CITY TRIBUNE
Commission slams mental health facility at UHG
An independent report into the running of the new adult mental health unit at UHG has raised concerns about physical restraints being used on patients, as well as the use of seclusion and delays in informing GPs of discharges.
Two patients were not told why they were being restrained or for how long, and there was no record to indicate if they had been medically examined within three hours of being restrained.
‘High risk’ failings were also recorded relating to the discharge of a patient – their GP was not given a discharge summary within the required three days and full information was not sent to relevant personnel for 23 days, rather than within the required 14-day timeframe.
During an inspection of the 50-bed Acute Adult Mental Health Unit (AAMHU) by the Mental Health Commission – the independent watchdog which oversees standards and practices – two patients had not been told why they were being physically restrained or how long the restraints would be used for.
The unannounced inspection was carried out at the €20 million UHG unit from November 27th to 30th last and the Commission published its findings last week.
Areas of inspection were deemed to be either compliant or non-compliant – where non-compliant, risk is rated as low, moderate, high or critical.
High-risk non-compliance was recorded in four areas: The Code of Practice on the use of physical restraint; the Code of Practice on admission, transfer and discharge and on regulations relating to staffing and the register of residents.
Dr Susan Finnerty of the Mental Health Commission said in her report that the inspection had looked at the clinical files of three residents who had been physically restrained.
“In two episodes of physical restraint, there was no record to indicate that the resident had received a medical exam at all by a registered medical practitioner within three hours after the start of an episode of physical restraint.
“In one case, while a medical exam did take place, there was no time record to show that it took place within three hours after the start of the physical restraint episodes.
“In two physical restraint episodes, residents were not informed of the reasons for, duration of, and circumstances leading to discontinuation of physical restraint. The reasons for not informing them was not documented in either case.
“In [each of] two episodes of physical restraint the residents’ next-of-kin was not informed about the physical restraint and the reasons for not informing them was not documented in two cases,
“In all three physical restraint episodes, there was no documented record to indicate that each episode of physical restraint was reviewed by members of the multi-disciplinary team and documented in the clinical file within two working days after the episode.”
The report also noted that: “In all cases, physical restraint was initiated by an appropriately qualified health professional. Physical restraint was used in rare and exceptional circumstances only when the resident posed an immediate threat of serious harm to themselves or others. Cultural awareness and gender sensitivity were demonstrated when considering the use of and when using physical restraint.”
The MHC’s report also found that not all staff had signed a log to indicate they had read and understood the policy in relation to using physical restraints.
In its response, the HSE said its corrective action would include a training schedule for medical staff and a checklist to be completed ‘post restraint’ to ensure regulations were met.
The inspection noted ‘high risk’ non-compliance in terms of regulations on staffing, which was due to the fact that not all staff had up-to-date mandatory training in basic life support; fire safety; management of violence and aggression and in the Mental Health Act. The HSE responded that training needs would be assessed and staff would complete mandatory training. The unit was also non-compliant (high-risk) with the Code of Practice on admission, transfer and discharge – one resident’s discharge plan did not include documented communication with the GP.
The preliminary discharge summary was not sent to the patient’s GP within three days and comprehensive discharge summaries were not sent to relevant personnel within the required timeframe of 14 days – instead, it was 23 days after the resident had been discharged.
Discharge summaries did not include details of prognosis and a follow-up appointment was not arranged within one week of discharge.
A memo has since been sent to all staff to ensure the discharge plan for patients complies with regulations, and a new ‘initial discharge book’ is being developed to send to GPs on the day of discharge.
‘High risk’ non-compliance was also noted for regulations governing the register of residents, which was found not to be up-to-date, while residents’ names were not consistently recorded. The HSE said a new computerised database was being developed to keep all information and staff have been reminded to input all data.
‘Moderate risk’ non-compliance with rules governing the use of seclusion was also recorded.
“In two seclusion episodes, the resident was not informed of the reasons, duration, and circumstances leading to discontinuation of seclusion. In two seclusion episodes, the resident was not informed of the ending of an episode of seclusion, and in one seclusion episode, the reason for ending seclusion was not recorded in the clinical file.” The HSE said a training schedule would be arranged for staff and a checklist for when seclusion of a patient is discontinued.
The ’moderate risk’ non-compliance for use of CCTV relates to the equipment being capable of recording the image of a resident who was under observation. According to the HSE, the system is no longer capable of recorded and this is checked monthly.
The Commission’s report found ‘low risk’ non-compliance with regulations on maintenance of records – these contained loose pages and notes were out of logical sequence, while one resident’s record contained multiple different dates of admission. The HSE said a memo was sent to all staff to file notes in keeping with regulations and audits of records would be undertaken every three months.
Overall, the inspection found the centre was compliant with 81% of regulations, rules and codes of practice.
Areas of compliance with regulations which were rated as ‘excellent’ included the identification of residents; food and nutrition; food safety; clothing; residents’ personal property; religion; communication and searches of patients and their belongings.
From the Galway City Tribune – An impassioned plea for a ‘masterplan’ that would guide Galway City into the future has been made in the Dáil. Galway West TD Catherine Connolly stated this week that there needed to be an all-inclusive approach with “vision and leadership” in order to build a sustainable city.
Deputy Connolly spoke at length at the crisis surrounding traffic and housing in Galway city and said that not all of the blame could be laid at the door of the local authority.
