CONTENTS

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3 Introduction

5 Methodology

6 Findings from Enter and View Visit

11 Conclusion

14 Recommendations

15 Northern Lincolnshire and Goole NHS Foundation Trust (NLAG) Service Provider Response

21 Scunthorpe General Hospital (SGH) –Action Plan

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Introduction

Visit details

Service address:CEO:Service Provider:Date undertaken:Wards visited:Authorised Representatives:

Theme of inspection:

Scunthorpe General Hospital, Cliff GardensKaren JacksonNorth Lincolnshire & Goole Hospital (NLAG)16��, 17��,23��,24�� October 201416, 18, 22, 23, 25, 26, 27, 28, Clinical Decision UnitLinda Byrne, Wendy Coffey, Kate Ellis, Julia PollockMichael Wilson

Dignity & Respect

Acknowledgements

Healthwatch North Lincolnshire would like to thank the service provider, serviceusers, visitors and staff for their contribution to the Enter and View programme.

What is Healthwatch?

Healthwatch North Lincolnshire is an independent consumer champion created togather and represent the views of the public. Healthwatch North Lincolnshire plays arole at both a national and local level, making sure the views of the public and peoplewho use services are taken into account.

What is Enter and View?

Part of the work plan of Healthwatch North Lincolnshire is to undertake Enter andView visits. Healthwatch North Lincolnshire authorised representatives carry outvisits to health and social care services to see how services are being run and makerecommendations where there are areas which require improvement.

The Health and Social Care Act allows representatives of local Healthwatchorganisations to enter and view premises and carry out observations for the purposeof local Healthwatch activity. Visits can include hospitals, residential homes, GPpractices, dental surgeries, optometrists and pharmacies. Enter and View visits cantake place where people tell us there is a problem with a service, but they can alsohappen when services have a good reputation so we can learn about and shareexamples of what they do well.

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Healthwatch Enter and View visits are not intended to specifically identify safeguardingissues. However, if safeguarding concerns arise during a visit they are reported inaccordance with Healthwatch safeguarding policies. If at any time an authorisedrepresentative observes anything that they feel uncomfortable about they inform their leadwho will inform the service manager, ending the visit. In addition, if any member of staffwishes to raise a safeguarding issue about their employer they will be directed to the CQCwhere they are protected by legislation if they raise a concern.

Disclaimer: This report relates only to the service viewed on the date of the visit,and isrepresentative of the views of the service users, visitors and staff who were spoken to onthat date.

Purpose of the visit

The purpose of this visit was to: • observe the environment and routine of the ward with a particular focus on how well it supports the dignity of patients • speak to as many patients as possible about their experience on the ward, focusing specifically on personal interactions with ward staff and others providing their care and treatment • speak to family members visiting patients about their perspective on the care provided • give ward staff an opportunity to share their opinions on respecting dignity on the ward

Strategic Drivers

Following the Care Quality Commission inspections in July 2014, the NorthernLincolnshire and Goole Hospitals Foundation Trust (NLAG) had come out of specialmeasures and were given an overall rating of ‘requires improvement’, with a rating of‘good’ for the ‘care’ domain. Healthwatch North Lincolnshire wanted to highlightexamples of good practice as NLAG had been under an intense spotlight and Enterand View visits could be an opportunity to provide reassurance to the public as wellas help monitor that further improvements are being made.

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Methodology

This report summarises themes and highlights any good practice identified from the Enterand View visits across the nine wards.

Healthwatch North Lincolnshire (HWNL) identified these specific wards for the visits asconcerns/issues had been raised by patient and carers through a Healthwatch survey createdspecifically to gather views and opinions about Scunthorpe General Hospital ahead of theplanned CQC inspection in April 2014. The report “Views on Scunthorpe General Hospital”(April-July 2014) details the findings of this survey alongside other intelligence gatheredduring that period from the Independent Complaints Advocacy Service (ICA), public contactwith HWNL and issues passed on to HWNL by other organisations. Healthwatch undertakesengagement on an on- going basis using a local “Experiences Survey” which identifies anyareas of concern with health and social care services as well as identifying good practice andproduced a report based on this survey called “Insights into Health & Social Care” (January toAugust 2014) which included experiences of care at Scunthorpe General Hospital.

