Probe into Scottish hospital’s staff numbers

Carseview Hospital in Dundee saw a "significant reduction" in their number of staff. Picture: TSPL

A review of mental health services at NHS Tayside was ordered after complaints from an anonymous caller to the NHS Scotland National Confidential Alert Line about concerns at Dundee’s Carseview Hospital in particular, including a lack of staff and the hospital running at full capacity.

Their report found a shortfall in nursing establishment in 2010–2011, 2011–2012 and 2012–2013 - the period during which concerns about staffing were raised.

The review also found a “significant reduction” in staffing at Carseview from 130 funded placed in 2010–2011 to 81.2 in 2013-2014.

The report said: “Whether or not the original figure was efficient, the impact such changes have on the workload and morale of the unit must be recognised.

“If staff were used to working with generous staffing numbers and these have been reduced to ‘normal’ it will feel like a significant increase in pressure.”

The review team also spoke to a number of staff who raised concerns about staffing levels. “This was seen as a risk because of the perceived levels of experience and competence of staff covering inpatient areas,” the report said.

“Staff regularly felt that ward staff numbers and skill mix were not reflective of patient need.

“Staff also expressed concern about agency staff with little or no experience of working within mental health services and about the difficulty they experienced in explaining these risks to decision makers within the NHS board.”

The report noted that in 2013/14, staff raised 55 concerns about staffing levels through internal systems, compared to 10 in 2010/11.

They concluded that although NHS Tayside’s mental health services now had the highest number of hospital-based nurses in Scotland, they had concerns about staff mix and levels within Carseview.

“This is problematic in terms of use of locum psychiatrists, nursing levels, psychology and allied health professionals,” the review team said.

“The significant reduction in staff between 2010 and 2013 is likely to have exacerbated this situation.

“The high level of spend on locum medical staff is also noted and this has been identified as an issue by both patients, carers and staff. Staff also report often feeling under undue pressure and that these pressures have the potential to affect person-centred care.

“It was evident that these issues continue to create tensions between frontline staff and management.”

Another concern raised by the caller was that patients were released into the community when they needed hospitalisation.

The review team said it had heard examples of concerns from some staff, patient and carers about the effectiveness and safety of discharge arrangements.

In total the report made 20 recommendations for improvements to mental health services.

Dr Alastair Cook, chair of the review team, said: “We have put forward a range of recommendations that are intended to help NHS Tayside secure further improvements in the local service.

“The review team also acknowledges the steps that NHS Tayside has put in place to strengthen the mental health service in recent months and the further work that is underway.

“We have asked NHS Tayside to provide a detailed improvement plan and we will follow up to ensure that progress is made so that patients in Tayside continue to see further improvements in the quality of mental health services.”

NHS Tayside medical director Dr Andrew Russell: “I am satisfied that all the recommendations contained within the HIS report are already covered by the work being progressed by mental health clinical teams in Tayside.

“For example, we have just recruited four new consultant psychiatrists in Dundee which will address the review team’s observation that there were challenges in providing continuity of care for patients due to the use of locum consultants.”