Staff crisis at Edinburgh brain injuries unit delays rehab work

The Royal Edinburgh Hospital. Pic: NHS Lothian
The Royal Edinburgh Hospital. Pic: NHS Lothian
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A SHORTAGE of staff at a specialist brain injuries unit is preventing vital rehabilitation work, leaving patients without meaningful activity and stopping new admissions, inspectors have found.

A report on the Robert Fergusson Unit at the Royal Edinburgh Hospital by the Mental Welfare Commission praised the work and commitment of the staff team, but urged an increase in staff.

The report said: “The central issue raised with us throughout this visit - by patients, their relatives, and consistently by the many professionals we spoke with - was the impact of current staffing levels on patient care.”

It said four of the 20 beds in the unit were empty when they visited despite a waiting list of three patients - because staffing levels were too low to allow new admissions.

The report said staff had told them patients were being referred with increasingly complex physical and mental health needs, often requiring one-to-one nursing care.

“Staff and carers also shared concerns about safety issues on the ward and a number of carers told us they were making complaints in relation to concerns about staffing levels.

“The staff told us they currently prioritised patient safety and the management of individual behavioural and physical/personal care needs. Both staff and carers told us that for many patients, their rehabilitation needs were not currently being met.”

The commission’s report recommended that managers should review current staffing requirements.

It said in spite of the current challenges, the staff team were committed to patients and working together to provide the best level of care they could.

But the report was critical of the new purpose-built building which the unit moved into in January 2017, bringing together two wards which had previously been on separate floors.

“Staff told us that the new environment had proved more challenging to provide care for patients than the previous two wards. In the new configuration, communal areas and bedroom corridors are spread over a large footprint. The bedroom corridors are not easily visible from a central point and are difficult to supervise.”

The report described the new unit to be “rather sparse and clinical” and recommended managers should review the problem of excessive noise levels on the ward, which could cause patients stress.

The commission said: “Both staff and relatives raised concerns about increased restrictions being placed on patients due to the nature of the new ward environment and current staffing levels. They advised that patients weren’t getting out as much as they had on the previous ward.”

And it said patients, relatives and the nursing team had also raised concerns about a lack of activity and meaningful occupation. “This was a clear change since we last visited, when we found a strong emphasis on socialisation. They highlighted that staff can no longer regularly facilitate outings, such as group visits to the cinema or to go shopping.”

Lothian MSP and Tory health spokesman Miles Briggs said: “This is another staffing crisis for the health board. It is another example of some of the recruitment problems we have been having and the demand around mental health services not being just about beds, but staff.”

Professor Alex McMahon, nurse director at NHS Lothian, said. “We are pleased the individual care provided to patients in the Robert Fergusson Unit at the Royal Edinburgh Hospital building was singled out for praise. We are very aware that current staffing levels and building design need to be reviewed. A service review is planned for the New Year to establish more effective workings models within the bespoke environment to maintain those high levels of patient-centred care and improved levels of rehabilitation.”