Statement
The safety and well-being of patients at Manannan Court, a hospital ward, is of utmost importance. Serious allegations have been made in press reports about the running of the facility and it is the Government’s duty to address them and establish that patients are being appropriately cared for.
Minister for Health and Social Care David Ashford said: ‘Recent coverage has not only raised concerns among the public but has caused anxiety and distress to patients and their families. I therefore asked senior officers to investigate the issues raised and provide a detailed response. These findings provide an insight into the complex and challenging issues involved in managing an acute unit of this nature and I am keen to share them with the public. In addition, an independent, external review of the service has been commissioned and will take place in April.’
Staffing
Over the past 12 months staffing in Harbour Suite, the acute in-patient ward at Manannan Court, has risen to seven in the morning, seven in the afternoon and six on night duty, with an additional member of staff from the Crisis Response Home Treatment Team available if needed at night. When additional staff are needed at other times or to cover staff absences, they are sourced via the nursing bank or agency staff are employed.
Staff absence in December was unusually high. On the occasion when nine members of staff were sick at the same time, two were acutely unwell, one had been injured in an incident with a resident and one was absent while an incident at work was investigated. The unit is staffed 24 hours a day and all staff absences are routinely covered.
The current shift pattern and work streams at Manannan Court were chosen by in-patient staff who had requested a change in the rotas in 2017. Unions were consulted and a consensus reached with staff as to the shift pattern they would like to adopt. This consists of two long days of 12 hours, 15 minutes, two normal length shifts and three days off per week. Overtime is paid for any additional hours worked, or can be taken as time in lieu. All overtime is on a voluntary basis and is never enforced.
Occupancy
On occasions, those under the age of 65 have been nursed in Glen Suite, the Older Adults Ward, to make way for a new acute admission in Harbour Suite. Transferring a client to the adjacent ward (still an acute psychiatric ward staffed by Registered Mental Nurses) is a medical decision based on their presentation and risk at the time. Clients moved are likely to be nearing discharge and may for example, be waiting for accommodation in the community or the allocation of a community mental health professional, or being supported at weekends.
Manannan Court was built with flexibility to increase either the Harbour Suite or Glen Suite by two beds. This ‘swing zone’, incorporated in the design of the building, is brought into play where there is a need to increase the number of beds in either ward by two.
When patients go on home leave, the bed may be used by another patient. If the home leave is successful, it is often the case the client does not return; if the patient returns, a bed is made available for them.
Therapeutic environment
Over the past year, an improved therapeutic programme has been introduced at Manannan Court. This has coincided with the introduction of an improved staff/patient ratio and has been positively received by the Mental Health Commission.
Additional to the programme, the following support is provided:
- two on-site dedicated occupational therapists – engaging with the most unwell patients to promote recovery and providing skills and expertise in planning for patients’ discharge
- a dialectical behavioural therapist - working with patients and staff to develop skills and engage in helpful coping strategies whilst on the ward
- two dedicated activities coordinators, five says per week
- a dedicated clinical psychologist who also works at weekends and evenings
Much effort has been put into developing a meaningful activity plan making use of community facilities such as the NSC, where bespoke programmes have been devised for groups.
In terms of one-to-one engagement with clients, there is less scope during the busy morning periods when ward rounds take place, than in the afternoons and evenings.
Self-harm
Incidents of self-harm or intended self-harm are documented by staff, as are accidental injuries. Policies for both are known to all staff and are reviewed regularly. Failure to report the use of ligatures is a disciplinary matter.
Manannan Court is a new facility and was made as safe as possible in terms of ligature-free environment, having been built in accordance with official guidance on the design of acute in-patient units in England, for adults aged 18 years and over.
The Harbour Suite is an acute ward for the most distressed and unwell patients. Each patient has a risk management plan and a care plan and the risk to each patient is reviewed daily. Enhanced levels of therapeutic observations are in place for the highest risk patients.
Figures for self-harm for the seven months to December 2018 have been provided to the newspaper, which clearly show the allegation regarding the number of incidents per day is unfounded.
Patients have access to every area of the ward including activity lounges, bedrooms and outside courtyards. On one occasion, when a potentially difficult situation arose, for safety reasons patients and staff were confined to the lounge area until the event was over.
Mobile phones
Manannan Court is a hospital ward, not a secure unit or a prison. Phones allow patients to contact family and friends during their recovery journey and to access music and other calming apps that enhance their wellbeing.
If mobile phones are used inappropriately they are removed. The reasons for this, to ensure the safety of the ward, are discussed with the patient. If a patient is suspected of using their phone in any way to self-harm or cause another to self-harm, staff have authority to remove the device.
Drugs
Action was taken when one patient was found with a suspicious substance. This was removed by police who have been asked to confirm the nature of the substance.
The most recent unannounced visit inspection report by the Mental Health Commission in October 2018 and the bi-annual meeting of on-Island members of the Commission with representatives of the Department of Health and Social Care on Tuesday 15 January 2019, stated that morale at Manannan Court was very good.
