This blog post is an overview of the Hergest Unit for the benefit of readers unfamiliar with the mental health services in north Wales or those unfamiliar with the history of the Hergest Unit. More detailed accounts of my own experiences of the Hergest Unit will be given in future posts.
The Hergest Unit is the acute mental healthcare unit for adults covering north west Wales and is situated at Ysbyty Gwynedd, Bangor. It now has an abysmal reputation and in the last few years has been the subject of much critical media coverage (often in relation to patient deaths) with a number of highly critical reports being compiled about the Unit. One such report (which was concealed by the Betsi Cadwaladr University Health Board for many months) described the Hergest Unit as being in ‘serious trouble’ and providing ‘worrying’ levels of patient care http://www.dailypost.co.uk/news/north-wales-news/ysbyty-gwynedds-hergest-unit-provided-10464590
Mental health patients in north west Wales know that the Hergest Unit has been in ‘serious trouble’ for a very long time – many of us were trying to alert the authorities to this as long as fifteen years ago but our concerns were ignored or dismissed.
It was not always so. The Hergest Unit was opened in the early 1990s in the wake of the closure of the North Wales Hospital Denbigh and it was seen as a bright new dawn for mental health services in north west Wales. There seemed to be a very genuine commitment among some of the staff to provide a really good service to patients, after years of patients enduring what one consultant psychiatrist admitted was the ‘very poor’ ‘service’ provided by Denbigh. When Denbigh finally closed, there was quite an interesting phenomenon evident in the Hergest Unit – patients were expected to forget about how bad Denbigh had been and to stop talking about the practices that had prevailed there. Of course this did not happen – patients remembered all too well what had gone on at Denbigh and the staff at Denbigh were all working in the new Units across the region such as the Hergest Unit. Dr Dafydd Alun Jones, the senior psychiatrist at Denbigh who had been the subject of much complaint, continued to visit the Hergest Unit to hold clinics. Patients would see him and inevitably swap anecdotes. There was an obvious air of embarrassment from the other staff, as if they could wish the grim history of the mental health services away. Despite Jones’s visits causing much anger among some of the patients, the Hergest Unit started off well. The physical facilities at the Unit were far better than what was on offer at Denbigh and a number of new staff and consultants gradually arrived, some of whom were excellent. Sadly this did not last long.
Within two years or so there were indications of serious problems at the Hergest Unit, despite the presence of some people who were still clearly trying to do their best for patients. Conflict between the staff became very obvious. Dafydd Alun Jones seemed to be determined to cause serious problems. He was clearly in conflict with some people in the NHS at a regional level as well as in the Hergest Unit and began to give media interviews complaining about the services. Which certainly mystified patients – we all remembered Denbigh and Dafydd Alun Jones very clearly and the early years of the Hergest Unit were most certainly a great improvement. Dafydd Alun Jones had reached retirement age and clearly didn’t want to retire, although a lot of people were desperately hoping that he would. The battle was fought out in the Welsh media. A number of TV programmes were screened in which Jones was portrayed as a hero fighting a valiant battle. There was no reference at all to the appalling conditions and practices that had prevailed at Denbigh under his ‘leadership’ and the many complaints about him. A local resident of Bangor, a young man with addiction problems, featured extensively in one of these programmes, praising Jones and claiming that he was worrying about what his fate would be should Jones fail to save the day. I was friendly with this young man’s former foster mother who was still very close to him – she was not happy at the thought of him being manipulated and asked him why he had agreed to appear in the programme. He replied that he had been paid to appear. The rows rumbled on, as did the media coverage but eventually Jones retired from the NHS (although he continued to do much private work and chair the addiction charity CAIS).
People breathed a sigh of relief once Jones had retired and there was a palpable feeling that at last the patients might stop talking about what had gone on at Denbigh. Within another two years or so however it was clear that all was not well at the Hergest Unit. It was very clear that a lot of the best staff were leaving for other posts, often in England. It was a trickle at first and patients presumed that staff were leaving for various personal reasons – but it soon became obvious that this was an exodus from the Hergest Unit. At the same time, the service started to be eroded.
