Review: Dispatches, “Inside the Priory”

Picture of Amy el-Keria, a young white girl with dark hair brushed across her forehead, wearing a maroon T-shirt with a dark blue apron over it, holding a plate of unidentifable food in both hands.This documentary on Channel 4 last night (19th Feb) exposed abusive practices, short staff, over-reliance on temporary staff (including the undercover reporter for this programme) and poor safety at a hospital unit, The Dene near Burgess Hill, Sussex, run by a company called Partnerships in Care which was taken over by the Priory Group in 2014. As it happens, many of us know of abusive practices in both pre-merger Priory and PIC units going back years, and had been waiting for a programme like this to be shown; it was a bitter disappointment, as it only focussed on one unit rather than a selection, and was too short at 25 minutes — when it finished, my thought was “is that it?” because Dispatches was always an hour-long investigative programme and there was so much more to expose than what was shown, which was bad enough but not the most egregious abuse I have heard of from both former patients and their families over the past few years. (Available on the Channel 4 website in the UK for the next 29 days.)

It is significant that they chose only a former Partnerships in ‘Care’ unit. This was, by the way, the same unit where Claire Dyer was held in 2014 after being moved while on section 3 from an assessment and treatment unit (ATU) in Swansea. I wrote about that at length at the time. The unit is a medium-secure unit which does not specialise in autism or learning disabilities, both of which Claire has: they took on a patient who was out of their expertise. Claire was transferred because of challenging behaviour towards staff at the unit, but had spent much of her time while at the unit, before she was sectioned and after, with her family on unescorted visits both home and outside, yet on arrival at The Dene was not allowed outside the building for several weeks. In the event she was allowed on unescorted outside visits after a few weeks and released from section after three months, but this kind of “institution-centred” care, taking no account of an individual patient’s condition, is a common phenomenon in the British mental healthcare world.

The Priory Group trades on its name: the Priory Hospital in Roehampton, south-west London, is a ‘prestige’ mental health unit for the rich and famous, but when people who do not know any better are facing a spell in one of their other units, they think they are getting the best mental health care going and in fact they are getting the bog-standard package the same company provides on NHS contracts. The Priory Group operates the Cheadle Royal hospital which ‘benefited’ from the closure of the West End Unit in Hull, a former weeknight-only inpatient unit which was closed down in 2013 because NHS England declined to fund it on that basis (and the American CEO was heard saying he hoped the NHS would close more beds so that private providers could fill the gap); teenagers were sent there from Hull (and elsewhere in the country) because of a lack of local (or even regional) inpatient NHS beds, making it difficult for their families to visit on a regular enough basis. Here are some of the abuses and bad practices I know of there:

  • Overuse of seclusion and restraint, often with an obvious punitive intention regardless of how staff dressed it up
  • Punitive responses to self-harm
  • Lack of respect for dignity (e.g. refusing sanitary protection to girls and women at risk of self-harm during their periods, something noted at PIC’s Ty Catrin in South Wales as well)
  • Incompetent management of self-harm, particularly involving ligatures (a girl took her own life in 2014 using the metal spiral binding of a notebook, after a staff member allowed her to keep it — which he should not have done — but said to her “you won’t hurt yourself with that, will you?”, something she had not previously considered)
  • Other incidents of neglect, such as noted in the case of Amy el-Keria, a 14-year-old girl with Tourette’s syndrome and various mental health problems who died at Priory unit Ticehurst House, East Sussex, in 2012
  • A cruel and inflexible approach to risk management: for example, a girl who had spent an afternoon in bed to avoid confrontation with other patients was then refused off-ward access in the evening because staff could not “risk assess” her
  • Lack of understanding of autism (other patients and low-status staff such as healthcare assistants knowing better about it than nurses and psychiatrists is often reported; this was noted at The Dene as well)
  • On one occasion at Cheadle, a teenage patient had to re-site another patient’s catheter after it fell out during a physical altercation.

There are many, many people Channel 4 could have contacted across the country if they wanted to make a programme exposing widespread abuses and safeguarding failures at Priory units, but they chose to focus entirely on the footage gained by one undercover reporter. Weirdly, despite uncovering criminal behaviour on the part of one of the full-time staff at The Dene — assaulting a patient who had entered the medicine room — the programme disguised his voice and face and does not give his name, perhaps because the intent is to expose the failings of the institution rather than individual staff members. But if the attack on the patient was not bad enough to show the perpetrator’s face, why did they stop at showing only that instead of the stories of other Priory Group patients who have experienced far worse?

This programme was a major missed opportunity; there is so much abuse and suffering of adults and children to be exposed at the Priory Group’s units. It hinted at the Care Quality Commission failing to investigate properly (a factor in the Winterbourne View scandal in 2011) noting that they had given it a good inspection report not long before footage shown last night was filmed. Again, the 25-minute documentary format has a lot to answer for, although in this case it was not a soundbite-filled bit of infotainment (like a lot of the more recent Panoramas) but what looked like the start of a serious investigation. We need to see part 2. Same time next week?

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