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The Priory Group

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The Priory Group is the parent company of The Priory and Partnerships in Care, and is the largest private provider of mental health services in the UK. Both subsidiaries are providers of in-patient mental health facilities, both secure and non-secure, and rehabilitation clinics. The companies have numerous contracts with CCGs and hospital trusts around the country for the provision of mental health services.

In December 2020, the Priory Group's owners, US private equity company Acadia, sold the Priory Group to the Dutch private equity company, Waterland, for £1.08 bn.

Strategy

The Priory was founded in 1980 and has grown through the acquisition of companies; in 1993 the Priory acquired the Jacques Hall Foundation, a specialist education services, in 2014 the Castlecare Group, one of the UK’s leading providers of local authority funded children’s services; in 2015, Priory acquired Life Works, addiction and mental health hospitals and Progress Care, a leading provider of specialist education and care in Lancashire.

In February 2016, The Priory Group itself was acquired by Acadia Healthcare, a US company specialising in behavioural care.

In November 2016, The Priory Group merged with Partnerships in Care to form the UK's largest provider of in-patient mental health services. The main business for Partnerships in Care was the NHS.

In December 2020, Acadia Healthcare sold The Priory Group to Waterland, a Dutch private equity group, for £1.08 bn. Waterland has said it will combine the Priory Group with Median, Germany’s largest provider of rehabilitation and neurology treatments, to create “Europe’s leading rehabilitation and mental health services providers”. The combined group will have the capacity to treat 260,000 patients across 570 clinics.

As Partnerships in Care, the company provides the following services:

  • medium secure, low secure, locked rehabilitation, open rehabilitation and community housing to support patients' safe and positive re-integration in the community
  • individually-tailored measurable and evidence-based treatment programmes with clearly specified goals and timescales
  • forensic specialisation with focus on risk reduction, relapse prevention and independent living skills
  • a full range of patient care pathways
  • acute service, stroke and respite care, specialist forensic older adult services, an end of life care programme for patients within our secure settings, gender-specific therapy to meet the needs of female patients and male patients
  • employee assistance support and programmes available for all staff , as well as external organisations, through our Care first division

As the Priory Group, the company provides acute mental health care, secure and step down services, specialist education, complex care and neuro-rehabilitation services, fostering and care homes.

Financials

In December 2020, the Priory Group was sold to Waterland, a Dutch private equity group, for £1.08 bn. Waterland has said it will combine the Priory Group with Median, Germany’s largest provider of rehabilitation and neurology treatments, to create “Europe’s leading rehabilitation and mental health services providers”. The combined group will have the capacity to treat 260,000 patients across 570 clinics. Waterland bought the group from Acadia Healthcare, registered in the USA. In 2019, Acadia put The Priory Group up for sale and in February 2020 reported that it had bids from several companies.

The latest accounts on Companies House for the holding company, Priory Group UK 1 Ltd, are for the year to 31 December 2019 and report revenue of £861.6 million, up from £830.4 million in 2018. Operating profit for the year was £45.1 million, up from a loss of £469.1 million in 2018. Loss after tax was £59.4 million (2018: loss of £522.1 million). The company received £456.3 million in revenue from NHS organisations and £320.3 million from social services in 2019.

Contracts

Partnerships in Care and The Priory have numerous contracts with CCGs and trusts and provide a wide range of services. Often Priory Group or Partnerships in Care are part of framework agreements. Examples of contracts include:

In March 2016, Priory Group and Partnerships in Care were awarded part of a framework agreement with CCGs in Sussex to provide specialist inpatient Adult Mental Health Services and Specialist Inpatient and Treatment for Adults with a Learning Disability. The whole contract is worth £27 million over three years.

Throughout 2017/2018, Various Priory subsidiaries were used by Birmingham Children's Hospital for the provision of inpatient beds for both children and adults with mental health issues; overall these contracts, each fairly short-term, came to a value of over £11 million.

By mid-2021, The Priory Group, along with all other healthcare and social care providers, was experiencing a major problem with recruitment due to Brexit. The Priory Group was offering a 'golden hello' of £5,000 for mental health nurses that join the company.

Concerns

Financial set-up

The Priory Group is a perfect example of how private equity groups operate. The Priory Group was built up by Chai Patel, who sold it to a Dutch bank in 2006. The firm then passed into hands of the Royal Bank of Scotland, which sold it for £925m to a private equity player in 2011. Five years later, it went to Acadia Healthcare. Now the group is going into the hands of Waterland, a Dutch private equity firm. These operations use debt to buy firms at low cost, then aim to extract cash and exit as fast as possible.

According to an article by Ian Birrell in iNews, the Priory Group encompasses a complex network of 218 companies that stretches to the Cayman Islands and £1.4m has disappeared into "the bulging pockets of its directors. Meanwhile it is seeking support staff on the minimum wage to care for people day and night on the front line of a lethal pandemic."

Care failures

The Priory has been the subject of several reports of failures in care in recent years, including several patient deaths.

