Significant pressure on a Minor Injuries Unit at Prince Philip Hospital is impacting on the delivery of safe care
Healthcare Inspectorate Wales (HIW) has issued a report (28 September 2023) highlighting the challenges faced by staff within the Minor Injuries Unit (MIU) at Prince Philip Hospital in Llanelli.
HIW completed an unannounced inspection of the unit on three consecutive days in June 2023. During the onsite inspection, HIW inspectors found the pressure and challenges within the department and the wider hospital were leading to an increased risk to patients.
The inspection concluded staff were working extremely hard to provide good quality care for patients but were under considerable pressure. At times, mental health, medical and surgical patients were being cared for over extended periods in a unit which has not been designed to treat those who are high risk. As a result, several areas for improvements were identified, some of which required action to be taken by the health board.
Inspectors were assured that patients presenting with minor injuries were receiving a good level of safe and effective care from a skilled workforce. However, Inspectors deemed the environment was not appropriate for mental health, medical or surgical patients who are admitted beyond the lengths of stay associated with a typical MIU. We were not assured that patients who required a longer stay within the unit on temporary beds were receiving timely, effective, and consistent care. Inspectors witnessed these patients having inadequate access to hygiene facilities, which was negatively impacting on their dignity. Inspectors deemed the environment was not appropriate for mental health, medical or surgical patients who are admitted beyond the lengths of stay associated with a typical MIU. The outcome of this issue was that the MIU was not functioning safely and effectively overall.
We could also not be assured that there was sufficient and robust support for Emergency Nurse Practitioners at times when there is an unexpected lack of medical cover on the unit. Some of the improvements identified, extend beyond the control of the unit and of the health board. This requires high-level discussions with partners to ensure patients receive timely care, in the right clinical environment for their needs. As a result, some of the actions provided within the immediate improvement plan have a longer time scale for completion than usually expected.
When asked, patients and carers told us they were generally satisfied with the service they had received, and inspectors witnessed staff treating patients with kindness and respect. We found that patients arriving at the unit with minor injuries were seen and treated in a timely manner. Care assessment and planning in relation to minor injury patients was completed to a good standard, and once seen and treated, patients received clear advice on how to manage their condition and what to do in the event of further concern. Staff were knowledgeable and were able to describe aspects of infection, prevention, and control (IPC) relevant to their roles and responsibilities. Inspectors identified aspects of good nursing and medical management on the unit, and staff spoke positively of the support they provide to each other on the unit.
Staff expressed significant dissatisfaction in several areas including lack of staff unity with some of them working within multiple roles, leading to a reduced amount of time given to their designated role. Staff also disclosed a lack of public awareness regarding the services available at a MIU, a poor staff skill mix and low engagement from senior managers and leaders when acting upon concerns. The health board must ensure that robust and sustained action is taken in response this.
The health board has produced a comprehensive plan with detailed actions on how improvements will be made within the emergency department.
Chief Executive of HIW, Alun Jones said:
The pressure on NHS services continues to be extraordinarily high and we have found evidence of a service struggling to meet demand and maintain patient safety with the resources available. I acknowledge the hard work and dedication of staff within this service, and our report provides an opportunity to highlight the challenges that patients and staff within this service are facing on a daily basis. The specific recommendations for action we have set out will support the health board to reduce risks to patients and staff whilst they continue to deal with this challenging period. We will continue to engage with Hywel Dda University Health Board to ensure progress against our findings.