Issues on some of the wards were highlighted at the Quality Surveillance Group in relation toClinical Quality and Safety issues. Furthermore, the CCG had been notified by the LocalAuthority Safeguarding Team of a number of patient safety incidents alerted by staff atNorthern Lincolnshire and Goole Hospital Foundation Trust (NLAG).

Following the CQC inspection, the Trust had expressed an interest for the three localHealthwatch organisations that serve NLAG patients to undertake Enter and View visits, andwelcomed the independence these visits would ensure.

Healthwatch North Lincolnshire informed the Trust of their intention to carry out Enter andView visits at the end of September 2014. This would complement other visits to NLAGhospitals planned by the other Healthwatch teams. A letter was sent to the Trust explainingour intention to carry out Enter and View visits, outlining the dates and times for thescheduled visits over a two week time period and the wards to be visited. Enter & Viewposters were also sent to the Trust with a request that the poster be displayed to informpatients, family and staff of the Healthwatch Enter and View powers, purpose and ourintention for these visits to commence.

Across the nine wards at Scunthorpe General Hospital, Healthwatch North Lincolnshire Enter& View Authorised Representatives spoke to 46 patients, along with a number of ward staffand visitors.

The visits took place on 16��,17��, 23�� and 24�� October 2014 and lasted for three hours each.Some visits took place over mealtimes and visiting hours.

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Authorised representatives used guided questionnaires to talk to patients and visitors andcarried out observations. The same questions were asked across each ward and focused onhow a patients’ dignity is respected.

Immediately following each visit we fed back initial findings to the matrons so thatimprovements could be made where this was possible and in the interests of patients.

This report will be presented to the NLAG Trust and we will provide adequate time for theTrust to respond. We expect not all recommendations will be implemented straight away butwe anticipate that the Trust will provide us with a plan to address these issues.

Findings from Enter and View Visits

Patient Understanding

Patients were asked if they were introduced to staff. They were asked if the reasonthey were in hospital and their treatment had been explained to them. They werethen asked if discussions with them about their care could be overheard by others.They were also asked if they had overheard discussions about other patients’ care.

Healthwatch Enter and View Representatives found that on the whole patients andcarers they spoke to had been introduced to those providing their care and had beentold why they were in hospital and what treatment they were to receive. There weresome patients who said that doctors were less likely than nurses to introducethemselves and some had gone on to ask the name of the doctor. In some cases thepatient had been too ill to remember if this information had been provided. On Ward22 a patient that had been confused on arrival was taken with their family to a quietarea to discuss their condition.

Several patients and carers across the wards visited had said that discussions abouttheir care had been carried out so that others in the bay could overhear, howevermost said that this was not something they were concerned about. They acceptedthat there were no physical barriers in the bay, with only curtains between beds forprivacy. Where a quiet room was available on a ward, patients had said they wouldprefer to be spoken to there.

Many said they had heard discussions about other patients, but that this was usuallygeneral information rather than a diagnosis or clinical information. One patient saidthat patients quite openly discussed things with each other as they share similarexperiences and conditions and were “all in the same boat”.

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However, one patient on Ward 25 and one on Ward 27 had said that the curtains arenot always closed when discussing treatment and they had overheard more seriouspatient discussions. On Ward 25 the patient had overheard someone being informedthat they were terminally ill. Voices had been raised as the terminally ill patient washard of hearing; however this caused some distress for the patient who overheard theconversation. Another patient had reported that on Ward 22 a patient had similarlybeen spoken to in a raised voice.

The Enter and View team noted that on some wards a private room is available fordiscussions if the patient is mobile, but on other wards availability of a quiet room islimited and a quiet room may be shared between wards.

Meeting Your Needs

Patients were asked if they had been given an opportunity to say how they wouldlike their practical and personal needs to be met. They were also asked if they hadfelt cared for.

Patients across all wards the representatives visited felt that they had been given thechance to say how they wanted their practical and personal care needs to be met.Many then went on to explain how these needs were met. On Ward 25 the family ofa patient with dementia were happy that they were able to stay with their relative for12 hours a day to help with feeding and other care needs. Patients spoke about howstaff went out of their way to make them happy and that knowing the staff werearound made them feel safe and secure. Patients said that needs such as providing acommode, extra pillows, hair brushing and washing were also being met. A patienton Ward 28 who did not speak English was able to have her English speaking relativewith her throughout the day to help with communication.