There was a very popular, well attended day centre at the Hergest Unit, staffed by people who had an excellent relationship with the patients. The day centre provided facilities for socialising and activities to many patients who were living very isolated lives in the community on very low incomes. It was mooted that the day centre should be closed as the concept of a day centre was ‘old fashioned’. The patients overwhelmingly supported the day centre whether it was ‘old fashioned’ or not – it was the only chance that a lot of them had to socialise and access health advice. Despite the rise of consumerism in the NHS and talk of patients ‘choice’ and ‘service user involvement’ it seemed that in the case of the day centre, the patients wishes were going to be ignored. Further discussions took place regarding its closure. Patients were told that the notoriously unpopular Arfon Community Mental Health Team were pushing for the closure of the day centre. This angered many of the patients, because most of the patients attending the day centre had made serious complaints about the Arfon team or had been refused a service from them. Patients began to speculate whether the Arfon team were experiencing embarrassment in the face of a day centre used by several hundred people from across the region, whereas the heavily staffed Arfon team themselves had alienated so many people (or refused to treat them) that their grandly titled ‘resource centre’ was hardly used. An audit was carried out, consisting of a series of focus groups. I attended one of these focus groups and we were asked why we were using the services of the day centre and not the Arfon Community Mental Health Team. Nearly every member of the group related extremely negative encounters with members of the Arfon team, or gave accounts of the ways in which the Arfon team had refused to provide them with any service at all. The results of the audit were eventually relayed to us – the day centre had received glowing reviews from all patients.
This did not seem to be enough for the manager of the Hergest Unit, the highly unpopular Alun Davies, however. Within months he’d announced yet another review of the day centre. He also implemented budget cuts and gradually the day centre started to decline. Eventually a meeting between the patients and Alun Davies was held. It was farcical, with the deeply compromised ‘service users rep’ (who had never been elected by any service users, who had achieved notoriety by publicly stating that ‘my job is to do what the NHS wants’ and who was widely viewed as Alun Davies’s stooge) using his position as chair of the meeting to protect Alun Davies from critical questions. One patient had been told by one very angry and disillusioned consultant that the medical director of Ysbyty Gwynedd had received a performance related ‘merit award’ in return for cutting the mental health services. When this patient asked Davies if this was true, the service users rep helpfully told Davies that he didn’t need to answer that question. So Davies didn’t and left the meeting shortly after – most of the patients had already walked out anyway denouncing the meeting as a farce. The day centre was shut down shortly after, with reports placed in the local papers by the hospital authorities saying that there had been extensive ‘consultation’ with patients.
At the same time as the closure of the day centre occurred there was a very obvious shift in attitude towards the patients by some staff – many of the staff with the best rapport with patients had left. Some of the staff remaining had a highly punitive attitude toward patients and prosecutions started to be mounted against patients for astonishingly trivial reasons. The police were also being regularly called to the Unit by staff, again for very trivial reasons. Rural north west Wales is a small community and I started to hear that the local magistrates and the police were expressing concern as to what was happening at the Hergest Unit. Sadly no-one actually put a stop to it. The prosecutions of patients continued and a pattern could be seen – these were usually patients who had made complaints against the Unit which was now deteriorating rapidly. They were also often patients, who, once they had made complaint, had been diagnosed with ‘untreatable’ personality disorders – even though many of them had previously received different diagnoses at the Unit or outside of the region. Scores of patients were told that they had ‘borderline personality disorders’ – they were all deemed to be untreatable. (Interestingly enough there was someone working at Bangor University who had substantial expertise in borderline personality disorder and its treatment – I was not aware that she was consulted by the Hergest Unit as they bandied this diagnosis around so liberally. Perhaps she should have been asked why a corner of rural Wales had so many people suffering from this ‘disorder’ – and why they were ‘untreatable’ when there is considered to be successful therapeutic interventions available.) The Hergest Unit became notorious for refusing to treat patients. On numerous occasions the police would detain patients after assessing them as being in need of a place of safety and take them to the Hergest Unit, only for the Hergest Unit to discharge these patients hours later. One woman was picked up by the police seven times in the course of one weekend and taken to the Hergest Unit, only to be immediately discharged again. This course of events resulted in the Assistant Chief Constable of North Wales informing the CEO of the North West Wales NHS Trust that if they picked up this young woman again they would charge the Trust for her care. Patients routinely described being treated more humanely by the police than by staff at the Hergest Unit. At this time I was friendly with a local junior doctor who had been employed at the Hergest Unit – he told me that he had been told by the consultants there that he was to admit as few people as possible as in-patients. Later, in his capacity as a GP, the same doctor told me that he gave up referring patients to the Hergest Unit because when he did so he inevitably received a letter back telling him that ‘this patient will not benefit from psychiatric input’. A local mental health social worker whom I knew socially told me a similar tale – that it was becoming virtually impossible to make a successful referral for secondary psychiatric care.
Relationships between staff – particularly between the consultants – became very obviously strained and it was openly talked about within the locality that some of the consultants at the Hergest Unit hated each other so much that they would not speak to each other. There seemed to be very dysfunctional staff dynamics throughout the Unit and there was obviously intimidation and bullying going on between the consultants. One long serving consultant retired early – for months patients had been openly told by some nurses that he was ‘mentally ill’ – and he made a point of asking that only patients, not staff, should attend his leaving party, so fraught was his relationship with his colleagues. His wife, who also worked as a consultant at the Hergest Unit, retired early shortly afterwards and it was rumoured that she had been overtly bullied out of her position once her husband had retired. Another consultant, at his retirement do, made a blistering speech attacking the Arfon Community Mental Health Team, denouncing their abuse of their positions.
