Welsh hospital ward ordered to make serious improvements after safety issues exposed

A ward at a hospital in Wales has been told it needs to make several improvements after a surprise inspection. After an unannounced visit at the Bryngolau Ward run by Hywel Dda University Health Board at Prince Phillip Hospital Llanelli, Healthcare Inspectorate Wales (HIW) has published a report identifying several areas that need ‘immediate improvement’ for patient and visitor safety.

The Bryngolau Ward provides specialist mental health care and services for older adults. The key concerns included unsecured areas like fire doors wedged open, cluttered areas near fire exits, and broken handrails.

While some of the issues found were addressed during the inspection, inspectors have noted that stronger governance procedures are needed to to effectively identify and manage risks. They have also recommended a full review of the audit and risk management procedures.

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Inspectors noted that even though an in-date ligature point audit process was in place at the ward, it did not detail each ligature risk. This included areas that were identified during the surprise inspection. Inspectors found that more attention is needed to make sure that staff recognises and captures all ligature risk points to maintain patients’ safety. For the latest health news, sign up to our newsletter here.

There were also concerns regarding the recording of restraint incidents. Inspectors found that even though more than 80% of the staff was trained in Reducing Restrictive Practices (RRP) training, the data did not detail which staff were involved in restraint incidents thereby making it difficult to verify whether only those trained were engaging in these practices. To improve accountability, the inspectors have recommended that improvements need to be made to the record keeping of staff involved in such incidents to enhance accountability.

Even in the light of these concerns, the staff at the wards were seen to be treating patients with kindness, respect and enthusiasm. The patients themselves gave a positive feedback on the care and treatment they were getting and the inspectors discovered that the staff had a strong understanding of safeguarding procedures and reporting protocols.

However, recommendations have been made for a structured programme of therapeutic activities to support the wellbeing of patients and rehabilitation. Some environmental improvements like re-positioning sensory boards, improving garden accessibility, and enhancing the overall therapeutic setting were also recommended.

Even though training compliance is high with 95% of staff has completed Basic Life Support (BLS) training, it was significantly lower for Immediate Life Support (ILS) training at 33%. Inspectors have called on the ward for ‘urgent action’ to address this gap and to make sure that staff receive and complete mandatory training.

In October 2023, a fire risk and assessment (FRA) at ward found several high risk issues. This included the improper storage of oxygen cylinders. In the current inspection, inspectors found that five oxygen cylinders that were not secured and posed a health and safety risk.

There were also issues in the infection prevention and control (IPC) including improper clinical waste storage and unlabelled food items. It was noted that even though staff compliance with IPC training was high, more work is needed to ensure that there is consistent adherence to IPC standards across the ward.

Inspectors also noted that the absence of patient photos on medication records created a potential risk of errors, while medication management was generally robust. The inspectors also made a note of gaps in post-rapid tranquilisation checks which highlighted the need for improved record-keeping and adherence to monitoring protocols.

Apart from this, feedback from the staff showed concerns regarding communication and senior management visibility on the ward, while some staff reported dissatisfaction and low morale. Further staffing issues were a critical issue as there were frequent shortfalls, and a heavy reliance on agency and bank staff. To ensure appropriate staffing levels and skillsets, an establishment review has been recommended.

HIW said that their report includes ‘a series of recommendations aimed at addressing these issues’ and that they will continue to monitor the health board’s progress in implementing these improvements.

Chief Executive of Healthcare Inspectorate Wales, Alun Jones said: “This inspection highlighted areas requiring immediate improvement to ensure the safety and wellbeing of patients, staff, and visitors at Bryngolau Ward. While it is encouraging to see the dedication and compassion shown by staff, there is an urgent need to address issues related to governance, staffing levels, and the overall environment to support safe, effective care.

He added: “We are committed to working with the health board to implement the necessary changes and improve patient care. Our recommendations will help strengthen staff support, improve governance, and create a safe, therapeutic environment for all.”

Liz Carroll, Director of Mental Health and Learning Disabilities at Hywel Dda University Health Board, said: We take on board all the comments and recommendations made in the Healthcare Inspectorate Wales (HIW) report into the Bryngolau mental health ward at Prince Philip Hospital, Llanelli, which provides specialist mental health care and services for older adults.

She added: “We immediately rectified issues identified for urgent improvement by the inspection to ensure the continued safety of patients, staff, and visitors. These concerns related to the physical environment of the ward. A comprehensive improvement plan, which includes strengthening processes for effectively identifying and managing risks as well as a fully reviewing audit and risk management procedures, is in place."

“Also, a number of improvements to enhance patient experience, including the introduction of a programme of therapeutic activity with further improvements to the ward environment and patient garden planned to be undertaken early next year. I am pleased to see that the report praised the way that staff support patients in a kind and respectful manner and that positive feedback was received from patients in our care."