Worried staff at a struggling ward at Dr Gray’s Hospital in Elgin fear only a ‘significant incident’ will bring about much-need improvements.
A damning new report reveals NHS Grampian has been unable to get on top of a string of issues raised by multiple inspections of the hospital’s mental health ward.
While patients reported feeling safe on the ward, inspectors have identified a number of risk factors within the ward’s environment – some a potential risk to life.
And they have have been told by some patients that staff are often so distant they feel as if they are effectively caring for themselves.
Undermanned medical teams on the hospital’s Ward 4, meanwhile, have questioned just what it will take for improvements to finally be made.
Health and Social Care Moray praised the hard work of staff at the hospital but accepted there had been failings.
A spokesperson said it understands “the seriousness of these concerns and their impact on patient care and on our staff”.
Staff recruitment and planned improvements to the ward, and the wider hospital, are said to have been held back by a lack of funding.
The Mental Welfare Commission for Scotland made 10 recommendations to the Elgin hospital following a visit in October last year.
They called for improvements to activity provision, risk assessments and the ward environment – but many have yet to be acted upon.
Despite most individuals praising the staff as caring and helpful, some reported a more negative experience.
The inspectorate said they were told staff tended to spend a lot of time in the office, and were often seen on their mobile phones.
Patient felt staff ‘let them to get on with it’ with little help
The report adds: “Some individuals told us about the regular one-to-one meetings they had with staff and the recovery nurse and how they found these sessions helpful.
“However, this was not the case for everyone.
“One individual told us that they felt ‘left to get on with it’ and ‘it was really up to me to get better’.
“Another individual told us ‘the nurse would just look in the door to do their checks and not do any more than that’.”
The inspectors said that not everyone they spoke to had seen their care plan, though most were happy with their current care and treatment.
The ward has a games room which individuals used to play pool and table tennis, together with some gym equipment was also available.
Most individuals, however, said there were too few activities available.
Inspectors had previously been told the hospital was in the process of recruiting an
activity coordinator.
The creation of that post has since been abandoned due to financial constraints.
On their past three visits, the inspectorate have raised concerns about the ward’s environment.
The inspectors critiqued the lack of garden space due to the ward being on the first floor.
They also found all windows were sealed shut, so there was “poor ventilation” in the ward.
Dr Gray’s staff feel they are waiting for a ‘significant incident’ to happen before changes to environment
Most individuals told the inspectorate they felt safe in the ward and that it was a place where they got better.
However, many of the bedroom and bathroom doors continued to have no locks, resulting in a lack of privacy and dignity for individuals.
There were numerous ligature points on the ward and staff told inspectors that managing the level of potential risk this presented was “extremely difficult”.
Managers, nursing staff and medical staff said they felt as if they were
waiting on a “significant incident” to happen before any changes would be made to the
environment.
Most individuals described the food as “awful”, though staff said this was down to ‘temporary’ issues.
On their last visit, inspectors said they were “pleased to hear” of plans for a full refurbishment of the ward.
Again, those works have since been cancelled due to NHS Grampian’s financial position.
“We continue to be extremely concerned about the lack of progress with regards to
the environment in Ward 4,” the latest report reads.
“It is directly and adversely impacting on the wellbeing and safety of individuals and staff on Ward 4 and also on the dignity and privacy of individuals admitted to the ward.
“We will continue to request updates from the chief officer of Moray HSCP and
escalate our concerns as necessary.”
Understaffing issues continue on Ward Four
The inspectorate adds: “The ward has had to continue to frequently use agency staff in order to provide sufficient cover in the ward.
“This has mainly been due to high staff absence.
“The ward had a recovery nurse in place, and we heard about the benefits this
role had brought to individuals recovery following admission to the ward.
“However, the recovery nurse was often pulled into the floor numbers for the day due to staff shortages.”
The inspectorate spoke with the recovery nurse on the day, who said they continued to receive supervision from the psychotherapist and they had undertaken
specific training around psychological therapies.
Their plan was to offer appointments to individuals to identify therapeutic interventions which would support their recovery and then set times for regular meetings.
Unfortunately the activity nurse continued to be counted in the daily staffing numbers when needed so could not plan to offer regular meetings with individuals.
A spokesperson for Health and Social Care Moray said: “We fully accept the findings of the Mental Welfare Commission for Scotland and understand the seriousness of these concerns and their impact on patient care and on our staff.
“We also acknowledge that several concerns have previously been raised by the Commission.
“We share the Commission’s concerns about the ward’s physical environment.
“The planned refurbishment of the ward as part of a bigger national treatment centre programme at Dr Gray’s has been halted as capital funding cannot be secured.
“Alternative solutions are being pursued through the NHS Grampian review of inpatient beds for people experiencing acute mental health issues and we are working with all partners to ensure the review addresses the needs of adults in Moray.”
NHS staff praised for being ‘caring, good and helpful’
They added: “The dedication of Ward 4’s skilled and knowledgeable staff continues to be a key strength.
“We are encouraged that individuals and families who spoke to the Commission’s visitors described staff as caring, good and helpful, and that people felt safe in the ward and viewed it as a place of recovery.
“We are now preparing a comprehensive action plan in response to the Commission’s recommendations and are committed to its rigorous implementation to ensure issues are effectively addressed as quickly as possible.”
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