Select Committee on Health Appendices to the Minutes of Evidence


Memorandum by Priory Healthcare (H 45)



  1.  Priory is part of Westminster Healthcare, Europe's largest provider of specialist health services in the independent sector. In addition to neurorehabilitation the company provides psychiatric, forensic, Senior Living, learning disability and diagnostic services spread among over 120 facilities across the UK. The company is based in Leatherhead, Surrey and employs over 10,000 people.

  2.  Priory Healthcare provides 123 beds for people requiring rehabilitation for traumatic brain injury and maintained an average daily occupancy across these units of 95.7 (88 per cent). Recent increased provision in the Southeast has seen a directly proportional increase in purchasing. (See appendix i)

  3.  Eighty eight public sector purchasers across the UK purchased over £6.5 million worth of services from the company's Brain Injury facilities last year. In most cases this accounts for between 85 per cent and 95 per cent of total revenues for brain injury services. The public sector uses our services because of their specialist nature. Unsted Park Hospital provides treatment for stroke patients who may by treated under private medical insurance schemes. Other private patients are treated with funding from compensation claims arising from their injury. Our services are often selected as the most effective treatment option (see appendix ii).

  4.  These beds are situated across the country in a mix of dedicated brain injury units and as part of larger specialist healthcare facilities. The four larger units at Lancashire, Surrey and Sussex (2) are registered under the Registered Homes Act. The two smaller units in East Sussex are registered with the Local Authority.

  5.  In addition to the current provision of brain injury services Priory aims to provide further specialist services within several of Westminster's Senior Living Division nursing homes to widen the availability of services and provide more facilities close to local areas of need. These units will be staffed over and above the usual provision for nursing homes with qualified staff skilled and experienced in brain injury rehabilitation to ensure that high standards of rehabilitation are achieved and most cost effective services delivered.


  1.  Units are managed within the structure of Priory, each facility has a Hospital Director or Unit Manager responsible for the operation at unit level. Consultant Clinical Neuro-psychologists and Consultants in Rehabilitation Medicine provide clinical management.

  2.  Staffing varies depending on the size and nature of the unit. Within the larger units rehabilitation is provided by a team, the constitution of which, varies according to the nature of the services provided. It normally includes a medical consultant with a specialisation in rehabilitation medicine, consultant clinical neuro-psychologists, senior nurses, physiotherapists, occupational therapists, speech and language therapists and social workers. At the Priory Ticehurst House there is a workshop technician to look at work-related skills. The children's services at Highbank Rehabilitation Centre employ a special needs teacher and play specialist. Additional input from creative therapies, dietetics, and pharmacy is provided as required.

  3.  The smaller residential units—Egerton Road and The Vines—are run by a Unit Manager and staffed by trained support workers. They receive regular input from Consultant Clinical Neuropsychologists and from other disciplines as required.

  4.  The majority of the staff are directly employed by the Company. Some Consultant posts, both medical and psychological, are contracted from the NHS or through an individual agreement with the Doctor concerned. General medical cover is generally provided by a GP who will have a special interest in neuro rehabilitation.

  5.  Postgraduate training for all qualified staff is encouraged. This may be provided in house or via a range of recognised training organisations and professional bodies. Those include the Bobath Centre in London, NW3 and the national Demonstration Centre for Rehabilitation at Derbyshire Royal Infirmary.

  6.  Recruitment of nursing staff into the sector remains as problematic as it is in the NHS. Registered Psychiatric Nurses and Registered Sick Children's Nurses are the most difficult vacancies to fill. Therapy staff, such as occupational therapists and physiotherapists, are easier to recruit with all units staffed to 80 per cent-90 per cent of their budgeted levels.

  7.  The attraction of the independent sector for clinical staff is the opportunity to influence clinical activity, work in highly specialised areas, and with greater autonomy. Reduced caseloads (in line with guidelines from professional bodies) enables a higher quality service to be provided. As an example a Senior II OT in a similar service in the NHS may have 35 or more patients on their caseload whereas in the independent sector the ratio is generally 1:5.


  1.  The company provides a mix of hospital and community based services. The larger facilities provide post acute rehabilitation where the patient is treated for a limited period of time with a view to returning to the community or being moved to a residential setting. This mix of service varies from unit to unit and is largely borne out of local need and demand. (See Fig ii). Patients live in residential settings and are encouraged to gain independence through structured rehabilitation programmes. Programmes are designed by a psychologist working with both the patient and the rehabilitation team.

  2.  The two residential facilities provide services where the emphasis is on integrating the patient into the local area. In some cases this will result in discharge from the unit into independent housing whilst in others the patient will continue to need long term residential care.

  3.  There has been an increase in the demand for "outreach" work. These are services that provide a range of interventions in the community either in the patients' own home or a dedicated facility in a local area. This demand seems to be in keeping with the general change in philosophy in the Health Care sector that champions' community based services against institutional care.

  4.  Priory recognises the need to ensure patients are returned to their home, community or to an appropriate supportive setting as soon as reasonably possible. The rehabilitation team works closely with the patient and their family and community agencies to ensure the most effective solution for the patient's difficulties. This in turn increases the throughput for the inpatient facility and assists addressing the increasing demand on such facilities.