On Ward 22 an Enter and View representative observed a nurse injecting a patientwithout closing the curtains to preserve dignity. The representative asked the nurse ifthe curtains should be closed and she then closed them. This issue was raised withthe Matrons following the visit. Also on Ward 22 representatives noted that amember of staff was calling many patients “Sweetheart” or “Darling” and wondered ifthis had been agreed with the patients as an appropriate way to address them. Thishad also been raised with the Matrons following the visit and they said they wouldspeak to the members of staff concerned.

On Ward 23 there was a concern raised about an incident where the dressing of apatient had not been completed properly and the patient had been leftuncomfortable when undergarments were not fully pulled up. This was noted by theMatron and agreed that this shouldn’t happen and that staff would be reminded ofproper procedure.

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One relative described how his wife had been admitted in an emergency and hadpreviously been fit and mobile, but by the time she was ready to leave Ward 23 shewas unable to walk. He was concerned that he would have to put arrangements inplace at home to enable her to sleep downstairs etc. and was unaware of how toarrange this quickly. Concern was raised that support to carers regarding provisionfor discharge needed to be put in place, alongside consideration of the carer’s need toadapt to potentially life changing situations.

One patient said their experience was bordering on poor as they compared it toanother hospital in London where a drug they were given was good at alleviating theirsymptoms. The patient had been told this particular drug was not available to her atScunthorpe General Hospital.

With the exception of one patient spoken to, all patients felt cared for whilst in thehospital.

Raising Concerns

Patients were asked if they had any concerns and if they had been able to raisethese with someone. They were asked if family and friends were able to commenton their care and feel listened to. A question was also asked about whether carewas given in a timely manner, for example responding to the call bell.

Everyone who offered an opinion about being able to raise concerns had indicatedthat they felt family and friends were able to comment on their care and that theywould be listened to. A patient on Ward 26 said that when she had been concernedabout a procedure she was able to speak to a midwife from upstairs to discuss it.

Enter and View Representatives asked patients if requests for help were respondedto in a timely manner. It was often the perception of patients that if the bell wasnot answered very quickly then it was because staff on the ward are very busy. Somepatients believed that how quickly the bell was responded to would depend on howmany staff were on that ward at the time.

Some patients described instances where they felt the response was not timely andhad resulted in their dignity being compromised. There was an incident on Ward 23where a patient said that they had rung their bell and nobody had come in time,causing a delay during which she wet herself. The patient also said she had been leftin the toilet in a chair for 45 minutes and as nobody came to help she had to call herhusband at 3am who helped her off the chair. A patient on Ward 16 had decided totry to get to the toilet herself when the call bell was not answered by unhooking herdrip, but found she was too weak to walk.

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On Ward 22 the Enter and View team noted that it took ten minutes for staff torespond to an alarm for a change of drip, however in discussions with the matronsafter the visit it was explained that the alarms sound well in advance of the dripneeding attention. It was accepted that the alarm noise could be a nuisance duringthe night.

Examples of a good response were also given. Patients on Ward 18 reported thatthere was usually a member of staff on the bay so there was no need to ring the bellas there was always someone there. A patient on Ward 28 was known to avoid usingthe call bell and as staff were aware of this they would regularly check if the patientwas okay.

On Ward 23 a patient had raised concerns about two members of staff who they felthad a poor attitude towards patients. They were unhappy when they knew thesestaff members would be on duty. A patient had said that during a previous stay onWard 23 her relative had been told to “shut up”.

These issues were raised with the Matrons immediately following the visit. Oneincident where a call bell was reported to be faulty was addressed immediately.

Meeting nutritional needs

Patients were asked if their diet had been discussed with them and whether thishad been taken into account at mealtimes. They were also asked if staff checkedwhether they had enough to eat and drink.

