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Inspection finds Heddfan Psychiatric Unit at Wrexham Maelor Hospital still requires improvement

Healthcare Inspectorate Wales (HIW) has issued a report (9 February 2023) into the findings from its inspection of Heddfan Psychiatric Unit, situated at Wrexham Maelor Hospital run by Betsi Cadwaladr University Health Board (BCUHB).

Heddfan Psychiatric Unit, Wrexham Maelor hospital

Staff within the unit were found to be committed to providing safe and effective care, and suitable protocols were generally in place to manage risk, health and safety and infection control. Key improvements were required in relation to staff restraint training, medication management and conducting regular audits.

HIW completed an unannounced independent inspection of the hospital on three consecutive days in November last year. During this period, a number of assessment areas were inspected on the Gwanwyn and Hydref Wards. Both wards accommodate up to 14 patients each and provide a comprehensive range of acute health services, including older persons and psychiatric intensive care.

Inspectors observed a committed team of staff who had a good understanding of the needs of the patients and were dedicated to providing a high standard of care. Staff were seen to be interacting with patients appropriately and treated patients with dignity and respect. The staff we spoke to were passionate about their roles and enthusiastic about how they supported and cared for the patients.

The onsite inspection identified that improvements were needed to ensure the activity rooms on both wards were tidied and maintained by staff, temperature control measures were in place, and broken facilities were repaired or replaced. It was also noted that the facilities for maintaining patient privacy and dignity are to be improved in bedrooms and in shower rooms.

Inspectors were generally assured that processes were in place to manage and review risks to help maintain the health and safety of patients, staff and visitors. Care and treatment plans were well organised and updated, but we did find the quality of the plans varied across the wards. Some improvements were required in respect of governance, record keeping and medications management.  During the inspection it was concerning to note that the monthly ligature audit workbook had not been completed since February 2022, which could threaten patient safety. Regular audits must be undertaken to monitor medicine management, security risks and the maintenance of clinic rooms on the wards.

Our inspectors witnessed the leadership team to be approachable and supportive to staff and had a good understanding of patient needs. We saw evidence of good collaborative working across the health board to support improvements and learning. We found that some staff did not have adequate levels of restraint training yet had participated in such incidents. Therefore, we were not assured that staff and patients were being fully protected and safeguarded against injury. Our concerns regarding this were dealt with under our immediate assurance process which requires urgent action be taken in order to keep patients safe.

It was noted that there were a high number of vacancies on both wards at the time of our inspection. Most staff told us they felt there were not enough staff to enable them to do their job properly. Senior management confirmed that maintaining adequate staffing levels was challenging, and they relied on agency staff to reduce staffing pressures.

Chief Executive of HIW, Alun Jones said:

It is positive to see the dedication of staff in delivering high standards of care at the Heddfan Unit. Our inspection identified improvements which required immediate resolution. The health board has produced a comprehensive plan which sets out improvement actions against the other recommendations we made as a result of our inspection. HIW will work with the health board to continue to closely monitor progress against this plan.

NHS Mental Health Service Inspection – Heddfan Psychiatric Unit – Wrexham Maelor Hospital, Wrexham

Inspection Summary Report – Heddfan Psychiatric Unit – Wrexham Maelor Hospital, Wrexham