danger.

“We are pleased that the CQC note that the people we support say they feel safe and are cared for with dignity and compassion.

“We are pleased the inspectors found staff are engaged and proud to work for us.

“We accept the inspectors’ concerns about cleanliness and other issues.

“Since July, we’ve ensured resource, time, money and expertise are in place to address these shortcomings and many have already been put right. In some cases, wards which the report referred to are being closed in the next few weeks. We have employed additional staff and plan to take on more over the coming months.”

Mr Straw said: “This report is very serious and requires urgent action to ensure patients are treated properly and humanely.”

Mr Stephenson said: “This a deeply concerning document. There must be prompt action on its recommendations.”

Mr Evans said: “This report is very worrying.

“It is an appalling catalogue of what should not happen to a human being.

“Urgent action is needed by the trust management.”

The trust action plan includes the closure of Chestnut Drive ward in Whalley, refurbishment of other parts of the site, a taskforce looking at alternatives to physical restraint and new programme for training and recruitment of staff.