Overall most patients spoken to said they had been asked about their dietary needsand that staff did check to make sure they had enough to eat and drink. On Ward 22there was a patient who was told they should see a dietician but they were stillwaiting for this to happen at the time of the visit and nobody had discussed this withthe patient. Also on Ward 22 a patient with diverticulitis said that although they wereaware of their own dietary considerations, staff on the ward had not asked themabout dietary needs. It was felt that not all patients would have an understanding oftheir own dietary needs. On Ward 23 a patient with bowel problems said they wereprovided with food that met their specific dietary needs.

Some patients on Ward 16 had said that they would prefer food aimed at the “oldergeneration” such as stews, pies, soups and puddings, but they did say that staff checkto see if they have eaten enough and food is plentiful. A patient on Ward 16 said thattea time is quite early and at home they were used to having a supper later on in theevening. Matrons explained to the Enter and View team that food and snacks wereavailable after tea and had been served if patients requested it. On a general note, itwas said that a plate is not always offered with a sandwich and a patient said theywould have liked it to have been given as standard.

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Satisfaction

Patients were asked to rate their overall satisfaction with the care received on ascale ranging from Excellent, Good and Satisfactory to Poor or Very Poor.

Overall levels of satisfaction with the care received on the wards were reported to behigh. There were no patients saying the service was poor or very poor.

Other Comments including from staff members/relatives

On Ward 23 a member of staff told Enter and View representatives that the ward wasgood to work on but very busy at times. Some frustration was felt that there was lessopportunity to spend as much time as they would like with each patient or answercall bells as quickly as they would like. It was also said that working with agency staffwho do not know the routine of the ward is difficult.

Patients and carers had said that they hoped the discharge process could be betterexplained and more efficient. One patient on Ward 18 had spoken about how theywere told they could go home and had phoned their wife who arrived within half anhour. It took six hours before the patient was able to go home, and he felt that bothhe and his wife had waited a long time. Some patients had said that they would liketo be kept informed of what they were waiting for and would be happier waiting ifthey are updated regularly.

One member of staff on Ward 18 expressed concern regarding medical cover whenconsultants are not on duty after 4.30pm. They said that staff knowledge of oncologyis basic and nurse practitioners have considerably less knowledge than consultants.The staff member suggested it would be beneficial to have a ‘staff grade’ doctoravailable on site after 4.30pm with more in-depth knowledge of oncology to providethe support they need.

Excellent

GoodSatisfactory

Satisfaction with care received

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Additional findings from observations

During the course of the visits, Enter and View representatives made observationsabout the ward environment and activity taking place. Representatives found thatwards that had not yet been modernised struggled with the storage of largeequipment, cleaning trolleys and drinks trolleys etc. Staff tried to leave corridors asfree as possible from obstructions.

Furthermore, the view was expressed by some patients that the layout ofbed/chair/locker in the bays needs reviewing to ensure privacy of patients. Somebays were found to offer little space between patients and having chairs next to eachother may suit patients who wish to speak to each other, but not all patients wouldlike this layout.

It was also noted that the layout of the toilet and shower facilities in Ward 22 doesnot maintain privacy and dignity as the male shower and bathroom access is in thefemale end of the ward so males have to go past female patient bays. There ishowever a male toilet in the male bay.

Enter and View representatives felt that the layout of the Clinical Decisions Unit withmodern wide corridors, plenty of storage and a large day room could be modelled asa good example for configuration of wards.

Conclusion

A number of themes have emerged from the patient, carer and staff experiencesdetailed in the findings from these Enter and View visits across the nine wards.

Introductions / Addressing Patients

It was highlighted that doctors were less likely to introduce themselves to the patient.It is clear that patients would prefer to know the name of the person treating themand what their role was in their care, as some patients felt the need to ask the persondirectly who they were. It is recognised that all staff should wear the new yellowname badges, but as good practice it should be noted that it is courteous for all staffto verbally introduce themselves to help put the patient at ease. Furthermore, it wasfound that one member of staff was repeatedly addressing patients using terms ofendearment such as “petal” and “sweetheart”. Staff should agree with patients howthey would like to be addressed, and it should be ensured that this practice isconsistently applied so that patients know who is responsible for the care they arereceiving.