She said that her preference would be the provision of light rail as the main form of public transport, but that this would have to be driven by the government.
“I sat on the local council for 17 years and despaired at all of the solutions going down one road, metaphorically and literally. In 2005 we put Park & Ride into the development plan, but that has not been rolled out. A 2016 transport strategy was outdated at the time and still has not been updated.
“Due to the housing crisis in the city, a task force was set up in 2019. Not a single report or analysis has been published on the cause of the crisis,” added Deputy Connolly.
She then referred to a report from the Land Development Agency (LDA) that identified lands suitable for the provision of housing. But she said that two-thirds of these had significant problems and a large portion was in Merlin Park University Hospital which, she said, would never have housing built on it.
In response, Minister Simon Harris spoke of the continuing job investment in the city and also in higher education, which is his portfolio.
But turning his attention to traffic congestion, he accepted that there were “real issues” when it came to transport, mobility and accessibility around Galway.
“We share the view that we need a Park & Ride facility and I understand there are also Bus Connects plans.
“I also suggest that the City Council reflect on her comments. I am proud to be in a Government that is providing unparalleled levels of investment to local authorities and unparalleled opportunities for local authorities to draw down,” he said.
Then Minister Harris referred to the controversial Galway City Outer Ring Road which he said was “struck down by An Bord Pleanála”, despite a lot of energy having been put into that project.
However, Deputy Connolly picked up on this and pointed out that An Bord Pleanála did not say ‘No’ to the ring road.
“The High Court said ‘No’ to the ring road because An Bord Pleanála acknowledged it failed utterly to consider climate change and our climate change obligations.
“That tells us something about An Bord Pleanála and the management that submitted such a plan.”
In the end, Minister Harris agreed that there needed to be a masterplan for Galway City.
“I suggest it is for the local authority to come up with a vision and then work with the Government to try to fund and implement that.”
The new Salmon Weir pedestrian and cycle bridge will be officially opened to the public next Friday, May 26.
Work on the €10 million bridge got underway in April 2022, before the main structure was hoisted into place in early December.
A lunchtime tape-cutting ceremony will take place on Friday, as the first pedestrians and cyclists traverse the as-yet-unnamed bridge.
The Chief Executive of Galway City Council, Brendan McGrath, previously said the bridge, once opened, would remove existing conflicts between pedestrians, cyclists and traffic “as well as facilitating the Cross-City Link public transport corridor over the existing 200-year-old bridge”.
The naming of the new bridge has been under discussion by the Council’s Civic Commemorations Committee since late last year.
One name that has been in the mix for some time is that of the first woman in Europe to graduate with an engineering degree – Alice Perry.
Ms Perry, who was from Wellpark, graduated from Queen’s College Galway (now University of Galway) in 1906. The university’s engineering building is named in her honour.
The bridge was built by Jons Civil Engineering firm in County Meath and was assembled off-site before being transported to Galway. Funding for the project was provided in full by the National Transport Authority and the European Regional Development Fund.
(Photo: Sheila Gallagher captured the city’s new pedestrian footbridge being raised on the south side of the Salmon Weir Bridge in December. It will officially open next Friday, May 26).
From the Galway City Tribune – Minister of State for Local Government and Planning, Kieran O’Donnell was labelled a “disgrace” for overturning councillors’ decisions to rezone land in the new City Development Plan.
Minister O’Donnell (pictured) confirmed in a letter to Council Chief Executive Brendan McGrath last week that he was reversing 25 material alternations made by councillors to the CDP 2023-29. He made the decision on the advice of Office of Planning Regulator (OPR).
Minister O’Donnell directed that 14 land parcels that were subject to land-use zoning changes by councillors as part of the Material Alterations to the Draft CDP should be reversed.
He directed that a further 11 land parcels in the city should become “unzoned”.
The Minister found that the CDP had not been made in a manner consistent with recommendations of the OPR, which required specific changes to the plan to ensure consistency with the national planning laws and guidelines.
At last week’s Council meeting Cllr Eddie Hoare (FG) asked for clarity on the process by which councillors could rezone the lands that had been changed by the Minister’s direction.
Cllr Declan McDonnell said, “What he [Minister O’Donnell] has done is an absolute disgrace”.
And he asked: “Do we have to have another development plan meeting to deal with it?”
Both Cllrs Hoare and McDonnell wondered what would become of the lands that were rezoned or unzoned by the ministerial direction.
Mr McGrath said the Council had put forward an argument in favour of retaining the material alterations in the plan, but ultimately the Minister sided with OPR.
He said if councillors want to make alterations to the new plan, they could go through the process of making a material alteration but this was lengthy.
The Save Roscam Peninsula campaign welcomed the Minister’s decision.
In a statement to the Galway City Tribune, it said the direction would mean the Roscam village area on the Roscam Peninsula will be unzoned and a number of land parcels would revert back to agriculture/high amenity.
A spokesperson for the campaign said: “the material alterations made by city councillors following lobbying by developers continued the long-standing practice of councillors facilitating a developer-led plan rather than an evidence- and policy-based plan that meets the needs of the city.
“The Minister’s direction is an important step in restoring confidence in the planning system. It is clear from the City Council’s own evidence on future housing projections that there was no requirement to zone these lands for residential purposes in order to meet the needs of the targeted population increase up to 2029,” the spokesperson added.
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