A CARMARTHENSHIRE hospital’s minor injuries unit is under significant pressure which is ‘impacting on the delivery of safe care’ according to a recent inspection.

The Health Inspectorate Wales carried out an unannounced inspection at Prince Philip Hospital in Llanelli on June 26, 27, and 28, with the report being published last week.

The report stated that the patients who attended the minor injury unit were provided with a ‘timely and overall positive experience,’ with patients telling inspectors that they were happy with the care and advice received from staff. Staff were praised for treating patients with kindness, dignity and respect and in a timely manner.

But this was not the same for those who were accommodated for longer periods on the minor injuries unit in medical or surgical ‘surge’ beds due to a lack of bed capacity on site or at another acute hospital. These patients reported a less positive experience stating a lack of facilities was impacting upon their dignity. This included a lack of toilet and hygiene facilities and some were seen to have been staying on these ‘surge’ beds for up to five days.

The inspectors were assured that patients presenting with minor injuries were given a good level of safe and effective care from a skilled workforce but that they were not assured that longer stay patients accommodated on the unit in surge capacity beds were receiving timely care when waiting for a bed in the hospital itself or waiting for a transfer to another hospital. Concerningly, the inspectors stated that this included patients who needed emergency transfers due to their acuity of deteriorating state.

The inspectors acknowledged that there were significant pressures on front door services, and at the time of the inspection, the service was under ‘immense’ pressure from multiple sources and noted that staff and the unit were not fully supported or equipped in light of the pressures including inappropriate pressures to the functionality of the unit as a minor injury service to be able to safely and effectively manage all presentations and patients accommodated in the unit. This included the inspectors not being able to be assured that there was sufficient and robust support for emergency nurse practitioners at times when there is an unexpected lack of medical cover on the unit.

They found that the environment was not appropriate for mental health, medical or surgical surge patients who were admitted beyond the lengths of stay associated with a minor injury unit and were not assured that there was robust care assessment and planning arrangements in place for medical and surgical ‘surge’ patients.

Eight questionnaires were completed by patients or their carers in the unit and 39 by staff working in the unit.

Staff spoke positively about the support they gave each other, however, also highlighted that there was not enough of them on shift to be sure they could do their jobs properly.

The report also said that staff were working extremely hard to provide good quality care for patients but at times were having to provide care to patients that the unit was not suitable for.

The report highlights a number of recommendations for the hospital to implement and noted that a number of them were outside of the hospital and health board’s hands.