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Communication and Information

Patients spoke about instances where conversations between doctors and nurses andother patients had been overheard. In some cases, this was because discussions hadtaken place in a shared bay with only curtains closed to provide privacy. It is acceptedthat in some cases, perhaps due to the patient’s mobility or the availability or an alternativelocation, conversations with patients may have to take place on the ward.However, staff need to be mindful of the need to maintain patient confidentiality andtake all steps possible to prevent others from overhearing. Furthermore, it has beenhighlighted that conversations with patients who are hard of hearing or who do not speakEnglish have not been conducted with sensitivity. The raising of voices where the patient ishard of hearing or does not speak English increases the likelihood of others overhearingsensitive information about the patient. Patients should expect to be able to have privateconversations about their care and treatment, and appropriate ways to communicatesensitively with those who are hard of hearing or who do not speak English need to be put inplace.

It was apparent that patients would like to be kept informed about all aspects of theircare and treatment. Where delays occur or patients find themselves unaware of theexpected next steps in their treatment, they would like at the least to be acknowledged andprovided with information as it becomes available. Providing timely information about thepatients care and treatment can help alleviate many patients concerns and providereassurance.

Healthwatch found some patients reported that their dietary requirements had notbeen discussed with them when arriving on the ward. Some of these patients had been awareof their own dietary considerations, however staff should be aware that not all patients will beas knowledgeable and assessment of dietary needs should be part of the initial assessmentprocess.

Discharge Procedure

Patients at Scunthorpe General Hospital should expect that planning for discharge starts upontheir arrival at hospital. It was found from our visits that patients were poorly informed aboutthe discharge process and provision that could be made for their return home. This wasleading to anxiety for patients and carers and from their perspective, there was little evidencethat discharge planning had started upon admission, with one carer left to worry about howthe necessary adaptations to his home environment could be made in time.

Some patients were happy to be told by a doctor that they were going home and madearrangements for someone to come and collect them as soon as possible. However, thedischarge procedure involves a number of stages before the patient can leave and somepatients feel increasing anxiety when they are waiting for several hours with the perceptionthat they are well enough to go home. Our findings suggest that patients are not made awareof the discharge process and their expectations that they are going home imminently are notbeing met.

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On discussion with the Matrons it was suggested that something as simple as a different formof words for Doctors to use in informing patients of their readiness for discharge would helpalleviate this. It was suggested that it would be more realistic to say "Once we haveeverything in place you should be ready to go home soon' rather than 'You are ready to gohome now'.

Dignity and Respect

Overall it was reassuring to see that dignity is given due consideration on the wardsand there appears to be much good practice going on as standard which is echoed bythe generally positive response by patients spoken to. However, our visits didhighlight some areas that could be improved. Loss of dignity was reported to haveoccurred where patient’s calls for assistance were not answered in time leaving themin a situation where they were unable to help themselves as they relied on timelyassistance. Attention should be paid to protecting the modesty of patients andensuring curtains are used where appropriate.

Perception of Staffing Levels

Patients highlighted that wards can be busy and that they believed the level ofstaffing directly affects the level of care patients may receive. Examples provided bypatients, particularly in relation to toileting needs, demonstrate that such delays incare do not only impact on patients’ dignity, but can also cause a patient to putthemselves at unnecessary risk. Such concerns with staffing levels were echoed bystaff members themselves who expressed frustration at not being able to spend asmuch time as they wished to with individual patients at busy times. Whilst it appearsthat measures have been taken by the Trust to help alleviate staffing pressures, onebeing the use of agency staff, anecdotal evidence suggests that such measures mayalso exasperate the situation.

Evidence of Best Practice

Evidence of best practice noted during the visits includes:• A special room is provided on Ward 27 for patient with dementia or learning

disabilities and their families to go to discuss their care. They can also be takento see where they will have their operation, to help calm their nerves.

• On Ward 23 patients who are vulnerable or at risk from falls are given redsocks to wear to identify this.

• The use of the “Big Word” translation service on some wards to supportcommunication with patients who do not speak English.

