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Service designJan 18, 2022

Weekly therapy sessions had been reduced at hospital placed on 'special measures' by the CQC

Patients’ progress at an independent hospital in Kent was impeded after their therapy sessions were cut from seven to three a week, inspectors from the Care Quality Commission (CQC) were told.

In a highly critical report on the 35-bed Hollanden Park Hospital in Hildenborough that was released today (19 January), the CQC states that patients sometimes lacked the support they needed to adopt healthier lifestyles.

‘Staff did not always support patients to have a healthier lifestyle. Patients did not have access to a range of social, cultural and leisure activities or education and vocational resources in the wider community.

‘Covid-19 had impacted on the availability of these activities. However, a relative expressed concern that patients were not receiving rehabilitation due to the lack of activities despite Covid-19.’

Photo Credit: Shutterstock
Therapy sessions had fallen from seven times a week to three at the hospital (stock image)


Cutting therapy sessions 'impeded progress'

The hospital assesses, treats and rehabilitates adults with a range of neurological conditions, including acquired brain injury and disorders such as multiple sclerosis in four settings. Many patients are referred by the NHS and those requiring rehabilitation typically stay for 12-weeks.

Half-way through a stay of this type, patients are assessed to check they are ‘on track’ and likely to be ready to be discharged in a timely fashion, and the results of the review would be disseminated to various agencies to allow for ‘continuity of care’, the inspectors were told.

But they discovered that some patients’ independence was compromised because staffing levels were too low to support therapeutic interventions.  ‘Staff and a relative told us patients used to be offered up to seven therapy sessions a week however, over time this had gradually been reduced to three sessions which they felt was reversing and impeding any progress made.’

The inspectors, who visited on 22 and 29 September 2021, observed patients sitting in their bedrooms with limited interactions and activities or sitting outside the entrance to the main unit. ‘Staff did not provide evidence of what alternative activities they had implemented for patients. Feedback from a relative stated that the care given was not indicative of a rehabilitation approach and felt that their relative spent a lot of time without any activities.’

'Reasonable adjustments' were made

Though the report does not make many specific references to physiotherapists – it generally refers to ‘therapy staff’ in general terms – it is more upbeat when discussing how well each individual’s needs were being met. ‘The service was inclusive and took account of patients’ individual needs and preferences,’ it notes.

‘Staff made reasonable adjustments to help patients access services. Patients had access to various therapies including but not limited to, physiotherapy, occupational therapy and music therapy. Sessions ran for 30 to 45 minutes and each patient had up to three sessions of each form of therapy a week.’

It also notes that physiotherapy was provided on a six-days-a-week basis.

The report is based on an unannounced comprehensive inspection of the facility, when it was called the Raphael Hospital. It was its first inspection after it opened under new provider (the Renovo Care Group) in October 2020.

Hospital's values were not widely known

We did not find the overall care to be of high quality and the provider was unable to demonstrate that they provided the best rehabilitative care outcomes. Our findings were supported by feedback from some staff ... and a relative of a patient who shared their concerns [CQC report]

The hospital’s mission was ‘to be recognised as the leading provider of neurorehabilitation services to the communities we serve by consistently providing high quality care that promotes and supports the best rehabilitative care outcomes possible’.

The inspectors pour cold water on this statement, however. ‘We did not find the overall care to be of high quality and the provider was unable to demonstrate that they provided the best rehabilitative care outcomes. Our findings were supported by feedback from some staff in the staff survey and a relative of a patient who shared their concerns about rehabilitative care outcomes. Staff did not know what the hospital’s values were and we did not see them displayed in any of the areas we visited.’

Leadership structure

There was a ‘clear’ leadership structure, which was led by a chief executive officer and included a director of operations and nursing who was also the CQC registered manager. The director of operations and nursing was supported by a quality lead, a head of therapies, an education lead, a support services lead and an estates manager, the report notes. ‘The leadership team were visible, and staff told us they were approachable. Staff told us the chief executive officer visited the hospital weekly and we saw positive interactions between the leadership team and staff during our inspection.’

Overall rating of 'inadequate'

The CQC gave Hollanden Park Hospital an overall rating of ‘inadequate’ and placed it on 'special measures'. It told Renovo Care to make a number of improvements. The service was also rated as ‘inadequate’ for being safe, effective and well-led, and received a 'requires improvement’ rating for being caring and responsive.

Amanda Williams, the CQC’s head of hospital inspection, said Renovo Care’s progress would be monitored and followed up: ‘When we inspected Hollanden Park Hospital, we were concerned to find that the leadership team didn’t have complete oversight of all the issues the service was facing, and they were not taking timely action to resolve them.

Ms Williams added: ‘Data collected by the hospital was not always reliable enough to monitor performance, identify areas of concern and make improvements.

‘Staff did not always complete risk assessments for each patient in a prompt manner. They did not always act to remove or minimise risks or update the assessments when risks changed.

‘It was also very worrying to find that patient records showed that there were long gaps when people didn’t receive food and drink. Some patients were unable to feed themselves so were reliant on staff to ensure that their nutritional and hydration needs were being met, yet staff were not always following recommendations made by the dietician.'

Hospital voices its 'deep disappointment'

A spokesperson for the hospital said: 'We are deeply disappointed with the inspection report, particularly given the very positive feedback we regularly receive from patients, families and commissioners regarding the care provided at the hospital. We are absolutely confident that we have always met our number one priority to keep our patients safe.

'However, we do take the inspection report seriously and immediately implemented a detailed action plan. We have already made a lot of progress, which is acknowledged within the report.  Several independent audits have also been commissioned which confirm good and sustainable progress. 

'Renovo Care has a strong commitment to quality improvement putting the care of our patients and residents first. This was demonstrated in the CQC report for Swanborough House in Brighton which was inspected in December 2021. The inspector rated the service as “good” in all areas and was very complementary about the quality of care provided.'

Summary of key failings

  • the service did not operate effective governance systems to enable them to improve the quality of services
  • not all staff had completed their mandatory training and there was a low compliance rate in key modules, including safeguarding and life support training
  • staff did not keep detailed records of patients’ care and treatment; records were not always clear, up-to-date or reflective of the care provided
  • incidents were not always effectively investigated to reduce the risk of potential harm from similar or repeated incidents; not all staff were able to describe what lessons were learned and were not aware of any changes to practice that would prevent them reoccurring
  • staff did not routinely involve patients and their families in making decisions about their care and did not always follow national guidance to gain patients' consent before providing care
  • the premises and equipment did not always keep people safe; clinical waste was not managed well

Some positive findings

  • staff knew the patients they were caring for, including their preferences and medical histories, and treated people with dignity and respect
  • staff provided patients with timely care to minimise their distress; patients were assessed for pain regularly and received pain relief in a timely way

Hollanden Park Hospital is one of four facilities that Renovo Care runs in the south of England. For more information on the company, visit: https://renovocare.co.uk

To access CQC reports, visit: https://www.cqc.org.uk

Author: Ian A McMillan
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