  5.  Of the facilities owned by Priory three currently provide outreach services with two providing a dedicated outreach facility. The Priory Hospital Ticehurst also employs Brain Injury Case Managers who have current caseload of 21 patients. Most of these patients are funded through insurance claims and are provided with bespoke packages of care.


  1.  Collaboration with statutory bodies and the provision of seamless care can be a difficult issue. There are pockets of good practice but by and large the working patterns of Local and Health Authorities vary so considerably that seamless service becomes difficult to provide. None of the facilities owned by Priory enjoys a consistently successful relationship with the public sector.

  2.  Services are generally purchased on an "ad hoc" basis with little or no planning or discussion with provider units as to the medium or long term arrangements for patients. Purchasers generally use our services because of the specialist skills our units possess.

  3.  The responsibility of public sector provider units and services to collaborate with the independent sector is not sufficiently clear and this can result in long delays, poor quality of discharge planning and in some situations relapse for the patient concerned. [8]

  4.  It often appears, anecdotally, that the quality of discharge and follow up in the community is dependent on the individual professional(s) involved. Where a collaborative and professional relationship develops with local authority employees, be it placement officers or social workers, then the process by which patients are admitted and discharged is more efficient and effective.

  5.  There is an untested hypothesis, among some facilities, that independent providers enjoy the least favourable relationship with their host Authority. Whereas purchasers from further afield will work more collaboratively with the facility and foster a more fruitful partnership.

  6.  Links with purchasers and other significant parties are maintained through a system of case conferences and family meetings, which are held on regular basis determined by the patients' length of stay. Families are routinely involved in the decision-making processes that relate to the care and treatment of their family member.

  7.  The largest single hurdle to better collaboration is communication. The apparent "spiders web" of communication lines that exists in both the Local and Health Authorities does not foster clear timely information. Moreover the failure of Health and Local Authority departments to work in collaboration exacerbates the problem for the independent provider who is often caught in the cross fire between purchasers, community service providers and the patient's family when trying to effectively settle a patient in the community. Clear lines of accountability and identified case managers for each patient within the public service sector would begin to ease the problem.

  8.  Where there are clearly identified individuals with properly defined roles the relationship between sectors improves drastically and the patient gets a "better deal". Strengthening and making mandatory the principles of "partnership" would help enhance these relationships and lead to more efficient health and social care network.


  1.  The services provided by Priory for Brain Injury rehabilitation are broad and geographically wide-ranging.

  2.  The services are provided in a mix of hospital and community settings with an emphasis on meeting local demand with high quality, flexible and cost-effective treatment facilities.

  3.  The further development of Brain Injury services is a key part of Westminster's strategic plan. This includes the use of existing local resources to bring the services closer to where they are required.

  4.  Over £6.5m is spent annually by the Public sector on Brain Injury Services provided by Priory.

  5.  The company is changing to meet the growing demand for outreach and community work and is developing services that meet a range of complex needs associated with brain injury neurorehabilitation and other services such as early onset dementia and other degenerative neurological disorders.

  6.  Collaboration with the statutory sector remains dependent upon the quality of the relationships developed between individual professionals and services. This is not the most effective approach and much work needs to be done on defining the responsibility of those concerned with admitting and discharging patients through the independent system.

] February 2001


Name of facility Number of bedsAverage daily occupancy Number of dischargesNumber of admissions Public sector purchasersPer cent of total purchasers
Highbank Rehabilitation Centre, Bury, Lancashire 524319 283891 per cent
Unsted Park, Godalming, Surrey20 16.39294 1143 per cent
The Priory Hospital, Ticehurst, Wadhurst, Sussex 148.124 351794 per cent
The Priory Grange, Heathfield, Sussex10 8.801 793 per cent
The Vines, Crowborough, Sussex11 1000 10100 per cent
Egerton Road, Bexhill, Sussex10 9.522 584 per cent
TOTAL12395.7 13716088

  Figure 1.   Availability of Services.


FacilityServices/Programmes Outreach Work
Highbank Rehabilitation Centre, Lancashire Post acute rehabilitation
Paediatric neurorehabilitation
Cognitive rehabilitation
Long-term care
Largely through the cognitive rehabilitation service
Unsted ParkStroke rehabilitation
Traumatic brain injury including day and inpatient rehabilitation
Spinal injury
The Priory Hospital, Ticehurst, Sussex Post acute rehabilitation
Cognitive rehabilitation
Challenging behaviour
Day patient rehabilitation
Largely through employed case managers with support from the Consultant Clinical Neuropsychologists and other members of the team
The Priory Grange, SussexLong-term care None
The Vines, SussexLong-term care None
Egerton Road, SussexIntermediate and long-term care Currently for one patient

  Figure 2.   Range of Services provided.

8   It is worth noting that in Priory's experience, patients who are discharged under Section 117 of the 1983 Mental Health Act are better provided for as the responsibility of all concerned are clearly laid down by law. A similar system for the discharge and community management of brain injured and other similarly disabled patients with complex needs would be a welcome tool for all concerned. Back

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Prepared 3 April 2001