Written Statement - Trusted to Care Spot Checks of Older People’s Mental Health Wards in Wales

In a Written Statement published on October 16, 2014 about the publication of the Trusted to Care spot check reports, I announced this programme of work would be extended to older people’s mental health wards.

Work is currently ongoing to analyse the full results of this further round of spot checks into the care provided to some of the most vulnerable people being looked after in Welsh hospitals. This statement updates Assembly Members on the preliminary results available from this important piece of work while the more detailed reports for each health board area and a national report are finalised.

During November and December 2014, 22 of the 51 wards providing mental health care for older people in Wales have been reviewed by teams made up of senior older people’s mental health nurses, pharmacists and occupational therapists drawn from the majority of health boards in Wales. Medical input was also provided during some of the spot checks.

These teams were led by professionals involved in the earlier spot checks, which took place in the summer of last year following the publication of the Trusted to Care report. I would like to put on record my thanks the review teams for their hard work and expert advice.

Professor June Andrews, director of the Dementia Services Development Centre; Mark Butler, director of The People Organisation and Professor Phillip Routledge, the former chairman of the All Wales Medicines Strategy Group, who developed the process for the first round of spot checks, also helped us devise the methodology for the spot checks of older people’s mental health wards. They were assisted by senior nurse Donna Ockenden, consultant psychologist Kim Williams and Healthcare Inspectorate Wales. This group’s work has been both helpful and informative.

Wards in every health board area in Wales have been reviewed, including those which provide care for older people with conditions such as dementia and mental illnesses, including depression and psychosis. The spot checks focused on the following issues, in common with the first phase of spot checks in general hospital wards:

• Continence care and personal care;
• Nutrition and hydration; 
• Medication, sedation and antipsychotic prescribing.

However, because of the particular needs of older people with mental health problems, the spot checks also focused on some specific areas:

• Use of restraint and the application of the appropriate safeguards; 
• Daily activities;
• Relatives or carers and their involvement in the care of their loved ones;
• Culture and leadership.

As with the earlier spot checks, these visits revealed many areas of good and excellent practice across Wales. All staff responsible for delivering high-quality, person-centred care to this vulnerable client group should be congratulated.

The review teams learned a significant amount from this process and benefitted from sharing ideas and experience. We want to see this continued and an older people’s mental health inpatient community of practice is being set up by Public Health Wales so this important work can be further developed and continued.

As expected, the spot checks also revealed some areas where improvements need to be made. The review teams identified considerable variation in standards and practice between and within health board area, which must be acted on. These include issues relating to:

• Prescribing and the storage of medications; 
• The skill mix of staff available to provide the most appropriate care; 
• Staff training; 
• The quality and dementia friendliness of the ward environment; 
• The application of mental health and mental capacity legislation in practice; 
• The provision of catering services.

The findings from each spot check visit were raised immediately with health boards and the issues have subsequently been raised with both the NHS chief executives and vice chairs who have responsibility for mental health services.

Detailed, individual reports about each visit will be published on the Welsh Government website together with a national report setting out further details of the themes, which have emerged from this process and recommendations for future action.