‘Serious issues’ found in inspection of Glan Clwyd mental health unit

Healthcare Inspectorate Wales (HIW) has issued a report today (October 19) following an visit to the Ablett Unit at the Bodelwyddan hospital, which took place across three consecutive days in July 2023.

The hospital, run by Betsi Cadwaladr University Health Board, provides inpatient mental health services for males and females.

Its inspection focused on the “Tegid” (mixed gender, older people) and “Dinas” wards (separate 10-bedded male and female acute admissions).

During the inspection, HIW identified issues in relation to the Section 136 suite, which is a place of safety under the Mental Health Act for patients being detained until an assessment of their needs can be carried out.

HIW said it was “disappointed to find that recommendations made in our January 2019 inspection on this same issue had not been acted on”.

It added: “Staff had experience of being required to support patients in this suite alone, due to insufficient staffing levels across other areas of the unit. 

“We acknowledge there are future plans for a new facility which aim to resolve this, but it is crucial that the health board manage the risks here and now.

“We have asked the health board to provide assurance on what actions will be taken in the meantime to improve the environment, and quality of care being provided to patients before the new facility is opened.”

Inspectors observed staff treating patients with dignity and respect, and patients spoken to by HIW were complimentary about the care being provided and their interactions with staff.

There was also a range of activities available for patients to engage with during their stay to improve their wellbeing. 

Information was displayed on the wards, meanwhile, to inform patients of their rights under the Mental Health Act. 

The language preference of each patient was recorded on the patient status “at a glance” board on each ward, which inspectors noted as good practice.

But HIW also found that the physical environment of the wards did not help to fully maintain the privacy and dignity of all patients.

For example, while the majority of patients had their own room, some patients had to share a bedroom.

Inspectors noted that it would benefit patients to be able to personalise their rooms to create a safe space, where they can express their personality to help promote their wellbeing.

HIW added: “We found that there were suitable policies and procedures in place to help staff provide safe and effective care.

“The environment of each ward was clean and tidy and had appropriate fixtures and fittings for the patient group.

“There were established health board policies and processes in place to ensure that staff safeguarded vulnerable patients with referrals to external agencies, as and when required.

“However, the health board must develop a policy that details the expectations on staff security in relation to wearing personal alarms for safety.”

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Patient records were found to be comprehensive, clear and of good quality.

There also appeared to be “appropriate internal governance and oversight”, including meetings to discuss any issues relating to patient care to identify improvements.

But, HIW added, “medication administration records must be fully completed and written clearly to avoid confusion by staff and reduce the risk of a medication error”.

Inspectors saw evidence of appropriate discharge and aftercare planning, with good involvement from the multidisciplinary teams, care co-ordinators and mental health teams from the community.

Mandatory training compliance rates were also high among staff within the unit.

The majority of staff said they would recommend the unit as a place to work and that they would be happy with the standard of care provided by the unit, for themselves or their friends and family.

But some staff members raised concerns about the staffing levels at the unit and felt that senior management were not visible, and the communication between senior management and staff was not effective.

HIW has asked the health board to provide assurance on the current staffing establishments.

The health board must reflect and provide assurance on how it will engage, listen, and act on staff feedback.

Chief executive of HIW, Alun Jones, said: “We are aware of plans for a new specialist mental health unit which would provide a significantly improved, modern facility, enabling staff to deliver higher levels of care.

“However, this is a number of years away from completion, and the health board must make improvements now to protect current patients and staff.

“It is great to see the dedication from staff in delivering safe and dignified care. It is also good to hear positive feedback from patients on their care.

“We will continue to engage with the health board on their plans for improvement.”

Welsh Conservative shadow minister for mental health, James Evans MS, said: “This report by HIW points to some serious issues at the mental health unit in Ysbyty Glan Clwyd.

“The fact that medication records are not being fully completed creating confusion and that patient dignity is said to be at risk is completely unacceptable.

“I was particularly disappointed to hear that patients are having to share rooms to save space, sacrificing their privacy, which is of the upmost importance.”

Welsh Conservative shadow minister for North Wales, Darren Millar MS, added: “Betsi Cadwaladr University Health Board was placed in special measures back in 2015 for failings in mental health services after the Tawel Fan scandal at the Ablett Unit.

“So, I am appalled that HIW has found that staffing shortages and poor medication records are still an issue some eight years later is not good enough.

“Both Welsh Government and the health board must get to grips with these issues and ensure that recommendations following inspections by regulators are fully implemented.”

In response, Teresa Owen, the health board’s executive director responsible for mental health and learning disabilities services, said: “I welcome the HIW report into its inspection of the Ablett Unit, in July this year.

“I note the positive patient feedback and the excellent work being undertaken by our staff to provide dignified care. Patient welfare is everyone’s absolute priority.

“The health board accepts HIW’s recommendations and all the team are already working to implement the changes.

“While it is heartening to hear the majority of our staff would recommend working in the Ablett Unit, I also noted the feedback from a number of colleagues around limited communication from senior managers.”

Plans are still progressing for the new inpatient mental health unit at Glan Clwyd Hospital, which would replace the Ablett Unit.

The health board is awaiting a decision on the planning application lodged with Denbighshire County Council.

A business case will be brought to a full meeting of the health board, and then Welsh Government.

Assuming these elements are successful, construction on the scheme would commence in 2024.

Ms Owen added: “The senior management team and I are committed to making sure every member of staff feels listened to, supported and safe in their roles - and we will work with them to address their concerns.

“Recruiting staff to mental health services is challenging across the UK and I know this puts pressure on colleagues, who regularly go above and beyond to provide vital services.

“We are continuing to try and recruit more people to support the teams.

“The health board recognises the need to rebuild the current Ablett unit, and the planning work for the new inpatient unit continues.”