Staff at a north Wales hospital's mental health unit have shared their concerns that they are unable to provide the "quality of care" they'd like to, a report by the Healthcare Inspectorate Wales (HIW) has found. The independent inspectorate and regulator of healthcare in Wales conducted an unannounced inspection at Heddfan Psychiatric Unit at Wrexham Maelor Hospital in November of last year.
The inspection, which reviewed into the Hydref and Gwanwyn wards of the psychiatric unit in Wrexham, found that although staff were committed to providing safe and effective patient care, with suitable protocols all generally in place, improvements were needed elsewhere.
According to HIW, some improvements were needed in relation to medications management, document completion and record keeping. They also found that some staff were deficient in Restrictive Physical Intervention training, yet had participated in incidents of patient restraint without any training or after their training had expired.
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As a result, HIW said that the were not assured that staff and patients were being fully protected or safeguarded against injury. It was noted that their concerns regarding this was dealt with under an "immediate assurance process".
It comes after another report by HIW on the emergency department at the Wrexham hospital raised concerns about its waiting times. The review, which was published on February 3, found that although patients were generally happy with the care provided and the way in which staff interacted with them at the emergency department, they were critical of waiting times.
The report found that the majority of patients were being appropriately assessed on arrival in the emergency department and that there were generally effective measures in place for assessing, monitoring, observing and escalating unwell or deteriorating patients. However, they noted some occasions when patients should have been escalated in a more timely way and that some patients were waiting a long time for triage and to be seen by doctors at times.
In the report about the mental health unit, patients who completed a questionnaire rated the care and service provided by the hospital as either "very good or good". The report also found that staff interacted and engaged with patients appropriately and treated patients with dignity and respect, but that the staff noted that staffing levels were a concern.
Staff members provided the report with the following comments: "I think the only thing that lets us down as a whole is staffing levels are sometimes not sufficient therefore, we are unable to provide the quality of care we'd like to. We have recently had a few posts filled with permanent staff so hopefully this will improve."
Another staff member said: "Our health care support workers are burnt out. They often express that they cannot get jobs done on time for the elderly as being asked to move wards and often leaves the wards short as other wards don't count their nurses and we do, yet we're often left struggling, and it impacts staff health and well-being in the work place mentally and physically."
When asked how the setting could improve service, staff members said that they needed help with the demand and that senior managers should take care more of the staff and patients and less about the paperwork and budget. They added: "Sometimes they don't want to know 'what can they do to help' but why did it happen? Budget is important but it should be done accordingly to the situation and place. Not just one will pay for everything. Leaving us short and not available of doing our jobs to the best of our knowledge isn't the answer, because staff will be fed up and leave the work."
In response to HIW's inspection into the Heddfan Unit, Becky Baker, Head of Operations and Service Delivery for Mental Health services in the East of Betsi Cadwaladr University Health Board, said: "We’re pleased that the inspection team noted the commitment of all staff to provide a high standard of care, with patients treated with the dignity and respect they deserve, supported by a leadership team who have a good understanding of patient needs.
"We have taken decisive action to address the improvement areas identified in the inspection report, as part of a comprehensive action plan which we have developed with HIW. This includes a commitment for all patient facing staff to be fully compliant with restraint training by May 2023. It was necessary to stand down this training during the COVID-19 pandemic. However, during this period, we put in place measures to mitigate the risk to both patients and staff. These measures have been strengthened further following this inspection."
In response to HIW's inspection into the hospital's emergency department, Michelle Greene, Betsi Cadwaladr University Health Board’s East Integrated Health Community Director, said: “The Health Inspectorate Wales (HIW) inspectors completed an unannounced inspection over three consecutive days in August 2022 in Wrexham Maelor Hospital’s Emergency Department.
"We’re proud that the inspectors praised our staff for being friendly, professional and committed to providing high quality care to patients, and that whilst under significant pressure they treated patients and their relatives in a polite, professional and dignified manner.
"The report highlights the pressures the Emergency Department is under resulting in much longer waiting times than we would like, despite the best efforts of our nursing and medical staff.
"Since the inspectors visited the hospital, we have expanded the department to create more consulting and treatment rooms for patients, and we are increasing the department’s workforce by approximately 40 whole time equivalent staff, and we are continuing to recruit to support the department.
"At the time of our inspection there were approximately 70 patients awaiting to be discharged from the hospital, limiting the department’s ability to transfer patients in a timely manner. We continue to work closely with local authorities and our health and social care partners to support patients and their needs.
"Despite these pressures inspectors found that the majority of patients were being appropriately assessed on arrival and that there were generally effective measures in place for assessing, monitoring, observing and escalating unwell or deteriorating patients. The report also highlights the infection prevention and control measures were robust throughout the department, and it was clean and tidy to a good standard.
"We have accepted HIW’s recommendations and have produced a comprehensive plan with detailed actions on how improvements will made. We would like to thank all our Emergency Department staff, and everyone that supports the department to function, for their continued dedication and commitment.”
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