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Hillview Hospital remains a Service of Concern following inspection

Healthcare Inspectorate Wales (HIW) has issued a report (12 January 2023) relating to its inspection of Hillview Hospital in Ebbw Vale, which specialises in young people's mental health care.

Hillview Independent - Hospital Tŷ Seren and Ebbw wards

This follows a previous inspection in November 2021 following which, Hillview Hospital was designated as a Service of Concern due to the number and severity of the issues identified. Although we saw improvements during this most recent inspection, we found insufficient progress had been made to improve incident reporting systems and management of restraint. As a consequence, Hillview Hospital remains designated as a Service of Concern, and we will continue to monitor the service to ensure all improvements required are addressed.

HIW completed an unannounced independent inspection of the hospital on three consecutive days in August last year. During this period a number of assessment areas were inspected within the Tŷ Seren and Ebbw wards. The hospital has 21 beds and provides child and adolescent mental health services to females aged between 13 to 18 years of age, who are diagnosed with a mental disorder, and who are detained under the Mental Health Act 1983. At the time of the inspection, the hospital was under the management of Regis Healthcare, which has since been acquired by Elysium Healthcare. 

During the onsite inspection, HIW inspectors saw improvements had been made in several areas since our previous inspection. For instance, the quality of care and treatment plans was now in line with best practice guidance. A dietician was available at the hospital and was responsible for ensuring the nutrition and hydration needs of the young people were being met. Each young person had a care plan in place which was being reviewed regularly. A mental health advocate was also available to the young people to provide them with further support and information.

Our previous inspection identified issues in relation to poor procedures for medicines management, and the upkeep of the clinical environments. We saw a marked improvement in relation to these issues, with revised procedures in place for the safe management of medicines. We also saw that work had been completed on the hospital environment and that the wards looked more appealing and pleasant.

We invited family members and carers of the young people at the hospital to complete questionnaires to obtain their views on the service provided. The results reflected a difference in opinion, with almost half of the respondents rating the setting as either good or very good and over half rating the setting as either poor or very poor. Our observations were of friendly and respectful interactions taking place between staff and the young people. The young people we spoke with during the inspection were also positive about the care they received and their interactions with staff. Around half of the respondents to the family member and carers questionnaires said that staff were polite, kind, or sensitive to the young people when they carried out care and treatment. This is a significant finding that will the management team will need to consider and evidence improvement.

We looked at a sample of records during the inspection and saw evidence that the physical health needs of the young people had been considered in addition to their mental health care. However, we noted physical assessments appeared to be generic and not tailored to the individual. For example, it appeared some sections had been copied and pasted from one set of records to another.

Our previous visit identified issues in relation to infection prevention and control procedures. Unfortunately, we saw that this remained an issue, with better procedures needed to ensure that patient and visitor areas are kept clean and clutter free. Infection prevention and control procedures were not adequate and therefore inspectors had to ask for areas to be cleaned following incidents.

We concluded that serious issues remained in relation to the quality of incident report. We reviewed a sample of reports to understand whether the use of restraint during incidents was justified. We found the reports lacked appropriate and sufficient detail to provide this assurance. This issue was identified previously and HIW inspectors did not find sufficient progress had been made in resolving and addressing this area of concern.

The setting has produced a comprehensive plan which sets out improvement actions. HIW will continue to closely monitor progress against this plan.

Chief Executive of HIW, Alun Jones said:

Whilst there have been improvements in the service since we last inspected, it is concerning that there has not been enough progress on several key areas. This requires urgent attention as the safety of the young people being treated in this hospital is paramount.

We will continue to engage with the service to ensure progress against our findings.

August 2022 – Independent Mental Health Service Inspection Report – Hillview Hospital

August 2022 – Inspection Summary Report – Hillview Hospital