Patients deserve much better - NAO lambasts ‘outdated’ Mt Carmel infrastructure

The NAO report has lambasted the ‘outdated’ and ‘restrictive’ infrastructure at Mount Carmel Hospital in its report on the state-run institution, pointing to its ‘unacceptable’ sanitary facilities, crowded living spaces, and generally inefficient building plan.

The hospital was built as a mental health institution in 1860 and designed to 150-year-old standards, with the NAO noting that the building itself “reinforces the prevalence of the negative stigma on mental health and the old socio-cultural approach towards the matter”, also observing that the sign ‘Asylum for the Insane’ was still exhibited on the institution’s main gate.

Number of patients exceeds intended capacity of MCH

The wards, the NAO report explained, presented several challenges as they accommodate a number of patients that exceed their intended capacity.

“In most severe cases beds were laid out almost touching each other, thereby restricting patients’ personal space and privacy, while presenting physical challenges for staff.”

Time-out or seclusion rooms are also being used to accommodate non-volatile patients due to overcrowding, depriving the wards of the facility.

In one particular ward, 28 patients together with staff are constrained to a common area the size of two average sized household living rooms.

With regards to the use of space, the NAO noted a general mismanagement in this regard, observing that while some wards had larger common areas, their dormitories remained relatively cramped.

The sanitary facilities, the audit team observed, were also inadequate, with nurses complaining that the number of available lavatories simply do not cater to the needs of all the patients.

“A small number of wards did not even have a functional shower, forcing nurses to assist patients to either wash in their own beds or use facilities in other wards.”

In cases where there were available sanitary facilities, they were “found to be significantly run-down and, in certain instances, in a completely unacceptable condition.”

Building itself makes it difficult for efficient management

The building itself is also making it difficult for its management to maximise the efficiency of its operations.

The fact that the wards are not built around a central nursing station, creates significant issues, the NAO notes, preventing nurses from being able to tend to other work while still having full visibility of all their patients.

“This issue becomes even more important when one considers the demanding supervision service that MCH patients require.”

Referring to a specific case involving the ward which houses men with substance abuse, the audit team noted that the nursing station physically separates the patient’s living quarters and the only available bathroom, meaning that every time a patient needs to use the facility, there is no other option that for the nurses to let him through their station.

“Nurses voiced their concern about the situation, especially in view of the generally volatile tendencies of these particular individuals, who, according to the MCH nursing staff, are more prone to become violent,” the report said, explaining that it essentially precluded them from having an effective safe place.

Maintenance requests remain pending for a number of years

While it did not conduct any professional structural integrity tests or any other studies, the audit team said that infrastructural related were ‘manifestly obvious and immediately identifiable’.

“A number of wards were deemed unsafe so that patients had to be moved to alternate locations.”

The process of actually requesting maintenance also appears to be bureaucratic, with nurses and caring staff identifying issues rather than the maintenance department itself, sending a written request through an Online Request system which is then forwarded to the maintenance team.

“A number of these request remain unaddressed for what is considered as an unacceptable period of time, with MCH personnel asserting that some cases, remain pending for a number of years.”

Urgent issues give prominence to long-term plan for hospital

While a long-term plan would be suitable, MCH officials told the NAO that it remained difficult to implement one, given that urgent issues constantly arise.

Two wards, it should be noted, have undergone significant refurbishment.

With regards to the 30 million investment promised by the government, the NAO noted that this remains significantly lower than the amount needed for the hospital and that while assurances have been given verbally, no official documentation had been sent to MCH’s CEO.