Shake-up at Irvine Unit follows complaint investigation

Hastings and Rother Primary Care Trust received a report on Wednesday on the situation setting out in detail the action now being taken.

On Monday, officers of the League of Friends of Bexhill Hospital, which has also been concerned about low staff morale at the unit, were given assurances that a new manager had been appointed and more nursing staff recruited.

The 54-bedded unit, used for intermediate care, rehabilitation and palliative care, was the subject of a complaint last December from the relative of a patient at the unit who had died following transfer to the Conquest Hospital.

Trust interim chief executive Vanessa Harris says this complaint followed earlier concerns that had already led to actions being put in place in late 2007 to improve care there.

A panel was set up under the chairmanship of Stuart Welling, a non-executive director of the Trust.

Vanessa Harris says in summary: "The panel considers that there was a decline in standards on the Irvine Unit over a period of time and a general failure of the management to recognise and rectify this.

"However, the review, which reported in June, considers that 'senior managers within the new PCT had taken significant action to remedy the situation' and makes a number of further recommendations for addressing the key issues."

An action plan is now being implemented including:

*Appointment of a new management team

*Increased specialist input

*Better multi-disciplinary working

*A staff development programme

*Improved patient record systems

*Dedicated nursing teams

*Improved discharge of patients

*Updated admission criteria.

Other action has included identifying a lead director to ensure the recommendations are implemented; agreeing monitoring arrangements; implementing a staff communications programme; auditing mandatory training for staff

and establishing a clinical lead accountable for professional development.

Vanessa Harris says that as a matter of policy "and certainly within six months," the Trust will:

*Increase the level of medical cover in the unit

*Review the role and function of the unit

*Ensure that all staff have up-to-date personal development objectives and performance plans

*Establish a rolling programme of patient satisfaction surveys

The complainant alleged that the Irvine Unit had not provided an acceptable level of physical and mental care for the patient and had requested an immediate review.

A chronology of events submitted by the complainant listed a series of failings regarding the patient's care. This included references to specific staffing issues, clinical and personal care given and communication issues.

It also included a formal complaint regarding the involvement of the GP practice of the patient.

The report says the complaint highlighted the failure of communication between the Irvine Unit and the GP practice.

The former chief executive of the PCT had responded in February, expressing his concerns at the content of the complaint.

"He accepted that there had been shortcomings and referred specifically to the apparent failure in the admission processes, staffing issues, failures in communication, and deficiencies in the personal and clinical care received by the patient.

Concerns had been expressed in June last year about the Irvine Unit. The Trust had set up an external independent review as a result of a briefing paper by its head of adult services for Hastings.

The independent review by a professional consultant took place last October and November. The Trust approved the closure of 12 beds at the end of November, six of which were re-opened this March, reflecting improving staffing levels.

It was agreed that the six remaining beds would re-open "when the investigation of the panel established by the PCT board had completed its deliberations and the concerns expressed had been alleviated."

The reviewer was asked to look at:

*A high number of incidents and complaints

*Significant failure of staff to undertake mandatory training

*Ongoing issues regarding staffing levels

*Temporary cessation of the Day Hospital

*Ongoing issues regarding staffing leadership, skill mix and management

"The general findings of the report concluded that the unit was disorganised and poorly managed with no obvious nursing leadership in place.

"Therapy input was inadequate and there was a lack of communication and an uncoordinated approach between professionals.

"Patient progress was in some cases impeded by delays in assessment, goal-setting and appropriate therapy-centred care."

The review said nursing care was provided in a "ritualistic, staff-centered manner which was neither holistic nor specific to patients' needs."

It said the balance between qualified and unqualified staff was inappropriate and unqualified staff were not properly used or supervised.

Care planning and documentation fell below standards set by the Nursing and Midwifery Council.

In a ten-point finding, the panel says: "Unit morale was poor and there were historical ingrained cultural issues and inappropriate staff attitudes which prevented the unit from moving forward and providing high quality care to patients..."

In conclusion, the panel says: "It is evident that the Irvine Unit had been subject to a a lack of effective management.

"It is clear that the senior managers within the new PCT have taken significant action to remedy this situation

"It is important that the processes of change management and robust action planning continues to allow staff to develop into new roles and new ways of working to increase the professionalism in the unit from all staff."