Patient safety concerns at child mental health unit in Wales
- Published
In March, inspectors found one patient had been fully restrained 109 times in six months at the unit
All patients from Wales at an inpatient child and adolescent mental health hospital have been removed after concerns about their safety, including excessive use of full restraint.
In one case, a young patient was restrained for more than an hour and a half at the hospital in Ebbw Vale.
BBC Wales understands that patients from England have not been removed.
Regis Healthcare said "historic reports are not a judgement of the current situation" and it had new management.
Healthcare Inspectorate Wales (HIW) , externalsaid Regis Healthcare remained a "service of concern" and was under its highest level of scrutiny.
The Regis Healthcare unit is the only "low secure" CAMHS hospital in Wales and offers services to private patients and the NHS. It has been inspected at least four times since March this year.
'We thought this type of control method was standard'
One father told BBC Wales about his teenage daughter's experience at Regis Healthcare. She had a range of complex mental health and behavioural issues and needed inpatient treatment.
Her father said he was initially impressed with Regis Healthcare but noticed things changing as time passed.
"Staff looked physically stressed while trying their best to look professional. There was a high turnover of staff and a high dependence on agency staff.
"This situation unsettled my daughter which led to further behavioural issues. It's a vicious circle. After a short while she was restrained a lot to control her behaviour.
"We thought this type of control method was standard and it seemed that it was the only place that didn't want to 'get rid' of her."
His daughter has now been moved to a unit 200 miles (320km) away from home.
Problems became apparent in the March inspection when HIW said the service was not compliant with regulations to safeguard patients from abuse.
Inspectors looked at the practice of full restraint - which means restraining a patient while on the floor, sometimes involving up to five members of staff.
NICE guidance said patients should not be restrained for longer than 20 minutes.
'Humiliating'
The inspection found:
A random sample of six patients showed one person was fully restrained 109 times in six months while another was restrained 76 times.
Another random sample showed patients were restrained for "excessive durations".
One patient was restrained for an hour and 40 minutes and two others were restrained for an hour each.
Seven patients told inspectors that full-floor restraints were used daily.
There were no individual risk assessments for restraint.
Young patients told inspectors the practice of restraint was undignified and "humiliating and uncomfortable to watch"
Significant concerns were also found with governance, staff numbers and record keeping.
A subsequent inspection noted there had been a decrease in floor restraints from 260 in January to 136 in June. But it also said there were not enough staff to provide safe patient care or look after patients who needed to be watched constantly.
The cleanliness of the wards was also described as "poor" and on two occasions inspectors said there was an overflowing sanitary bin in one of the ward toilets.
Regis Healthcare said the low secure unit was now "excelling in providing quality care"
In June, HIW stopped Regis Healthcare from admitting any new patients from Wales.
Three months later the decision was made to remove all patients from Wales.
The most recent inspection report released this month said this was due to "the lack of significant or sustained improvements, the absence of strong leadership and management of the hospital, inadequate governance… and the potential impact of these on the safety of patients".
'A last resort'
A mental health consultant with 40 years' experience in the NHS said restraint should be a last resort and could have a detrimental impact on someone's mental health, including post-traumatic stress disorder in extreme situations.
Helen Bennett added: "If you have to restrain once you have to look at what's going on, so for someone to be restrained that many times is very concerning.
"I would be looking at staffing, support from the organisation, leadership, the philosophy of the unit, environment of care, the mix in the unit, staff and training and whether there's a use of agency staff."
In October, Regis Healthcare was named as the "fastest growing business in consumer services" in the Wales Fast Growth 50 business awards.
The company said it has a new board of directors and a new management team, which took over in October, and it was now "excelling in providing quality care".
Monitoring
A spokesman added: "All staff are contracted and we're currently not using agency workers.
"Following the recent [HIW] inspections, we are now in a better and improved position to be able to work with commissioners to provide a much-needed CAMHS service for young people."
A HIW spokeswoman said Regis Healthcare had made written representations detailing the actions they were going to take to address concerns.
"We will be monitoring the service very closely to ensure the required improvements are made."
- Published24 September 2018
- Published24 September 2018
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