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8 Ysbyty r Eglwys Newydd Whitchurch Hospital Park Road, Whitchurch. Heol Parc, Yr Eglwys Newydd Cardiff, CF14 7XB Caerdydd, CF14 7XB Phone Ffôn Eich cyf/your ref: RW/JP/EAST2A Ein cyf/our ref: PH-sj Welsh Health Telephone Network: Direct Line/Llinell uniongychol: Paul Hollard Interim Chief Executive 6 TH June 2012 Ms C Thomas Head of Inspection Healthcare Inspectorate Wales, Bevan House, Caerphilly Business Park, Van Road, Caerphilly, CF83 3ED Dear Ms Thomas Healthcare Inspectorate Wales Mental Health Act visit to : Ward East 2A (Patient Intensive Care Unit), Whitchurch Hospital Date of Visit: 23 January 2012; Visit Reference: RSMH/18826 I write in respect of the announced visit to Ward East 2A at Whitchurch Hospital and the subsequent report from Healthcare Inspectorate Wales, Review Service for Mental Health. Cardiff and Vale University Health Board acknowledges and very much appreciates the positive comments made by Mrs Mackenzie, Reviewer on the day, particularly about the provision of positive, highly motivated and supportive clinical nurse leadership. It was also pleasing to note Mrs Mackenzie s observation that the ward cleaner is much valued for his hard work and humour by patients and staff. I will ensure that her comments are passed on to those members of staff. Description of Service The Health Board must inform HIW of the plans and time scales for this essential service development. Contd Bwrdd Iechyd Prifysgol Caerdydd a r Fro yw enw gweithredol Bwyrdd Iechyd Lleol Prifysgol Caerdydd a r Fro Cardiff and Vale University Health Board is the operational name of Cardiff and Vale University Local Health Board

9 2 6 th June 2012 A review of Adult Mental Health Services across Cardiff and the Vale of Glamorgan was undertaken during 2012 by a multi agency steering group chaired by the Vice Chair of the University Health Board. As part of a range of recommendations, the Review Steering Group proposed a move away from the current model of undifferentiated locality inpatient wards to establishing dedicated in patient treatment wards accessed from an Assessment/Triage ward. It was also recommended that the separate Crisis Teams should be re-aligned within a single Crisis service. A project plan was developed by the Mental Health Division in April 2012 which included proposals to establish a dedicated Assessment/Triage ward in advance of the commissioning of the new Adult Inpatient Unit planned for the University Hospital Llandough site which, subject to Full Business case approval, will be commissioned in The project plan includes the re-designation of Ward East 5A at Whitchurch Hospital as the Assessment/Triage ward. In parallel with this exercise, work is ongoing to review the alignment of current CMHTs with the remaining Treatment and Recovery wards, the remodelling of the medical staffing structure to better support the Assessment/Triage ward model and the co-location of Crisis Teams at Whitchurch Hospital. Our expectation is that the Treatment and Recovery wards, of which Ward East 2A will be one, will have an improved ward milieu with a clear focus on delivery of care and treatment without having to deal with the disruption of unexpected admissions. This in turn should ensure that service users have an improved experience of in patient care as a whole. It is anticipated that these changes will be implemented towards the end of 2012/ early We will of course keep HIW updated of progress. Environment The Health Board must ensure that an interim refurbishment programme, particularly redecoration of patients rooms, new flooring, storage and improved privacy and dignity for patients, is undertaken as a matter of priority. Redecoration of three bedrooms has been successfully negotiated with the Estates department. One room at a time will be closed for a twenty-four hour period to accommodate this so there will be minimum disruption to the ward. A quote for new flooring to replace the gallery carpet has been obtained and this cost has been approved by the Directorate Manager. Contd Bwrdd Iechyd Prifysgol Caerdydd a r Fro yw enw gweithredol Bwyrdd Iechyd Lleol Prifysgol Caerdydd a r Fro Cardiff and Vale University Health Board is the operational name of Cardiff and Vale University Local Health Board

10 3 6 th June 2012 New storage lockers have been delivered to enable patients to store a small amount of personal belongings on the ward. As the ward environment does not have sufficient space to accommodate larger items, the University Health Board has acquired two secure rooms to store large items/ amounts of clothing and personal possessions. This storage can be accessed by the patient with a member of staff at any time. The Health Board must provide HIW with the outcome of the Divisions review of environmental risk and actions planned to address these events. Dimmer switches will be fitted to the outside of the patients bedrooms. This will allow staff to safely observe patients without disturbing them through the night by opening the bedroom door and either turning on the light or shining a torch. The Division awaits a date for this work to commence. An audit has been completed by the Ward Manager and the Health and Safety Advisor assessing the ligature risks on the ward. The Health Board must ensure that there is an adequate ventilation system in the smoking room to ensure that the smoking room facility is appropriate for use. The fan in the smoking room has been cleaned on three occasions since the Reviewer s inspection. It has now been identified that the fan in place is no longer fit for purpose. A quote has been requested for a replacement fan and will be forwarded to the Directorate Manager for approval once obtained. Chairs have also been purchased for the smoking room. Multi-disciplinary Team The Health Board must review the membership of the multi-disciplinary team on East 2A with a view to ensuring appropriate, consistent professional membership and effective and collaborative multi-disciplinary teamwork. Contd Bwrdd Iechyd Prifysgol Caerdydd a r Fro yw enw gweithredol Bwyrdd Iechyd Lleol Prifysgol Caerdydd a r Fro Cardiff and Vale University Health Board is the operational name of Cardiff and Vale University Local Health Board

