Neglected St Ann’s Hospital crumbles

“We are the bastard of the Ministry of Health,” a senior nurse with more than 20 years experience said with reference to St Ann’s Hospital. He said that mental health was not even part of the Health Sector Reform Programme which started in 1996. When another nurse who worked in a supervisory position was asked what improvements have taken place during his time working at the facility, he said: “leave out the improvement.” The two health workers, whose combined experience in mental health nursing is 53 years, spoke  about the problems which continue to affect nurses at St Ann’s and those which arose with the new management system under the North West Regional Health Authority (NWRHA). Better conditions at the facility have mostly been cosmetic. “Yes they will do physical work, put two coats of paint here, a little cement on something but everything remains the same,” the supervisor said.

To illustrate his point, he referred to the Psychiatric Social Work section which was refurbished and extended. But the floor was not changed and the area was condemned. “It is looking good on the outside,” he said. Newsday was shown the kitchen of the hospital which was ordered closed by the Public Health Department in February last year due to unsanitary conditions. Refurbishment work started in September then stopped and was re-started at Carnival time. Work has stopped again. Meanwhile, another area is used to prepare meals. NWRHA corporate communications manager Charmaine Codrington said tenders have gone out for contractors and the job should be completed by June. Although the conditions at St Ann’s are symptomatic of other health facilities, it is more acute because the facility is the only public mental health facility in the country. Overcrowding, staff shortages and insufficient supplies have steadily whittled down staff morale. Patients also feel the brunt of the inadequacy of the system.

There are more than 800 patients and a nursing staff of approximately 147. Less than half the complement (350) required. The number of patients can rise to 1,000 if those on home-leave and those who ran away are included. The supervisor said the role of the nurse as educator cannot be done because of the number of patients. On some wards, where there are more than 70 patients, 30 to 40 are allowed outside on custodial care while the others are monitored on the ward. “Meal time and medication” are the main focus for the nurse. “We don’t have the staff to do anything else. Even if we decide to do group work with eight, who watching the others.” The present circumstances also make it difficult to keep detailed records of patients (behaviour, hygiene), and devising plans for their rehabilitation. Safety is a major concern especially in areas where disturbed patients are accommodated. The senior nurse noted that there is no redress or health benefit for nurses injured on the job.

The Regional Health Authorities (Amendment) Act 2004 transferring the remaining Public Service (PS) health workers across to the Regional Health Authorities has heightened concerns about job security. He questioned the security of workers’ pension plan since State-owned pension plans had difficulties in the past. “When there is a shortfall, they use the money from the Plan and ask Government to put it back.” The nurse also questioned what happened to the right of workers under the Act to choose a secondment or remain in the PS. He criticised the NWRHA practice of “retiree patronage” which, he said, is preventing the upward mobility of younger nurses. “Some of them were not functioning before they leave and did not make a difference.” While the system needs the help of nurses with experience, he said they should not be employed in supervisory positions and block the progress of nurses in the system. The supervisor said he looked forward to the RHA system as an end to the bureaucracy associated with hiring, and promotions in the Public Service. But he has lost confidence.  

He said promotions should be based on qualifications and experience. Instead, he said under the NWRHA promotions are based on years in the system although the individual may have made no attempt to update their education. There is bureaucracy in getting things done too. The supervisor referred to the $1,000 limit  placed on spending at St Ann’s. Purchases exceeding $1,000 must go to the NWRHA head office. The nurse said if Government is serious about attracting nurses, then the remuneration should be “near” what is offered in England. He wondered what happened to the “package” to retain nurses which former Health Minister Colm Imbert spoke about when he was in office. The nurse said the Ministry should offer educational opportunities, scholarships as incentives to nurses. The supervisor intends to leave St Ann’s at the end of this year. Summing up, he said in 1970 the Public Services Association presented a 23-point plan to Kamaluddin Mohammed, the Health Minister at the time. “Nurses are still asking for the same thing at the end of my career.”