A specialist mental health unit in Ysbyty Gwynedd shows improvement but further issues remain
Healthcare Inspectorate Wales (HIW) has issued a report (22 September 2023) following an unannounced inspection of a specialist mental health unit at Ysbyty Gwynedd in Betsi Cadwaladr University Health Board. The inspection focused on three wards and took place over three consecutive days in May 2023.
Situated at Ysbyty Gwynedd in Bangor, the Hergest Unit provides acute in-patient mental health assessment services including a Psychiatric Intensive Care Unit (PICU).
During our inspection, we generally found suitable protocols in place to manage risk, health and safety and infection control. Established governance arrangements were in place to provide oversight of clinical and operational issues and the leadership team was approachable and supportive to staff, having a good understanding of patient needs. Further improvements were required including staff compliance with mandatory training, there was evidence of some staff taking part in restraint of patients without adequate training.
Throughout the inspection we observed all staff treating patients with dignity and respect, we heard directly from a small number of patients and were pleased to note feedback from some that staff were polite, supportive and helpful. It was positive to note that patients had their own programme of care that reflected their individual needs and risks. However, we found a lack of dedicated therapeutic activity programmes in place for patients to aid their recovery.
Staff were committed to providing safe and effective care but told us they could not always prevent patients from bringing restricted items onto the wards, which poses a risk to patients, staff, and visitors. Patients also confirmed that it was possible to bring restricted items onto the ward despite being searched by staff and a very small number of patients told us this could make them feel unsafe. Despite these responses, most patients still felt that the service provided by the hospital was ‘good’ or ‘very good.’ The health board must review its existing policies and procedures to prevent restricted items being brought into the ward.
We saw evidence that staff who were untrained or who were not up to date with restraint training had continued to participate in the restraint of patients. However, we were assured that all unit staff would be fully compliant with their training by September this year.
Satisfactory arrangements were in place to promote and protect patient rights, but the dormitory sleeping arrangements compromised patient privacy, dignity, and safety. It was positive to note that six patients had their own rooms, however, we recommend that the health board consider additional opportunities for single person accommodation to improve the patient experience on the unit.
Some staff did voice concerns that patients could no longer access dedicated inpatient psychology or specialist consultant support. Staff reported there had been recent improvements in the unit’s culture, morale and working practices, however we noted there were a high number of staff vacancies at the time of our inspection. We were advised some of the vacant posts would soon be filled by nurses who were near to qualifying and there were ongoing recruitment processes to increase resourcing.
Alun Jones, Chief Executive of Healthcare Inspectorate Wales says:
“It was positive to note the improvements in culture, morale and working practices at the Hergest Unit. However, there will need to be a strong focus on improving the safety of patients from restricted items being brought onto the ward. The health board has produced a comprehensive plan setting out their improvement actions. We will continue to closely monitor their progress.”