Video report by ITV Wales Health Correspondent James Crichton-Smith
Staff morale at a north Wales mental health unit was "the worst ever seen" with nurses "bursting into tears" as they described working there, ITV News can reveal.
Among the latest details from the 2014 Robin Holden report are accounts of how "whistleblowers complained of an 'atmosphere of bullying and intimidation.'"
It comes a week after ITV News first revealed staff fears in the report, which centred on the care of patients on the Hergest Mental Health Unit at Ysbyty Gwynedd in Bangor and management of it.
Patients' families and politicians have accused the health board of a "cover up" by continuing to refuse to make the Robin Holden report public.
The latest details about the working environment include allegations in the report that senior staff were told by a manager to "'bang the Ward Managers' heads together' if they failed to co-operate." And that they wanted "Ward Managers to be glued to the computers" so that paperwork was completed on time.
One witness giving testimony to the Robin Holden investigation said: "Morale is the worst I have ever seen … Staff are stressed before they come in through the door". Another said: "Nobody has a smile on their face" and "It was almost surreal, it was just grim - you know -really grim."
I’ve worked with a few Nurses and we have all gone home crying.
The report says these accounts "were typical of the testimony received. The level of emotion expressed by those interviewed, with many bursting into tears, was significant."
ITV News can also reveal more about how staff were 'fearful' for their jobs after some employees were redeployed.
The report says that there was a "chasmic leadership void" on the unit. One witness said: "We don't know what is going on or if something is going to happen to you" and "There was a period when I felt, they've got rid of [anonymous], [anonymous], and [anonymous], and I felt I'm next".
The report author wrote that accounts like this "were typical of the staff testimonies."
Further details can also be disclosed around patient safety concerns, with some staff 'feeling exposed'.
The concerns centre around the availability of doctors at the Hergest Unit.
The report states that: "Junior Doctors were no longer available between the hours of 6AM and 9AM, as well as 5PM and 9PM; [that] has left Ward Staff feeling exposed. Testimony was also given that there were other unplanned absences of Junior Doctors and consequently Nurses were unsure whether a Junior Doctor would respond to their pager at all."
Also linked so safety concerns were worries about the mix of patients on the unit.
Staff members told the investigation:
On our ward we have a handful of young men in their twenties with ninety year old ladies with zimmer frames needing toileting every two hours. Not practical. Not a good mix.
It's awful. The other day I had to do three ward rounds and leave a bank nurse on his own.
Responding to these latest details, the health board said it had nothing to add to what it has previously said.
The original statement from Simon Dean, Interim Chief Executive of Betsi Cadwaladr University Health Board, said: "We have a duty of care to our employees and are concerned that publishing this full report would breach the confidence of those members of staff who contributed to it.
"Since this report was produced in 2014, we have taken a range of actions to improve standards of care on the Hergest Unit. Reports from unannounced inspections of the unit by Healthcare Inspectorate Wales show that standards of care, staff morale and leadership arrangements have improved in recent years.
"Consultant medical cover has also improved and all posts in the West area are currently filled. Through service user and carer organisation Caniad we are using feedback from patients on the Hergest Unit to drive up standards of care. This feedback shows that while we do not always get things right, patients are generally very positive about the care that they have received.
"We encourage anyone with concerns about the care that they or a loved one have received to contact us directly."