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Recommendations

Overall, it is important to share with staff the positive feedback from patients followingthese Enter and View visits and to celebrate the areas of good practice identified in thisreport. Healthwatch North Lincolnshire makes the following recommendations based on thefindings of these Enter and View visits:

1. The Trust to take steps to ensure all staff introduce themselves at the initialpoint of contact with the patient and explain the role they have regarding theircare. Steps should be taken to monitor compliance with this practice. TheTrust should reinforce with staff their policy of asking each patient how theywish to be addressed and ensure adherence to this process is monitored.

2. The Trust to ensure training for staff members at all levels includes awarenessof appropriate and sensitive ways to communicate with all patients includingthose experiencing barriers to communication such as language or hearingdifficulties. Best practice regarding appropriate communication should beinvestigated and incorporated into the Trust training programme to ensurecommunication is sensitive to the needs of individuals.

3. The Trust to provide comprehensive and realistic information about thedischarge process, both on the wards and through links with the dischargelounge. Patients should be made aware of their next steps in the dischargeprocess, realistic time scales and the support arrangements available to themafter discharge. Opportunities for multi-agency approaches to dischargeplanning should be fully explored to facilitate seamless care and allay patientsconcerns and anxieties.

4. The Trust to consider carrying out a survey with ward staff to obtainconstructive feedback from frontline staff on how they feel pressures could bealleviated at busy times, and how alternative staffing options may be mosteffectively deployed. Particular attention should be given to how more timelyresponses to calls for assistance can be enabled, thus enabling greaterpreservation of patient dignity. Healthwatch North Lincolnshire would bewilling to support the delivery of such an exercise.

The Next Steps

This report will be submitted to Northern Lincolnshire and Goole Hospitals Foundation Trustunder the Healthwatch power to make reports and recommendations. The service has 20days from receipt of the report to respond. Healthwatch North Lincolnshire will monitorresponses to our recommendations and keep members of the public and stakeholdersinformed of progress and actions to deliver improved services. Such monitoring activity mayinclude a repeat of enter and view visits to wards to determine whether improvements havebeen made.

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Service Provider Response

The Trust very much welcomes the involvement of Healthwatch in undertaking visitsof this nature. The feedback gleaned from these Enter and View visits is invaluable asit highlights positive feedback in relation to successes, provides reassurance to thepublic and also helps to identify areas where improvement is needed.

The maintenance of dignity and respect for our patients and their families is a primaryconcern for us and we welcome the opportunity to demonstrate actions that can betaken to minimise distress and to improve in the delivery of high quality care.

We have noted the observations and the subsequent findings and would wish to offera response to the themes. In addition we have discussed the findings at our PatientExperience Group and are developing an action plan to progress some of theimprovements identified. We will then utilise a range of opportunities to ensure thatkey messages and actions are communicated across the wider organisation, includingthe CEO cascade, operational group meetings and senior team meetings includingNMAF (the Nursing and Midwifery Advisory Forum).

Patient understanding

We note that on the whole, patients and carers had been introduced to thoseproviding their care however on occasions it would appear that doctors were lesslikely to introduce themselves to patients than nurses. Earlier in 2014, the Trustlaunched its local version of the Hello my name is ….. campaign, to which a significantnumber of staff submitted a pledge. This campaign was further developed to includestandard telephone greetings and also posters to use for door signs etc. to reinforcethe message. We monitor this standard currently through our Ward Review processwhere patients inform us that a high % of staff introduce themselves however it willbe helpful for us to continue promotion of this key message across the Trust.

We have introduced yellow name badges into the Trust for front-facing staff to helpembed the ‘Hello my name is …” approach and also to ensure that patients knew thejob role of the person caring for them. We need to ensure that this is fully rolled out wherestaff have not yet received them.

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We are also in the process of ensuring that there is a named nurse/clinician boardabove every inpatient bed so that this reinforces to patients and carers the healthprofessionals responsible for the patient’s care that day.

A concern was noted in relation to sensitive conversations occurring betweenpatients and health professionals in front of other patients, particularly evident whena patient had difficulty hearing. This could also be applicable for those patients whodo not speak English as their first language. We recognise that this is a challenge andthat it is not always possible to move patients away from a bay area for a number ofreasons however there is a need to remind staff that when a patient is fit to take toan alternative area for such discussions, e.g. a private room, then this should beundertaken. If this is not possible, then steps should be taken to maintain privacy andconfidentiality as much as possible. In 2014 we have worked hard to identify additionalspaces in our hospitals to develop as relative rooms which can also be used as privatespaces for confidential conversations. We will continue to make this a priority and toreinforce the use of confidential spaces where possible. We also intend to reinforcecommunication issues during the handover process between shifts and are currentlyreviewing the communication skills training that is delivered locally.

