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Significant Improvements made to Mental Health Services at Royal Glamorgan Hospital in Llantrisant

Healthcare Inspectorate Wales (HIW) has issued a report (22 February) following an inspection of mental health services at the Royal Glamorgan Hospital in Llantrisant, managed by Cwm Taf Morgannwg University Health Board.

Royal Glamorgan Hospital  Admissions Ward, Ward 21, Ward 22 and the Psychiatric Intensive Care Unit

The inspection took place over three days in November 2023 and focused on various specialist wards and the Psychiatric Intensive Care Unit, all of which provide adult mental health services. 

Inspectors found a team of caring and professional staff who were committed to providing tailored care to patients. Since HIW’s last inspection in 2019, significant efforts have been made to address improvements in the areas of patient discharge arrangements, care planning and audit activity. 

Immediate assurance was sought due to the low levels of staff compliance with critical mandatory training. This included training on basic life support, and on how to de-escalate conflicts and only use physical force as a last resort, to keep patients safe. Therefore, we could not be assured that staff were appropriately trained to maintain professional standards. The health board must ensure training is accessible and mandated. 

The arrangements for discharging patients was a commendable area of good practice, which featured good collaboration between ward staff and community-based teams, with the clear involvement of patients. 

An excellent standard of care planning was identified by inspectors, with patient treatment plans being detailed and individualised. This was reflected in surveys, where patients told inspectors that they were treated well by staff, with tailored, comprehensive care. 

Despite the good standards of care observed, inspectors found a high number of staff vacancies. There was an over reliance on agency staff to fill vacant shifts, and staff told us that there were insufficient resources to meet patient demand. During the inspection visit there was no night manager found onsite, and only one qualified nurse per ward. Although, there were on-call systems in place, this presented potential risks to patient safety. The health board must continue to actively focus on the recruitment of permanent staff to outstanding vacancies.

We found that, in general, patients were being treated with dignity and respect. Phones available for patients to contact their families, and private rooms available for visits. Room locks were respected but could be overridden if required. However, there were some shared rooms, which did impact on patient privacy. 

There were robust and effective governance systems in place to provide oversight of clinical and operational issues. There was a clear organisational structure with clear lines of management and accountability. Staff told inspectors that they were satisfied and felt supported in their role. Inspectors were assured that staff were aware of safeguarding procedures to ensure vulnerable adults and children were protected.

Inspectors found that there were good audits and processes in place to manage risks, health and safety, and infection control, with regular de-briefs taking place following incidents. The inspection team witnessed positive de-escalation of difficult behaviours during the course of the inspection, all of which were handled respectfully and in a supportive manner.

Chief Executive of HIW, Alun Jones said:

“It is positive to see the improvements that have been made following our last inspection of the mental health services at Royal Glamorgan Hospital, particularly around care planning and the patient discharge process. We will continue to engage with the health board to ensure there is sustained progress against our findings.”