Mental Health Inpatient Programme adapts to suit those who need it most

James Robinson, Mental Health Project Lead

I’m extremely pleased to report that the mental health workstream has picked up some real momentum during the last six months.

The workstream consists of senior representatives from each Health Board across Wales. They follow an evidence-based approach to create robust methods, tools and techniques that will be used to determine appropriate nurse staffing levels within mental health inpatient wards. The tools that are devised by the work stream will enable Health Boards and Trusts to calculate the right number and skill mix of nursing staff required to provide effective care for patients on mental health inpatient wards, as well as contributing overall to A Healthier Wales.

Over the last few months, the mental health inpatient programme scope has been reviewed and refined. This was in part due to the complexity and wide variation of mental health inpatient wards and that of peoples’ needs who require them. Therefore, it was reasonable to refocus the scope of the programme to ensure the tools produced are fit for purpose.

To refine the programme, it was essential to categorise inpatient wards that held similar functions. A scoping exercise was undertaken and resulted in the work stream defining the inclusion criteria of “admission and treatment wards”.

Admission and treatment wards are typically the first point of access to inpatient mental health service users from age 16 and above. The decision to refine the scope of the programme has not been taken lightly. However, we understand that the work undertaken within the admission and treatment areas will have wider application to other mental health facilities. Furthermore, this process enables the programme to better engage with stakeholders and to ensure co-production with mental health nurses across Wales, making these services work as a single system

I am pleased to report a further version of the interim nurse staffing principles specific to admission and treatment wards has been drafted. This draft has been agreed by the mental health nurse staffing group and All-Wales nurse staffing group. The next steps will be for Health Boards to conduct impact assessments. These assessments will explore the financial and resource impact of the principles. In turn this will enable Health Boards to develop their workforce plans and monitor them against compliance with the principles. I am extremely proud of the work undertaken thus far. The interim nurse staffing principles for admission and treatment wards are truly progressive and will undoubtably make a significant impact on patient’s experience, quality of care and our nurse’s wellbeing.

The Welsh levels of care tool for mental health have been devised through co-production with mental health nurses and continue to be developed. We have agreed five nursing themes and will be working towards the development of overarching clinical and lay descriptors, in preparation for pilot testing. I am extremely grateful for the contribution of nursing colleagues throughout this process. I feel that we have a range of tools that are not only person-centred, but applicable within mental health services.

Defining the nurse sensitive quality indicators specific to mental health inpatient wards has been complex. To better understand the unique needs, two workshops were held in September 2021 to explore use of the quality indicators within mental health inpatient services. We will also commission task and finish groups to undertake further work to define falls, pressure ulcers and medication errors. The work will need to align with robust processes for reporting and investigation, thus ensuring standardised practice across Welsh admission and treatment wards.

The mental health professional judgement audit took place during May 2021. The data provided has since been collated and Health Boards have received their ward reports. The workbooks are providing the programme with valuable information and data, which I hope can be utilised by Health Boards when reviewing their nurse staffing requirements. I am currently in the process of gathering feedback from nurses who have used the tool. The next steps will be to refine the tool based on their feedback, prior to the next bi-annual audit being conducted  in November 2021. The aim is for wards to have their own bespoke workbooks that have been developed alongside ward managers and senior nursing leaders. This should enable more accurate data being provided, as well as a greater degree of assurance when benchmarking across admission and treatment wards within Wales  

Finally, as the lockdown is gradually being lifted, I am looking forward to being able to visit Health Boards and wards across Wales and meet nursing teams in person! In the meantime, stay safe and thank you for the amazing work that you do!

More information about the Mental Health Workstream can be found on the All Wales Nurse Staffing Programme of HEIW’s website.