Meeting the patients’ needs

It was pleasing to note that across all wards, patients felt they had been involved in their careand that there were examples found of person-centred compassionate care that madepatients feel safe and secure. We note that a nurse was observed injecting a patient withoutfully closing the curtains which is unacceptable practice and a concern was raised by 1patient who had been left uncomfortable. These issues were escalated at the time of the visitand addressed by the Matrons with the individual staff members concerned. The report alsoraises concern about a member of staff who was observed using terms of endearment toaddress patients. Again this was picked up by the Matron at the time of the visit. Theadmission document includes a question in relation to the patient’s preferred name howeverwe need to reinforce the message that staff need to ask patients how they would prefer to beaddressed.

There were a few patients who reported concerns in relation to the discharge planningprocess, including lack of support/information, delays and inadequate access to a particulardrug. It is important that we commence the discharge planning process early in the patient’sstay and involve them and their family in discussions about support needs on discharge. Wehave a Discharge policy that emphasises this and the Trust has a discharge and transfergroup, reporting into QPEC, which has representatives from different operational groups thatattempt to improve discharge processes. These issues will be fed into this group forconsideration and further action. In addition, a patient information leaflet is underdevelopment and there are plans in place to increase the use of the discharge lounge. Weare also monitored on the timeliness and quality of discharge through the contractmonitoring route.

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Raising concerns

The report indicated that patients and their carers felt comfortable to raise anyconcerns. There were however a number of comments that indicated that at times theresponsiveness of nursing staff to the use of patient call bells was not as timely asrequired and on occasions had resulted in their dignity being compromised. This wasdistressing for us to read as we recognise the upset caused for individuals which iscompletely regrettable. Concerns were also noted by staff members spoken to inrelation to staffing levels on some of the wards. It was also noted that 2 members ofstaff were described as having a poor attitude. Patients commented on how busy thewards are and recognised that this may contribute to the issue. Our wards are busy interms of activity and the acuity and dependency of our patients has also increased. Wehave taken a number of steps this year to try to address these issues.

Several months ago we introduced ‘intentional rounding’ or ‘care rounds’ whereward-based staff visit patients every hour and review the patients’ needs, e.g. do theyneed a drink, would they like assistance to the bathroom, do they need support tochange their position, do they have their glasses, hearing aid etc. to hand. This has ledto an audible reduction in the use of call bells on the wards, reducing some of thenoise within the environment. An audit of the care rounds is currently underway.

We have also reviewed the staffing levels for each ward and mapped this against theacuity and dependency of patients, making investments in the ward establishments asa consequence to ensure that we have the right staff, in the right place, at the righttime. These staffing levels are publicly made available through NHS Choices and theTrust website as well as being displayed at ward level so that patients and the publiccan see the actual numbers of nurses on duty and what actions are being taken ifwards do not meet their planned staffing levels that day. Throughout 2014 we haveinvested significantly in nurse staffing posts for the inpatient wards and subsequentlyundertaken a vast recruitment campaign, locally, nationally and internationally. Nurserecruitment is an on-going challenge, not just for our organisation, and much workhas been undertaken to recruit nurses from overseas. The nurses recruited fromSpain and Portugal have been valuable - as well as bringing a high level of competencywith clinical skills, they have demonstrated a high level of care and compassion in theward areas. The Recruitment Hub in the hospital continues to work hard inconjunction with the senior nursing team to ensure that wards are appropriatelystaffed to match the patients’ needs.

