Immediate improvements needed at Haverfordwest's Withybush hospital

An unannounced three-day HIW inspection took place in August, identifying a number of infection, prevention and control, governance and patient safety issues, which required immediate action, exacerbated by the demand on the emergency department, far exceeding the capacity and resourcing available.

Hywel Dda University Health Board had declared an internal major incident that month after Reinforced Autoclaved Aerated Concrete (RAAC) was discovered at the hospital; HIW acknowledging the significant challenges presented after the closure of over 100 beds for safety reasons.

“Staff were not able to effectively protect the privacy and dignity of all patients due to the high numbers of people presenting to the department, and the limited space available as a result of poor patient flow within the wider hospital. Structural issues within the hospital were also significantly impacting patient flow, with multiple wards closed for safety,” an HIW report said.

Inspectors found patients were being accommodated in several ‘surge’ areas – used when the hospital has reached over-capacity - within the Emergency Department; patients being seated or bedded in open areas of the department, and more than one patient within a cubicle at a time.

Staff were “working hard to ensure patients were provided with dignified and respectful care despite significant challenges,” but some reported not being able to provide timely care to patients due to the numbers of patients present in the department and insufficient staffing levels.

“Immediate improvements were needed in relation to infection, prevention, and control processes to minimise risks to patients, staff, and visitors. Inspectors identified several immediate assurance issues, which required the health board to take urgent action,” the report added.

“Examples included staff not always wearing the appropriate protective equipment or adhering to infection prevention policies, and ineffective cleaning due to overcrowding.

“Risk assessments were found to be outdated and checks regarding the availability of lifesaving equipment during an emergency were not consistent. It was noted that whilst the department was warm there were no blankets or pillows provided for those patients sleeping in chairs overnight. There was a short supply of toilet and shower facilities and amenities available for patients.”

HIW said it was informed that the General Surgical Clinical team has been unable to sustain a 24/7 consultant on-call cover at the hospital due to vacancies and staff absences, with patients who required a transfer from the department to Bronglais Hospital for surgery due to these circumstances.

Chief Executive of Healthcare Inspectorate Wales, Alun Jones said: “There are mounting pressures on NHS services and Withybush General Hospital, like all hospitals across Wales, continues to face extraordinary challenges due to increased demand. Patient flow is a nationally recognised problem, caused by system-wide pressures and HIW acknowledges the health board is working to manage these challenges.

“It is positive to hear the commitment of staff to ensure the fundamental care needs for patients are being met at such a challenging time. Some immediate improvements were identified during our inspection, and I hope this report will accelerate Hywel Dda University Health Board to take improvement action. We will continue to engage with the health board to ensure progress against our findings.”

Andrew Carruthers, director of operations at Hywel Dda University Health Board said the HIW comments and recommendations were being taken on board.

“There is always a great deal of pressure on Emergency Departments. The situation at Withybush Hospital was particularly challenging as the inspection happened shortly after the health board declared an internal major incident due to the discovery of Reinforced Autoclaved Aerated Concrete (RAAC) planks at the site. This led to the closure of six wards and the loss of 100 beds, so we were unable to transfer patients from the Emergency Department to our wards as we would normally do.

“However, I am pleased to see that the report praised the way that staff had dealt with patients in a kind and respectful manner and that they had received some positive feedback from patients and relatives.

“I would like to take this opportunity to yet again thank the public and patients for their support and understanding during this difficult time at Withybush and also staff who have had to work under challenging conditions in order to deliver care.”