An inspection of the company's Keston Unit, part of Priory Hospital Hayes Grove, in September 2020 led to the CQC telling The Priory that it must make urgent improvements. The unit caters for a specialised mixed gender unit for adults who have a diagnosis of Autistic Spectrum Disorder (ASD) with psychiatric co-morbidities, people with ASD and mild learning disabilities.  Previously in January 2020, a CQC inspection rated the unit inadequate and placed a condition on the provider’s registration, preventing it from admitting patients to the Keston Unit until improvements had been made. In September, inspectors found that the unit had failed to make sufficient progress since January and that the quality of care and treatment provided remained unsafe and compromised people’s privacy and dignity. The Priory Group has now decided to close the Keston Unit by the end of 2020.

The Bristol Cable has published an expose of The Priory Group's hospital in Bristol. In July 2020, the Cable reported that Banksy ward in the hospital was closing down less than three years after opening because of staffing problems. The patients had to be transferred to the nearest ward of its kind 100 miles away in Maidenhead.

The Cable conducted a six month investigation looking at testimony from current and former workers and documentary evidence. The publication revealed that the problems on Bansky ward went back over a year, including struggles to keep permanent staff, regular incidents of self-harm and violent attacks on staff by patients.

Allegations from staff and former staff include that staffing levels on the ward were too low to deal with incidents, such as self-harm, and the high needs of the patients. There were physical attacks on staff and the high number who left meant that the hospital had to rely heavily on agency staff.

Admissions to the ward were halted in Autumn 2019 after an internal investigation by the Priory.  The ward was reopened to new patients a few months later, but following discussions with NHS England, has now closed. The police are investigating a serious incident on the ward in June 2020. The Priory closed the Brunel ward in September 2020, leaving Bristol without any residential beds for children. For the rest of the hospital, by April 2021, The Priory had made sufficient improvements for the CQC to rate it as Good overall. However, the CQC did raise concerns over the high number of registered nurse vacancies (60%), patients missing out on occupational therapy because of staff vacancies, agency staff not having access to patient electronic records, patient records not being updated regularly and key emergency items such as defibrillation pads missing.

In 2016, an inquest ruled that the death of a 14 year old Amy El-Keria at a Priory hospital in 2012 was as a result of months of serious failings at the hospital, including staff failing to pass on the fact that she had spoken of wanting to end her life. The inquest also ruled that staff failed to dial 999 quickly enough and failed to call a doctor promptly. Staff were also not trained in cardiopulmonary resuscitation (CPR). Staffing levels were also found to be inadequate and a lack of one-to-one time caused or contributed to Amy’s death in a “significant” way.

Following the death of Amy, the Health and Safety Executive brought a case against The Priory Group under the Health and Safety at Work Act. In January 2019, The Priory Group pleaded guilty; reports state the fine could be unlimited, but the prosecutor suggested it would be at least £2.4 million. Eventually the company was fined only £300,000 in April 2019; the judge reportedly took into account that the firm pleaded guilty to criminal charges and reported that its 2017 turnover was £133 million with an operating profit of £2 million.

However, The Guardian reported in May 2019 that campaigners argue that the £133 million is only a fraction of the company's actual turnover; Priory Group’s overall accounts for 2017 report an operating profit of £62 million. The total revenue for the group was £797 million, of which around 90% (£720m) came from contracts with the NHS and social services. The investigation by Corporate Watch also found that the boss at the time of Amy's death received £458,000 as a "golden goodbye" when he left the same year of her death.

Early in 2016, the the family of 17-year-old Sara Green, who died in the Priory Royal in Cheadle in 2014, called for the company to have its NHS contract cancelled. In March 2016, the Priory and Solent NHS Trust admitted liability for the death of 15-year-old George Werb, who had been a patient at the Priory Hospital Southampton. According to a Sunday Mirror investigation, since Amy El-Keria's case in 2012, there has been “at least a further 11 deaths following failings in care at The Priory group’s clinics since".

In February 2019, the Priory's hospital for children with learning disabilities in High Wycombe was closed, following a CQC report that gave the unit an overall rating of 'inadequate'. The CQC found the hospital “not adequately equipped to care for young people with complex needs”. The hospital had only opened in April 2018 and catered for children aged 13 to 17 with learning disabilities and/or autism.

In February 2018, the company's Roehampton hospital in Wandsworth was rated "required improvement" overall. Then in July 2018, the company's hospital in Southgate, North London, was rated “requires improvement” overall by the Care Quality Commission, following an unannounced inspection. However, the CQC rated it as “inadequate” for safety and noted several concerns across its child and adolescent mental health services, acute adult wards and substance misuse services.

In July 2019, the CQC placed two Priory hospitals in special measures. The two hospitals - Priory Hospital Blandford in Dorset and Kneesworth House in Royston, Hertfordshire – were found by the CQC to be unsafe and uncaring and rated them both as inadequate. The hospitals have been given up to six months to show improvement or face closure.

Outside healthcare

Schools

In June 2019, Priory College in Swindon, where people with social and communication difficulties are taught had an Ofsted report that reported serious safety issues. The report from the inspectors said that “serious and widespread failures at the college mean young people are not protected and their welfare is not promoted or safeguarded”. The inspector also reported that there is no track kept of when the learners go missing and there were also no reports on self-harm, online safety or bullying.

 

 

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