11 4 6 th June 2012 The Multidisciplinary team for the ward regularly consists of the relevant consultant psychiatrist, junior medical staff, nurses and a pharmacist. Other disciplines, such as Occupational Therapy or Dietetics attend the ward as requested to accept referrals, complete assessments and continue ongoing work with specific patients. There continues to be a lack of dedicated psychology input to the inpatient area and the Health Board is currently undertaking a review of psychological services. Administration of the Act It was pleasing to note that documentation relevant to and supporting the admission of detained patients was compliant with the Act. I can confirm that trends have been identified with regard to inconsistent standards of reporting by Approved Mental Health Professionals during the admission process. This has been raised with the Local Social Services Authorities by the Mental Health Act Manager. Mental Health Act documentation will continue to be scrutinised and audited by Mental Health Act Administrators for quality purposes and performance monitoring outcomes will be reported to the Mental Health Act Monitoring Committee. The Health Board must inform HIW of what plans are in place for upgrading and/ or repositioning the Section 135/136 assessment area as the facilities remain totally inadequate. An additional waiting room has been identified to accommodate patients and Police officers on arrival at the hospital however there are no plans to relocate the assessment area at present. I hope that my comments are helpful. Please do not hesitate to contact me if you have any further queries. Yours sincerely Paul Hollard Interim Chief Executive Cc Dr Sharon Hopkins, Executive Director of Public Health Helen Bennett, Divisional Nurse, Mental Health Division Dr Maria Atkins, Clinical Director Bwrdd Iechyd Prifysgol Caerdydd a r Fro yw enw gweithredol Bwyrdd Iechyd Lleol Prifysgol Caerdydd a r Fro Cardiff and Vale University Health Board is the operational name of Cardiff and Vale University Local Health Board

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18 Ysbyty r Eglwys Newydd Whitchurch Hospital Park Road, Whitchurch. Heol Parc, Yr Eglwys Newydd Cardiff, CF14 7XB Caerdydd, CF14 7XB Phone Ffôn Eich cyf/your ref: Ein cyf/our ref: PH-sj Welsh Health Telephone Network: Direct Line/Llinell uniongychol: Paul Hollard Interim Chief Executive 25 May 2012 Ms C Thomas Head of Inspection Healthcare Inspectorate Wales Bevan House Caerphilly Business Park Van Road Caerphilly CF83 3ED Dear Ms Thomas Healthcare Inspectorate Wales Mental Health Act visit to : Ward East 1, Whitchurch Hospital Date of Visit: 18 January 2012 Visit Reference: RSMH/18825 I am writing in respect of the routine visit to Ward East 1, at Whitchurch Hospital, by Mrs Jane Mackenzie, Reviewer on the day, and of the subsequent report from Healthcare Inspectorate Wales, Review Service for Mental Health. Cardiff and Vale University Health Board acknowledges and appreciates Mrs Mackenzie s complimentary comments about the nursing team as well as her observations concerning the positive impact that national initiatives and projects have had on the ward to improve quality and efficiency which has benefitted patients considerably. The Health Board must consider as a matter of priority, an interim ward refurbishment programme and to ensure necessary facilities and equipment are available to support the recovery and rehabilitation process for patients on East 1. I can confirm that the directorate has allocated funding to upgrade and replace the flooring on East 1. As part of the continuing service development of the ward a capital bid has also been submitted to completely refurbish the ward. The aim of this development is to maintain the evidence based efficacy and quality of the interventions provided by the ward, along with maintaining the dignity and respect of those who are inpatients by providing individual rooms to service users and a redesign of the whole ward environment. The Health Board must consider suitable sitting/resting furniture that will afford reasonable comfort for patients using the smoke room for short periods. Bwrdd Iechyd Prifysgol Caerdydd a r Fro yw enw gweithredol Bwyrdd Iechyd Lleol Prifysgol Caerdydd a r Fro Cardiff and Vale University Health Board is the operational name of Cardiff and Vale University Local Health Board

19 It is pleasing to note that HIW supports the view that smoking should be discouraged to promote good health. However the decision of ward staff to remove chairs from the smoking room to deter patients from remaining in there for a long time was made with the best intentions particularly as it was felt that this was impacting on patients health and care programmes. The situation has now been reviewed and a successful bid has been submitted to upgrade the smoking area. There will be a new fit for purpose extraction fan to maintain air quality and chairs to ensure service user comfort. I hope that my comments are helpful. Please do not hesitate to contact me if you have any further queries. Yours sincerely Paul Hollard Interim Chief Executive Copy to: Dr Sharon Hopkins, Executive Director of Public Health Helen Bennett, Divisional Nurse, Mental Health Division Dr Maria Atkins, Clinical Director Bwrdd Iechyd Prifysgol Caerdydd a r Fro yw enw gweithredol Bwyrdd Iechyd Lleol Prifysgol Caerdydd a r Fro Cardiff and Vale University Health Board is the operational name of Cardiff and Vale University Local Health Board