As consultants left/retired it became clear that the Hergest Unit was unable to recruit replacements. Vacancies were left unfilled – except for one consultant vacancy that was filled by a man who had been the subject of many complaints during his years as a junior doctor. It was alleged that the Hergest Unit knew that this man was an unsuitable candidate but that the vacancy had been advertised several times and he was the only applicant. The complaints continued after this man was appointed as a consultant.
By the early 2000s it was clear that the Hergest Unit was, as was admitted 15 years later, in serious trouble. Numerous patients were finding it nigh on impossible to secure treatment, patients had started dying at an alarming rate, people who were admitted to the Unit were having very distressing experiences, complaints about the Unit were soaring – some of these complaints concerned physical abuse of patients by staff – but were not investigated properly and facilities had been successively shut down. Patients had started to approach politicians but nothing improved. There were stories of staff going off sick at a high rate.
Subsequently, at one point, there was a much publicised inspection of the mental health services in north west Wales. Things were so bad by then that a number of patients, myself included, made a point of making appointments with the inspector that had been despatched to tell them that things were not good at the Hergest Unit. I found out later that two members of staff were also so concerned that they too had made appointments with the inspector to blow the whistle. One of the patients that gave evidence to the inspector had had the most extraordinary experience at the Hergest Unit. She had been diagnosed with a ‘borderline personality disorder’ and had been arrested for ‘threats to kill’ staff. She later demonstrated with the help of a second opinion from outside the hospital that the diagnosis had been wrong and not only had she not threatened to kill anyone but that the ‘clinical psychologist’ who had made this allegation wasn’t a clinical psychologist at all – he was a nurse with a PhD whom the hospital were presenting as a clinical psychologist. (Upon being made aware of this patient’s evidence, unusually for the Hergest Unit, the confrontational behaviour towards her stopped and the Trust agreed to fund treatment at a private clinic of her choice.) Eventually we all received a copy of the inspection report. It was a wonder to behold – the Hergest Unit was given a glowing review and compliments were paid regarding the ‘excellent relationship’ between the Arfon Community Mental Health Team and the Hergest Unit no less. The patient who had unmasked the nurse posing as a clinical psychologist commented that it was like reading about a completely different hospital. The two whistleblowers were dumbfounded and commented that they had been very frank with the inspector regarding the serious problems in the Unit. This inspection report was produced before the avalanche of bad publicity in the UK regarding glowing inspection reports being produced about very troubled services…
In the years that followed, the Hergest Unit went into meltdown. I was told by a former nurse from Ysbyty Gwynedd that there were huge rows taking place between the psychiatrists and other consultants as psychiatric patients were being admitted to the medical wards with injuries after attempting suicide and the psychiatrists were refusing to treat them. I was told that one patient had jumped off the Britannia Bridge three times after being refused treatment from the Hergest Unit – when he was admitted after the third jump, he was simply allowed to stay on one of the medical wards until the consultant treating him considered him to be no longer suicidal. GPs and mental health community workers simply stopped referring patients to the Hergest Unit because they were of the opinion that there would be no help forthcoming, patients continued to be prosecuted in great numbers, patients committed suicide at an alarmingly high rate, Alun Davies quietly left and a new manager took over who subsequently developed severe clinical depression and had to leave his post – and two psychiatrists committed suicide. The one whistleblower left was ferociously bullied, but continued to raise concerns regarding standards of care at the Unit. His concerns were ignored and eventually very few members of staff at the Unit would even speak to him. The Hergest Unit had become completely toxic – and unsafe.
In 2014 a report by one Robin Holden was commissioned by the Health Board – it admitted in this report that the Hergest Unit was in ‘serious trouble’. But Robin Holden had known that for years – he had worked as a senior nurse manager at the Hergest Unit. Another inspection report also reported what everyone had known about for years as well – that staff relationships were terrible and that two consultants, Tony Roberts and David Healy, refused to speak to each other and that this was impacting on patient care. David Healy has become famous for his expose of the wrongdoing of Big Pharma – what a pity that he didn’t apply the same rigorous scrutiny to the Unit where he works.
Health Inspectorate Wales produced another report about the Hergest Unit earlier this year (2016). It states that things are improving but that there are still serious problems (one memorable feature in this report was the numerous ligature points in the Hergest Unit that the inspection had revealed). The Betsi Cadwaladr University Health Board is now in special measures because of the sorry state of the mental health services. The Health Board is unable to recruit, so I very much doubt that much has improved at the Hergest Unit despite the comments of Health Inspectorate Wales – no-one will work there and the best answer now is probably just to close it down. The Hergest Unit didn’t hit the buffers overnight. It ended up in this state because for many years serious complaints from patients were ignored or concealed and whistleblowers were bullied out of their jobs.