'Unsafe' Antrim psychiatric unit will not be replaced for four years
A psychiatric intensive care unit that does not meet basic safety standards will not be replaced for at least four years, it can be revealed today.
Lissan 1, a unit at Holywell Hospital on the outskirts of Antrim, provides care to men who are experiencing severe mental crisis and are some of the most vulnerable patients in Northern Ireland.
It can also be revealed that ligature risks in the unit remained three years after they were identified by the Northern Health Trust as a risk to patient safety.
The age of the building means that the Northern Health Trust has struggled to reduce the number of ligature points around the ward, but it has now emerged that a planned new psychiatric hospital will not be open until at least 2024.
It is the latest damning indictment of the facilities and care available to patients with mental ill health in Northern Ireland, coming as police probe allegations of abuse of residents by staff at nearby Muckamore Abbey Hospital.
The Alliance Party's health spokeswoman, Paula Bradshaw, said: "Ensuring the safety of patients is the absolute minimum level of care that should be provided by the Northern Trust.
"I am horrified to learn that this is not being afforded to the vulnerable patients of this psychiatric intensive care unit. It is recognised and lamented that the health and social care system here is under tremendous financial pressures. However, the failure to implement the changes required to make the unit safe is indefensible and needs to be addressed with the utmost urgency."
Northern Ireland's health watchdog first raised concerns about the safety of patients at Lissan 1 in 2016.
The Regulation and Quality Improvement Authority (RQIA) was so concerned by the findings of an inspection of the ward in May of that year that it raised the matter with the Department of Health and the Trust's chief executive.
The RQIA's report from the inspection said: "A large number of ligature points located on the ward required to be removed/managed.
"Inspectors were concerned to note a number of ligature points located within the ward. These included taps and door fixtures.
"The Trust had completed an audit of the ligature points within the ward in July 2015. A large number of ligature points were recorded. A subsequent action plan had also been produced.
"The action plan detailed specific timetables within which ligature points would be removed, replaced or subject to a locally (ward staff) managed protocol.
"However, inspectors noted that the timelines for completion of ligature works had slipped and ligature points and associated risks remained.
"The audit completed in July 2015 suggested that a number of ligature points could be managed by the ward staff.
"It was concerning to note that the suggested action plan, including the management of ligature points by ward staff, had not been agreed with the ward manager.
"Given the seriousness of these concerns, this issue was escalated to the Trust's Chief Executive and the Department of Health on June 10, 2016."
The RQIA ordered the Trust to create a clear plan as to how it would manage ligature risks to help ensure patient safety, with a deadline of July 1, 2016.
However, when the RQIA returned on January 23 and 24, 2018, the inspector found that the call for improvement given following the visit in May 2016 had not been met.
He also discovered that not all ligature points identified during a risk assessment in July 2015 had been dealt with.
"Areas requiring anti-ligature work remain outstanding from 2015, such as the water cooler dispenser and window supervision levers in the gym door and interview rooms," his report said.
He was also told by the ward manager that he had reported concerns about the risk of a ligature on a pillar in the ward to Trust senior management on January 4, 2018 and had requested measures to be put in place to manage the risk. However, at the time of the inspection, no reply or response from senior management had been received.
The report also said the ward's design was still not in accordance with the standards for a psychiatric intensive care unit as set out by the National Association of Psychiatric Intensive Care and Low Secure Units Guidance for Commissioners of Psychiatric Intensive Care Units 2016.
He noted that the Trust had submitted an application to the Department of Health requesting capital to commence building a new acute inpatient mental health admission facility.
Responding to the concerns highlighted by the RQIA, a Northern Health and Social Care Trust spokesman said it is hoped the Trust's business case will be approved in 2019/20.
He said it is believed the scheme will take between four and four-and-a-half years to complete, subject to all approvals of funding being in place.
He continued: "Patient safety remains the utmost importance for the Trust.
"It is acknowledged that there are inherent challenges regarding ligature points on mental health hospital sites including Holywell Hospital.
"The Trust recognises the importance of actively managing this risk and has escalated it to a corporate risk level."
The spokesman added: "There is an audit tool in place for the ongoing assessment of ligature risks and regular liaison with estates services departments to ensure that any works required are undertaken in line with Trust policy and in a timely manner."