A health watchdog has vowed to continue raising concerns about staff shortages, as it found units relying on agency staff to fill the void.
The Mental Welfare Commission released the findings of 13 inspections of wards across the Scotland on Wednesday, including visits to Stobhill Hospital, Glasgow, and the Melville unit at Edinburgh’s Royal Hospital for Children and Young People.
Claire Lamza, executive director (nursing) at the commission, said that while many of the “reports include very positive comments about staff, they also give an insight into the pressures caused by staff vacancies,” and said the watchdog would “continue to raise concerns about staff vacancies”.
“The consequent over-reliance on agency or bank staff, particularly in nursing, is evident,” she said.
The commission reported concerns about staffing at many of the units they visited, with carers at Marchburn Ward at East Ayrshire Community Hospital having told inspectors of the “use of bank staff due to staff shortages and the implication this could have on the consistency of care”.
The report said there are five registered nurse vacancies, but the service “is in the process of re-advertising the vacancies”.
At the Royal Hospital for Children and Young People’s Melville Unit, inspectors were “told that staff shortages can present problems, especially at weekends when bank and agency staff tend to cover the majority of shifts”.
“Some of the young people told us that they did not feel as safe or supported when bank and agency staff were on shift; these staff do not have the same understanding of their care and treatment plan as regular staff,” the report said.
“Relatives that we spoke to were of the view that multiple changes in staff has contributed to a lack of consistency in their child’s care.”
Of the commission’s unannounced inspection of the Skye House Regional Adolescent Inpatient Unit at Stobhill Hospital, report writers said that in recent years “the staffing of the unit has continued to appear fragile and this has particularly been the case during the Covid-19 pandemic”.
“Vacancies for the case manager posts, which are key to the co-ordination and integration of care and support for communication between inpatient and community services, has been difficult and we heard that the difficulties in recruiting and retaining of ward nursing staff has had an impact on staff morale and the service overall at times,” the report said.
“Due to these challenges in the unit, we are aware that, on occasion, other members of the multidisciplinary team have replaced nursing staff in supporting ward activities such as meal time management for the young people.
“The teamwork and collaborative attitude behind this practice is noteworthy and commendable, however we believe it is important that this practice is clearly tracked to ensure it is supported by proper governance and is monitored to ensure that this response by other colleagues is required only exceptionally.”
Inspectors also said they became “acutely aware of the particular demands placed on staffing levels when trying to support young people with eating disorders appropriately in the context of wards in which self-isolation practice was in place” at the in-patient unit for youngsters aged 12- to 18-years-old.
And at Aberdeen’s Royal Cornhill Hospital’s Loirston and Strathbeg Wards, inspectors said that “staffing challenges were acknowledged by managers who are continuing to be proactive in their efforts to recruit to posts”.
“A few of the patients we spoke to felt that at times, bank/agency staff were unfamiliar with their care and treatment plans which had an impact on their ability to deliver the quality of care they wanted,” the report said.
“We heard that where possible, the wards use regular bank staff to promote consistency and relationship building, which enhances the quality of care provided.”
Ms Lamza said: “We understand the pressure this puts on everyone working on these busy wards, and the lack of continuity it can bring to patients.
“We will continue to raise concerns about staff vacancies wherever we see them, while recognising the extraordinary effort being made by those working in these circumstances.
“We also found the environment and facilities on some wards to be lacking, and not conducive to positive care and treatment.”
A spokesperson for NHS Grampian said: “We are actively working to recruit to a number of posts.
“As part of this process, we are working closely in partnership with the Robert Gordon University who run the return to practice course, for nurses whose registration has lapsed.
“We will soon be launching a new advertising campaign in a further effort to boost recruitment.”
A spokesperson for NHS Greater Glasgow and Clyde, said: “We greatly value the work and commitment from all of our staff throughout the pandemic. They have gone above and beyond to deliver excellent services to our patients.
“As has been the case across the country, there have been some staffing challenges placed on all of NHSGGC’s services, including those at Skye House. These have been caused by a range of factors including, staff absence rates due to COVID-19, vacancies and more recently annual leave for staff members who have earned a well-deserved break.
“Following extensive work between the Senior Management Team and our Director of Nursing, we are pleased to confirm that all vacancies at Skye House have been recruited to and we are looking forward to welcoming new staff in the near future.”
Traey McKigen, service director for mental health with NHS Lothian, said: “When staying in any of our wards or units, people can expect to be cared for by the same groups of staff most of the time. In certain instances, we call on agency and bank staff to support us, all of whom are trained in our procedures and are familiar with our practices and values. Many of these staff are well-known in the areas they work in.
“Like other areas of the NHS, the Melville Unit is currently facing increased staffing pressures. Agency and bank staff are one of the measures used alongside bringing in experienced staff from other areas across our CAMHS and broader mental health services to help ease the impact of these pressures.
“We are always working to improve our communication, both with each other and with our patients, to ensure that we are providing holistic, person-centred care.”
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