Healthcare Inspectorate criticises mental health unit that made teenage patients feel ‘desperate’

Martin Shipton

A hospital mental health unit that two suicidal teenagers said made them feel desperate has been strongly criticised by Healthcare Inspectorate Wales following an unannounced three-day visit.

In 2023 Nation.Cymru reported major concerns about the Hafan y Coed mental health unit at Llandough Hospital near Penarth, run by the Cardiff and Vale University Health Board.

Relatives of patients staged a protest outside the hospital attended by around 30 people.

We spoke to patients Anya Del Amo, 18, and Tynia Hancock, 19, both of whom told us of virtually non-existent treatment programmes that left them feeling desperate, and neglectful monitoring that made it easy for them to harm themselves and abscond, even when they had been sectioned for their own safety after multiple suicide attempts.

The teenagers’ fathers Scott Del Amo and Mathew Hancock also voiced concerns, going into harrowing detail about incidents involving their daughters.

Banned

After speaking to Nation.Cymru, Mr Del Amo was banned from visiting his daughter on Father’s Day in what he described as an act of cruelty.

Both young women have since left the unit but Healthcare Inspectorate Wales (HIW) has now issued a report that reflects their concerns.

The inspection of the unit focussed on two adult mixed-gender wards: Cedar Ward’s Crisis Assessment Unit and Alder Ward’s Psychiatric Intensive Care Unit.

Patient safety

The report states: “During the inspection we identified several issues which led us to seek assurance that immediate action would be taken to improve patient safety. This included inaccurate recording of patient restraint incidents and the involvement of untrained staff in these incidents – issues that were also identified during a previous inspection in January 2023. Additionally, inspectors were concerned about building maintenance problems which posed health and safety risks, including swollen floors that prevented fire doors from closing and several trip hazards.

“Inspectors observed that the care team on both wards only consisted of two types of healthcare professionals, which raised concerns about the lack of diverse expertise in decision-making. Immediate action was requested to include a broader range of disciplines in patient care decisions to meet national standards.

“The staff we spoke with were passionate about their roles, and enthusiastic about how they supported and cared for the patients. Inspectors witnessed staff treating patients with respect and kindness and patients we spoke to generally gave positive feedback on their care. However, inspectors did witness instances where staff did not respond to patients who needed help. The health board must explore ways to ensure staff are able to engage with patients and respond in a timely manner. We have recommended that the health board considers the installation of emergency assistance call points within patient bedrooms and throughout the wards.

“It was positive to note the high staff compliance with mandatory equality, diversity and human rights training. We were told that some staff had completed additional voluntary training to improve their awareness and understanding of equality and diversity issues, which was recognised as good practice. However, inspectors noted low compliance with infection prevention and control training, gaps in daily cleaning schedules, and a lack of evidence showing that communal facilities were regularly cleaned.

“Both wards had strong procedures for safely managing medicines and monitoring the Mental Health Act. While the clinical record-keeping and patient care planning were generally good on Alder Ward, Cedar Ward had poor record-keeping overall. Many patient intervention plans were incomplete and not tailored to individual needs. The health board must establish strong governance processes to enhance the quality of patient records.

“There were adequate staffing levels across both wards, but we noted a high turnover of staff and a high reliance on agency staff to fill vacant shifts on the Cedar Ward. The health board must conduct an establishment review to ensure the staffing numbers, skillset and experience amongst staff are appropriate to support patient safety and provide patient-centred care. We found that ward staff meetings were not regularly taking place, and there had been no meetings within the last six months prior to our inspection. Regular ward staff meetings are important to ensure effective communication, address concerns, and to promote coordinated patient care.

“It was positive to see that Alder Ward had an Activities Coordinator, and patients were given appropriate therapeutic activities. However, neither ward had an Occupational Therapist, and inspectors were not assured that Cedar Ward patients had access to adequate activities to support their health and wellbeing. The health board needs to do more to ensure that all patients can take part in personalised therapeutic and social activities to help with their recovery.

“Each patient had their own bedroom with ensuite shower facilities, which maintained their privacy and dignity. Inspectors noticed that monitor cabinets, used to observe patients without disturbing them in their rooms, were left unlocked which compromised the privacy, safety and dignity of patients. We were also concerned that most rooms did not have privacy screening for the ensuite bathrooms, or curtains to stop light from external windows, and recommend that these are installed.

“Most staff who completed our questionnaire felt that senior managers were not visible, and that communication between senior management and staff was not effective. The health board should reflect on this feedback and investigate whether improvements in relation to management visibility and communication with staff could be made.

“There were well established processes in place to ensure incidents or key issues were being effectively investigated, escalated and scrutinised to prevent reoccurring issues. However, “improvements are needed to make sure actions are completed quickly and lessons learnt are shared.”

Immediate improvement

HIW chief executive Alun Jones said: “Our recent inspection at Hafan y Coed Mental Health Unit has highlighted areas requiring immediate improvement to enhance the quality of care provided. It is disappointing that some areas had not improved since our previous inspections, and we will be working with the health board to ensure these issues are addressed. However, it is encouraging to see that the health board has already begun addressing some of these concerns, and staff were receptive to our feedback.”

A spokesperson for Cardiff and Vale University Health Board said: “We recognise the importance for the public and patients in having confidence in the services we provide and the integral role HIW plays in providing these assurances around quality and standards of care delivered by healthcare organisations. As a learning organisation, we are open and fully receptive to any areas for improvement as recognised in our improvement plan.

“It is positive to see a number of the recommendations identified have already been completed since the initial visit to the Crisis Assessment Unit (Cedar Ward) and Psychiatric Intensive Care Unit (PICU) (Alder Ward) was undertaken in July and that a robust improvement plan has been agreed with HIW to address any outstanding areas.

“Capital, Estates and Facilities colleagues are undertaking a comprehensive programme of exploratory work with contractors to address the maintenance issues referenced within the report. To facilitate the repair work, patients have been transferred to an alternative ward within adult mental health services to ensure services and care can continue during this time.

“While we recognise the concern raised in relation to Occupational Therapy, the health board is fully compliant with the National Minimum Standards for Psychiatric Intensive Care in General Adult Services. Interim arrangements continue to be provided across all inpatient mental health services whilst recruitment is ongoing to these posts, while recognising there are national shortages in this professional group.

“The welfare, safety and quality of care of patients has always remained our utmost priority. To address the issue of the call bells, all patients in Hafan y Coed have a comprehensive and individual care plan that is risk assessed, and where it is considered clinically appropriate, they are provided with emergency assistance call points in line with national standards.

“We would like to reassure service users and families that mental health colleagues are fully qualified and competent in managing behavioural issues which require restraint, and the health board has taken a concerted and proactive effort to improve compliance of training and development, particularly around improving cultural competencies within equality, diversity and human rights training. We would like to assure service users and their families that, whilst it is sometimes necessary to physically restrain people in order to ensure their safety, this is done proportionately and is always in the context of a dignified and trauma-informed approach.

“The health board is pleased to read in the report that colleagues within mental health services are enthusiastic and passionate in the delivery of care to patients and patients shared they are treated with respect and kindness. We will continue drawing on the expertise and lived experience of colleagues and service users to coproduce further solutions which continually improve the services we provide.

“If any patients or members of the public are concerned with any services or aspects of care provided, please contact the dedicated concerns team.”