Problems at mental health hub as trust is rated good
The borough's flagship new mental health facility has been criticised by a watchdog inspection of the region's mental health trust.
The service provided on wards for older adults by the North West Boroughs Healthcare NHS Foundation Trust, which includes wards at Atherleigh Park in Leigh, has been rated inadequate by the Care Quality Commission (CQC).
Inspectors raised a number of concerning issues, including mixed-sex wards where men and women could freely mix unsupervised, areas which were not properly cleaned and equipment that was unfit for purpose.
Although the North West Boroughs as a whole was rated good, the regional in-patient service for people with autism which is used by Wigan families was judged to require improvement.
Wiganers needing to speak to the assessment team also faced unacceptably long waits of six weeks and there were out-of-date clinic supplies at the Wigan and Leigh early intervention team’s base, the inspectors concluded.
The Trust stressed the overall conclusion of the report was good but acknowledged there were things that needed improving and promised changes.
Helen Bellairs, Trust chairman, said: “It is a fantastic achievement to have maintained our good rating and recognises the hard work staff put in every day to deliver high-quality patient care.
“I’m particularly proud to receive positive feedback about our patient-centred culture, our strong leadership, and evidence of good physical health monitoring in our mental health services which demonstrates our whole person care approach.
“While we remain ‘Good’ overall, there are some areas for improvement which we are now focusing on.
“The CQC process is about identifying where continued improvements can be made and working together to make them happen.
“We have action plans in place and have already begun addressing the ‘must do’ and ‘should do’ requirements in order to ensure provision of quality, safe, effective and efficient patient care to support our communities to live life well.”
The strongest criticism in the CQC report was reserved for the Parsonage and Golborne wards at the multi-million pound facility which were being inspected for the first time after opening in 2017.
The report concluded there were “considerable issues” with patient safety, with male and female bedrooms on the same corridors and patients of different genders seen wandering in and out of rooms with no staff around to intervene in any incidents.
This also raised questions about patients’ privacy and dignity, the CQC said.
The state of the wards also drew inspectors’ attention, with sharp edges protruding from a damaged window on a bedroom door on Golborne ward.
The CQC also expressed concern about fixed beds on Parsonage ward and unsuitable bedroom furniture on Golborne ward as well as the lack of a shower curtain in assisted bathrooms there.
Parsonage ward was not cleaned often enough, raising the prospect of infection, and staff were not moving and handling equipment correctly and using kit that was not fit for purpose.
Patients’ alarm buttons were also not easily in reach on Parsonage ward as they were behind the heads of the beds.
In addition two medicine-related issues were raised with ward managers during the inspection.
However, the clinic rooms were kept clean and tidy, medical cover was adequate and nurses regularly reviewed an dupdated the risk assessments.
Gail Briers, the Trust’s chief nurse and executive director of operational clinical services, outlined how the areas of concern would be tackled.
She also pointed out some of the problems raised have already been rectified.
Ms Briers said: “While all our wards for older people have individual male and female bedrooms in line with NHS guidance for mixed sex accommodation, we are reviewing how we can strengthen this single-sex provision to ensure we do not breach the guidance.
“On the day of the inspection, the CQC found a cleaning issue on Parsonage Unit. We have since reviewed our cleaning plans and are assured there is a robust cleaning schedule in place to maintain environmental hygiene at all times.
“Our new 2018 Manual Handling Policy and Procedure contains guidance and standardised risk assessments for all staff to use and follow.
“Two patient-related medicines concerns were raised with the ward manager at the time of the inspection and were promptly addressed, resulting in no harm to the patient.
“Beds on Parsonage Unit are fixed in position to enhance patient safety and reduce ligature risks. A concern relating to the potential difficulty of less mobile patients being able to reach the alarm as a result of the fixed beds was identified during a recent internal patient safety visit and we are considering an approach to improve this.
“However, patients are kept safe through two additional alarm points in each bedroom and emergency alarm buttons provided for less mobile patients to wear. This is in addition to frequent staff checks during the day and night.
“We are looking at how to improve the way wardrobe doors on Golborne Unit are opened to make sure patients with dementia are able to use them effectively.
“We can confirm there is a shower curtain in the assisted bathroom on Golborne Unit to protect patient dignity.
“Following identification of out-of-date supplies during the inspection, immediate safety checks were carried out and supplies replaced to maintain safety, prevent harm and ensure staff had appropriate supplies to carry out their role. These checks have beenembedded into our standard practice to make sure supplies do not become out of date.”
The Trust also spoke about the importance of producing balanced meals and promoting choice of food for patients after the CQC queried this.
On the autism ward Ms Briers said feedback from patients and carers had been positive, with staff described as kind and caring, and stressed person-centred care plans were developed to identify and manage risks.
The CQC had expressed considerable concern about this Warrington-based service for people from across the region, with incoherent use of interventions, inappropriate and aggressive behaviour towards a patient spotted and care practices departing from national guidelines.
Ms Briers also responded to the CQC’s concerns about waiting times to get help from community-based services.
She said: “We aim for people to be able to access our services safely and effectively, without delay.
“Waiting times are reviewed on an ongoing basis, and action is taken as necessary to address any increases and keep patients safe. “Introduction of a screen panel to review all cases on the waiting list and a review of care pathways have already had a positive impacton Wigan Assessment Team waiting times and access to face-to-face assessment appointments.”
The overall verdict from the CQC, though, was that the region’s mental health services were in a strong position and getting better.CQC deputy chief inspector and lead on mental health Dr Paul Lelliott said: “Since our previous inspection in 2016, there has been a significant change in the structure of the trust and expansion to its services. It is therefore pleasing to see the improvements we had seen being maintained.
“In general, we found the trust leadership to be strong. Inspectors noted that the prevailing culture across the trust was to put patients at the centre. Staff recognised this was a top priority which was reflected in the staff survey results.”