Five inspectors, a Mental Health Act Reviewer and a Specialist Advisor (Consultant Forensic Psychiatrist) visited Broadmoor Hospital on 21 November. CQC had received information from a number of sources raising concerns about the staffing levels in the hospital and the impact could have on people who use services.

We visited Ascot, Leeds, Sheffield, Canterbury and Cranfield wards and visited the day services provided onsite. We spoke with people who used services and staff, including health care assistants, nurses, ward managers and medical staff. We also spoke with other professionals within the hospital such as social workers, occupational therapists and advocates. We reviewed some patient records and requested information from the trust after our inspection to inform our judgement.

People were provided with care and treatment from a skilled and committed workforce. People were generally very positive about the support they received from staff. There were programmes of therapeutic activities available and on the assertive rehabilitation wards which we visited, we saw that there was a strong focus on recovery. We checked some records on the wards we visited and found that care and recovery plans were comprehensively completed and risk assessments were thorough and up to date. The hospital had recently moved to a new electronic database system. Some staff told us that this meant information was shared more speedily.

The trust provided us with details about staffing levels over the three month period prior to the inspection and we checked the published 'safe staffing' figures on the trust's website. We found that while staffing had been identified as a concern, the situation was improving, as action had taken by the trust to speed up recruitment and new staff were coming through the recruitment process. Staffing levels had been identified by the management as a concern and there were plans in place to address this.

On the day of our visit, we saw that this was beginning to have an effect. Staff on the wards we visited told us that "things were getting better". We saw the trust had a good understanding of the concerns on the ground. While there was a high use of bank and agency staff, this ensured that staffing was maintained at a safe level.

Some staff told us that they did not feel 'connected' with the hospital and trust management. However, other members of staff told us that they felt there was an improvement in engagement. We saw plans the trust had to work on staff engagement in the future.

Patients told us they were given information about the hospital and how their treatment and care would be delivered. They told us weekly community meetings were held and ward based patient representatives said they attended the monthly patient forum meetings.

Patients reported there was access to a good range of facilities including the gym. They said there was a programme of activities but the advertised activity didn’t always take place particularly in the evening or at weekends. They told us they made choices about their dietary needs to maintain their religious and cultural requirements.

Patients told us they were involved in developing their care plan and in making decisions about their support needs. They said they knew about the medication they were taking. They said they could use the advocacy service to support them when meeting with medical and nursing staff.

Patients were in general positive about staff on the wards. They told us there were a number staff leaving which they said was “a bit of a worry”. They told us they were satisfied with the standard of care provided. A patient’s relative told us that “he (the patient) had hopes for the future and was looking forward to his discharge and reintegration into the community".

We provided Broadmoor Hospital with 24 hours notice of the inspection. We were provided with a list of wards and chose to visit Newmarket, Isis, Epsom and Leeds Wards. We spoke with patients in informal groups and individually on the wards.

The visits to Broadmoor Hospital took place over two days. We provided the Trust with 24 hours notice of the inspection visit. During the inspection we visited nine wards, the Primary Health Centre, Newbury Therapy Centre and the Education Centre.

We spoke with approximately 25 people who use the service and six relatives/ representatives of people who were using the service. We spoke with a minimum of 43 staff of different disciplines. During the inspection we met with members of the independent advocacy service for the hospital. We also met with the social work manager.

The majority of feedback we received from people who use the service was positive. One person said “I feel that I am respected” and “staff do their best”. All the relatives and representatives of people commented that they were pleased with the care people received.

There were a number of staffing vacancies within the hospital, which the Trust was aware of and was taking action to address.

We did identify that whilst staff had a good awareness of safeguarding issues, they were not always aware of how to raise issues with external statutory bodies.

We also found a few examples where the use of seclusion for nursing people might not have fully complied with the Mental Health Act Code of Practice.

The Trust had systems in place to regularly assess and monitor the quality of service that people received.