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We have also undertaken a specific project in conjunction with the Patients’Association, the University of Hull and Hull York Medical School where we used anumber of different methodologies to capture and review the patients’ experience ofusing call bells. This yielded some positive results including:

· 85% of patients had been given a good explanation of how to use a call bell· 82% had the call bell always within reach· 82% of patients had their needs checked regularly· 93% rated their experience of using call bells as ‘exceptional’ or ‘good’· Hospital staff are to be commended for compassionate, person-centered care

In addition we are taking a number of steps to address poor attitude of staffincluding:

· Launch of Trust Vision & Values· Introduction of values based appraisals· Development of a proactive campaign in relation to the standard of behaviours

we expect - the Trust takes a Zero Tolerance to a number of issues and thisincludes standards of behaviour

· Introduction of Values champions that assist to champion expected standardswithin their area

· Use of patient stories within training and team meetings to powerfully sharemessages from the patient or carer feedback (positive and negative)

· Increased face-to-face meetings with complainants· Performance management of individuals where poor standards are in evidence

In relation to your recommendation to carry out a survey to obtain constructivefeedback from front-line staff, we have a number of mechanisms currently in placeincluding CEO cascade and ‘An Audience with Karen’ and the SHINE networkencourages staff to come forward with ideas and solutions, e.g. Dragons Deninitiatives. We deliver a quarterly morale barometer survey to glean informationabout how staff are feeling and we have plans in place to commence specific staffengagement activities to drill down into underlying causes of staff concerns in January2015.

Meeting nutritional needs

Overall the patient feedback appears to have been very positive about assessment ofneeds and assistance being given where needed with dietary requirements. A numberof helpful comments were received including:

· Variety of food not tailored to specific need, e.g. stews, soups, etc.· Some patients would like to have supper· Patients prefer sandwiches served on a plate· Dietary requirements not fully discussed

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These points have been shared with the Hotel Services General Manager fordiscussion at the Catering sub-group that has been formed to lead improvements inthe overall “food and drink experience” for patients. The group is already looking atimplementing a number of actions including reviewing the patient menu and willconsider providing plates for sandwiches. A snack list is already available and will bepromoted at ward level. In addition the Trust is investing in new beverage trolleysthat will enable a soup option to be available 24/7. Finally although the dietaryrequirements of each patient are noted in the admission record, we have identifiedthrough this feedback that it would be helpful to include them in the Nutrition &Hydration Care Pathway so this will be amended accordingly.

Our lead Quality Matron for nutrition has a detailed action plan that draws together anumber of actions Trust-wide that aim to improve the experience of patients. Sheworks closely with the Hotel Services General Manager and the Lead Dietician and theywill be key to progressing some of the relevant actions to benefit patients. We monitorpatient feedback each month through our menu card survey and make adjustments asneeded. In relation to improvement over the year, the Trust has made changes to thesupplier and catering provision which has contributed to a marked improvement beingseen within the Food score element of the PLACE assessment.The Catering sub-group are committed to ensuring that further improvement isachieved in the coming months.

Additional findings

There were some specific findings that did not naturally reflect a particular theme,including:• Concern from 1 member of staff in relation to medical cover in oncology• Older wards struggling with storage of equipment• Layout of bays needing a review• Layout of toilet and shower facilities on ward 22 not conducive to maintaining

privacy and dignityA visit to the oncology ward has been undertaken by our senior nursing team and thecomments appear to have been the opinion of the individual on the day however theWard Sister is confident with the knowledge and the skills of the teams available outof hours.

The concerns in relation to the environment will be taken to the Trust PLACEEnvironment group for further discussion and identification of short-term andlonger-term solutions where possible.

20

Satisfaction

We were pleased to note that the overall levels of satisfaction were found to be veryhigh. It was also positive to note the areas that were evidencing ‘best practice’ andwe will ensure that the positive feedback is disseminated to those teams and services.

The actions flowing out of this report will be monitored via the Patient ExperienceGroup with additional oversight by the Quality & Patient Experience Committee whowill offer further challenge so that the Trust Board and Healthwatch receive thenecessary assurance that appropriate actions have been taken that will becomeembedded and help to improve the standards of patient care across all of ourhospitals. We would welcome a further visit at an agreed time to review progress.

ENTER & VIEW SGH - ACTION PLAN (December 2014)

This action plan on the following page presents the actions identified following avisit from Healthwatch members to Scunthorpe General Hospital in October 2014.It is recognised that although the visit was on one hospital site, many of the issuesmay well be applicable Trust-wide and actions will therefore be targeted across theorganisation where appropriate. ‘‘

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