Improvement required at a specialist mental health ward in Neath Port Talbot Hospital
Healthcare Inspectorate Wales (HIW) has issued a report (24 August) following an unannounced inspection of a specialist mental health ward in Neath Port Talbot Hospital. The inspection took place over three consecutive days in May 2023, and focused on the delivery of safe and effective care within ‘Ward F’, an inpatient assessment and treatment ward for adults experiencing acute mental health problems.
Inspectors found staff were committed to providing safe and dignified care, and suitable protocols were in place to manage risk, health and safety and infection control. However, improvements were required in relation to ward security, information sharing and updating patient’s care and treatment plans.
When asked, patients spoke positively about their interactions with staff, and inspectors witnessed patient’s being treated with dignity and respect. Completion rates of mandatory training for staff were high at nearly 90%, these included courses relating to equality, diversity, and inclusion.
It was positive to find that patients, family, and carers could engage and provide feedback on the provision of care in numerous ways. Staff also took time to speak with patients and address any needs or concerns they raised, which demonstrated a responsive and caring attitude towards the patients.
When reviewing patient records, we were not assured Care and Treatment Plans (CTP) reflected patient’s individual needs. We uncovered some CTPs were not being updated, held out of date information or were not in place at all. Upon inspection we also witnessed the staff ‘glance’ board was not covered, which meant patient confidentiality could be compromised. Furthermore, due to an increase in patients, we noted that there was not enough space on the board to capture information about each patient. This meant that it was not easy to understand the information presented causing potential delays, confusion to staff and risks to patients.
We looked at a sample of patient records and we were not assured that appropriate arrangements were in place to meet their physical health care needs. Some patient records did not document whether physical healthcare assessments had been undertaken upon admission. We also saw that one patient had a diagnosed medical condition but that no plans were in place for managing this on the ward.
During our review of patient records, it was not clear what therapeutic interventions had been put in place for each patient to aid their recovery. We were informed that some activities were being organised and undertaken with patients, for example, cookery lessons and walks. We saw that some books and games were available in the dining room but there appeared to be a lack of other therapy facilities on the ward. The health board must do more to ensure that patients are able to participate in a range of activities to aid their recoveries.
We found limited written information was available to help patients and their families understand their care. We were told by staff that patients are provided with an information leaflet on admission to the ward. However, some patients we spoke to during the inspection told us that they had not received a copy of the leaflet. We also noted that the leaflet was out-of-date and included incorrect information.
Most staff told us that they feel supported in their roles and were satisfied with the organisational management. Staffing levels were appropriate to maintain patient safety within the wards at the time of our inspection. Staff also told us that they would feel secure raising concerns about patient care or other issues at the hospital and felt confident that the health board would address their concerns. A whistleblowing policy was in place to provide guidance on how staff can raise concerns. However, some staff members we spoke with did not know about the policy. The health board should disseminate the whistleblowing policy and remind staff where they can access it should they have any concerns.
We were told that patient satisfaction surveys are sent to patients after they have been discharged to help identify areas for improvement. However, we did not see any evidence of changes that had been made as a result of formal patient feedback. At the time of the inspection, we saw that 83 per cent of staff had received their annual appraisal. However, three of the ten staff members that completed a questionnaire said that they had not had an appraisal in the last 12 months.
A meeting was being held every morning for staff and senior management on any concerns, issues or incidents that had taken place the day before. We attended one of these meetings and noted good discussions being had around patient care needs.
We saw Welsh speaking staff members present on the ward who were identifiable by a ‘Iaith Gwaith’ badge embroidered on their uniform. Staff were undertaking Welsh language training to understand the importance of meeting the language needs of patients. However, we did not see any bilingual patient information on display throughout the ward.
A range of up-to-date health and safety policies were available and appropriate risk assessments were being undertaken. However, we felt further improvements were needed to provide a safer environment for patients and staff. The environment of the ward was tired, well-worn and in need of redecoration. The health board must liaise with the contractors to provide a safe environment for patients. An up-to-date ligature point risk assessment had been undertaken that detailed the actions taken to mitigate and reduce risk. We recommend the health board completes further anti-ligature refurbishment work as a priority due to the expected increased demand due to the ward becoming the single point of assessment for the region.
During the inspection we were informed of potential issues with the interior door that separated the ward, from the main reception and waiting area. It appeared that the door was not secure enough to prevent patients from absconding. We saw that personal alarms and radios were available for staff to use in an emergency. However, during the inspection we noted that staff were not using them. We asked to see the policy on the use of personal alarms and were told that no such policy was in place. Furthermore, we noted following refurbishment work undertaken in the patient bedrooms, the beds were now situated far away from the nurse call alarms so we were not assured that patients could summon assistance if required in an emergency.
Chief Executive of Healthcare Inspectorate Wales, Alun Jones said:
“It is positive to see the dedication from staff in delivering safe and dignified care at Neath Port Talbot Hospital. We have recommended a number of improvements as a result of our inspection and Swansea Bay University Health Board must take timely action. The setting has produced a comprehensive plan which sets out improvement actions and we will continue to closely monitor their progress against this.”