A Northern Ireland hospital which treats extremely vulnerable patients has finally been ordered to improve by the regulator – three months after the Belfast Telegraph revealed serious concerns about what has been going on inside the facility.
Lakeview Hospital is a small specialist facility in Londonderry for those with learning disabilities and patients detained under the Mental Health Order.
The regulator said it was not even clear if patients were able to eat and drink as a result of the “disorganisation” at the site.
In December, the Belfast Telegraph revealed that four months earlier a team of inspectors from the health regulator, the RQIA, had visited the Derry hospital unannounced and were shocked by what they discovered.
But the RQIA did not make this public for months, with their serious concerns only emerging after a whistleblower contacted the Belfast Telegraph.
The inspectors’ findings were taken right to the top of the Western Trust which privately feared it may have been forced to shut the hospital – yet relatives of those cared for in the hospital were not told of the findings.
The whistleblower said that the trust’s Assistant Director of Adult Learning Disability Services, Christine McLaughlin, had in a meeting with staff described the regulator’s decision not to publish its report immediately as “an absolutely wonderful gift” because it allowed the trust to make changes without formal improvement notices — which would be public.
The whistleblower said that the trust was relieved at the RQIA’s decision to keep the process out of the public eye for so long, telling staff that if it had not done so there would have been “damning” media coverage.
Eventually, that inspection report was published in January. It revealed that the initial inspection took place after an anonymous letter to the RQIA which “outlined concerns about the standard of care, staff morale, training, recruitment practices and the governance arrangements of the Adult Learning Disability Services” within the Western Trust.
But last month the regulator conducted another inspection and now it has moved further, formally ordering the Western Trust to improve conditions at the hospital because even months of behind the scenes work – and the embarrassment of that becoming public – have been insufficient to secure the necessary changes.
The two improvement notices published today make clear that the hospital has improved in half of the 13 initial areas of concern identified by inspectors, but failed to do so in the other areas.
The RQIA said: “At this most recent inspection, although significant progress has been made on a number of those issues, concerns about adult safeguarding and incident management at the hospital remained.
“Additionally, concerns about the need to improve care and treatment to support recovery and resettlement of patients were heightened.”
The trust has been given until 10th September to make the necessary improvements. One of the improvement notices states that there has been “significant progress” around “respect to patient’s physical health care needs, fire safety and the management of anti-psychotic medications, with evidence of improved outcomes for patients”.
But it said there remained concerns about other issues, including adult safeguarding, incident management, care and treatment, and understaffing.
The RQIA said that “the wards were found to be stark, and bedrooms lacked individualisation and personal effects.
“There are insufficient quiet areas and dayrooms for patients and patients were observed to spend long periods of time in corridor areas. This was compromising their privacy and dignity at times when they displayed challenging behaviours.
“Bedrooms were not personalised to enhance patient’s stay and support their recovery despite some of the patients residing in Lakeview Hospital in excess of three years.”
It also found there was "not an appropriate standard of cleanliness within the hospital”.
Disturbingly, it said that “as a result of disorganisation it wasn’t clear that all of the patients had opportunity to have a meal and/or a drink”.
The regulator said that it had been assured by the Western Trust that patients’ families had been advised of the inspection findings, and were kept fully informed of the actions being taken.
Karen O’Brien, the trust’s director of adult mental health and disability services, said in a statement that it had “made considerable progress in a number of areas” but admitted that “a number of areas of improvement remain”.
She said: “An Improvement Plan was provided to RQIA by the trust which establishes the key focus and related work that will continue to be taken forward in relation to the identified concerns.
“This is managed through a project team and project board as well as being overseen by the trust corporate management team. As part of the normal RQIA inspection processes, families of patients in Lakeview Hospital continue to be communicated with.
“The trust is committed to providing the highest quality services for all the patients and service users in its care. The trust take very seriously the areas identified as requiring improvement in Lakeview Hospital and has demonstrated its willingness to take whatever actions are necessary to ensure the service is compliant with the relevant standards and practices.”