Care quality commission inspections of high-security hospitals
| Published date | 06 March 2020 |
| Pages | 83-96 |
| DOI | https://doi.org/10.1108/JFP-09-2019-0044 |
| Date | 06 March 2020 |
| Author | Sana Rabab,Jack Tomlin,Nick Huband,Birgit Völlm |
| Subject Matter | Health & social care,Criminology & forensic psychology,Forensic practice,Sociology,Sociology of crime & law,Law enforcement/correctional,Public policy & environmental management,Policing,Criminal justice |
Care quality commission inspections of
high-security hospitals
Sana Rabab, Jack Tomlin, Nick Huband and Birgit Völlm
Abstract
Purpose –Patients detained in high-security psychiatric hospitals are particularly vulnerable to
excessive restrictions and exploitation. In the UK, the care quality commission (CQC) monitors and
regulates forensichealthcare provision. The purpose of thisstudy is to identify key concerns highlighted
in CQC inspectionreports of the three high-secure hospitals in Englandbetween 2010 and 2018.
Design/methodology/approach –In this qualitative study,49 CQC inspection reports from three high-
securehospitals were subjected to thematicanalysis.
Findings –Five central themes emerged: staffing and management; restrictive practice; physical
environmentand ward atmosphere; patients’needs and involvement in theircare; and legal and statutory
matters. There was some variation in the overall quality of care between the hospitals. Positive
staff–patient interactions and good practice in assessing and delivering care were consistently
observed. However, enduring staff shortages within each hospital were experienced negatively and
sometimes co-occurred with concerns over restrictive practices, poor care-plan procedure and
inadequate legal documentation. Over time, Rampton and Broadmoor Hospitals appeared to worsen
with regardto staffing levels, staff morale and managementinvolvement. While servicesprogressed over
time in providing patients with access to advocacy and information concerning their rights, in some
recent inspections it remained unclear whether patients were adequately involved in the care-plan
process.
Practical implications –These findings provide preliminary indicators for areas requiring further
attentionfrom policymakers, clinicians and advocates.
Originality/value –This study appears tobe the first systematic analysis of key concernsexpressed in
CQC reportsof English high-security hospitals.
Keywords High-security hospitals, Quality of care, Care quality commission, Forensic, Mental health,
Inspection reports
Paper type Research paper
Introduction
Forensic-psychiatric services provide treatment and care for patients who suffer from a
mental disorder and have offended or are undergoing legal proceedings. In the UK, in-
patient treatment for this group is provided in high, medium or low secure forensic-
psychiatric facilities, which aim to treat the disorder and any behavioural disturbance and
reduce the risk of re-offending. In England, patients with severe behavioural disturbance
who are considered a particular risk to others receive treatment in one of three high-secure
hospitals, which are run independently under the administration of local NHS trusts. All
patients entering high-secure services are detained under the Mental Health Act 2008,
although not all are detained under criminal sections of the Act. In accordance with the
National Health Service Actof 2006, these individuals “require treatment under conditionsof
high security on account of their dangerous,violent or criminal propensities”. They will likely
experience complex, co-morbid mental disorders and substance misuse problems are
liable to attempt absconding (NHS England, 2015). This allows an individual to be
incarcerated and treated againsthis or her will.
Sana Rabab is based at the
Department of Psychiatry
and Applied Psychology,
University of Nottingham,
Nottingham, UK.
Jack Tomlin is based at the
Department of Forensic
Psychiatry, University of
Rostock, Rostock,
Germany.
Nick Huband is based at
the Department of
Psychiatry and Applied
Psychology, University of
Nottingham, Nottingham,
UK. Birgit Vo
¨llm is based at
the Department of Forensic
Psychiatry, University of
Rostock, Rostock,
Germany.
Received 23 September 2019
Revised 20 January 2020
Accepted 20 January 2020
DOI 10.1108/JFP-09-2019-0044 VOL. 22 NO. 2 2020, pp. 83-96, ©Emerald Publishing Limited, ISSN 2050-8794 jTHE JOURNAL OF FORENSIC PRACTICE jPAGE 83
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