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Lancaster Suite Royal Lancaster Infirmary Enter and View Report
Contact Details: AshtonRoadLancasterLancashireLA15AZ
Staff met during visit: WardManager;LisaWinn,andtheDeputyMatron;ErianThornton.
Date and time of visit: 19thMay201610.30-12.00amand1.30-2.45pm
Healthwatch Lancashire Authorised Representatives:
LindaBrown(Lead)MicheleChapmanIlyasPatelNeilGreenwood(Volunteer)
V2.1
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IntroductionandcontextInFebruary2015,HealthwatchLancashiredocumentedfivepatientjourneysfromward39atRoyalLancasterInfirmary(RLI)overaperiodofsixconsecutivedays.Areportofthefindings‘PatientJourneysWard39’waspresentedtotheUniversityHospitalsofMorecambeBayTrust(UHMB).TheHealthwatchLancashirereport‘PatientJourneysWard39’canbefoundatwww.healthwatchlancashire.co.uk.AsaresultofHealthwatchLancashire’sfindingsfromthefivepatientjourneys,thefeedbackhighlightedanumberofreoccurringthemeswhichbroughtchangesinthefollowingfiveareas:
1. Introductionofnameboardswhichnowincludepatientname,nameofconsultant,nameofnurseandanyindividualorspecificneeds.
2. AnewposterdesignedanddevelopedinassociationwithHealthwatchLancashiretoinformhowpatients,carers,relativescanraiseconcernsormakecomplaints.
3. A‘SleepWell’campaignwaslaunchedonWard39.4. Areviewofstaffingoversevendayswasundertakentoensurestaffingissufficientoverthefull
week.5. Reiterationoftheprofessionalresponsibilitiesofallstaffwhencaringforpatients.
HealthwatchLancashire’steamofrepresentativesreturnedtoward39onthe19thMay2016tospeaktothepatients,staffandfriendsandfamilymembersabouttheirviewsonthechangesmadeinthefiveareasthatwerehighlightedasrequiringimprovementduringthepreviousvisit.
ImprovementstopatientcareInFebruary2015,areportwaspresentedtotheExecutiveChiefNurseatUniversityHospitalsofMorecambeBayNHSTrust,whothensharedthereportwiththeChiefExecutive,Chairman,theboardofdirectorsandstaffonward39atRoyalLancasterInfirmary.Thereportincludedanumberofpositivecommentsbypatientsandtheirfamiliesalongwithrecurringthemeswhichhighlightedwherecarecouldbefurtherimproved.Sincethislastreportwaspublishedward39hasbeenreducedtoa34beddedunitandrenamedTheLancasterSuite.“BeforeChristmastheinitialbuildingworkonRLI’slargestward,ward39began.Theaimoftheworkwastomakeitssizemoremanageable.ThiswasapriorityasithadbeenaconcerninthepastforboththeTrustandourregulators-theCareQualityCommission(CQC).Asaresult,in2015theTrustproposedtotheCQCthattheywoulddivideward39creatingageneraladmissionwardandcombinedcardiologyunit(CCU).Theformerward39nowconsistsoftwosmallermoremanageablewards.Thelargerleftsectionofward39isnowknownastheLancasterSuiteandthesmallerbeddedbayareawillremainnamedward39,untilsummer2016whenitwillbecomeknownasCCU.”AARONCUMMINS,DEPUTYCHIEFEXECUTIVE/DIRECTOROFFINANCE
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AcknowledgementsWewouldliketothankLisaWinn,theWardManager,togetherwithpatients,staff,andvisitorsontheLancasterSuiteforbeingsowelcomingandtakingpartintheEnter&Viewvisit.WewouldparticularlyliketothankLisaforbeingsoaccommodatingandtakingthetimetospeaktous,despiteherbusyschedule.MethodologyOnThursday19thMay2016anEnterandViewvisitwasundertakenbyauthorisedrepresentativesfromHealthwatchLancashirewhohavetheauthoritytoenterhealthandsocialcarepremises,announcedorunannounced,toobserveandassessthenatureandqualityofservicesandobtaintheviewofthosepeopleusingtheservices.TheteamoftrainedEnterandViewrepresentativesrecordtheirobservationsalongwithfeedbackfromserviceusers,staffand,wherepossible,relativesandfriends.Theteamcompileareportreflectingtheseobservationsandfeedback.Theirreportissenttothemanagerofthefacilityforvalidationofthefacts.AnyresponsefromthemanagerisincludedwiththefinalversionofthereportwhichispublishedontheHealthwatchLancashirewebsiteatwww.healthwatchlancashire.co.ukTheteamreviewedtheoriginalreportandconsideredthefindingswhenconductingtheEnter&View.Inordertoobservewhetherthoserecommendationshadbeenimplementedwespoketoelevenpatientsandrelatives,structuringourconversationsaroundthefiveareasidentifiedintheoriginalreport.TheaimwasalsotogatherinformationconcerningpatientsoverallexperienceofthenewLancasterSuitewhichhasreplacedthepreviouslynamedward39.Inaddition,wewerealsoabletospeaktosevenstaffabouttheirviewsaboutstaffinglevelsandskillmix,howtheyfeltaboutthenewLancasterSuiteandiftheywouldbehappytorecommendthewardtoacloserelative.Theteamalsorecordedtheirownobservationsontheenvironmentandfacilities.The34beddedunitwasfullyoccupiedonthedayofourvisit.DISCLAIMERTHISREPORTRELATESONLYTOTHESERVICEVIEWEDATTHETIMEOFTHEVISIT,ANDISONLYREPRESENTATIVEOFTHEVIEWSOFTHESTAFF,VISITORSANDPATIENTSWHOMETMEMBERSOFTHEENTERANDVIEWTEAMONTHATDATE.
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TheFiveAreasforreviewfromthe‘PatientJourneysWard39’Report2015(LancasterSuite)
1. Introductionofnameboardswhichnowincludepatientname,nameofconsultant,nameofnurseandanyindividualorspecificneeds.
Theteamfoundthatthemajorityofnameboardswereuptodatehowever,threeoutoffiveinonefemalebayhadnotbeenupdatedfromthedaybeforeandtwoofthosedidnotshowtheconsultantsname.Allthenameboardshadthepatientscorrectname,keynurseandspecialinstructionsonthem.Thishastobeviewedincontextthatthewardwasunderstaffedonthedayofourvisitduetosickness.
• Allofthepatientsandrelativesaskedtoldusthattheinformationaboutthemwaskeptuptodate.“IwasnotaskedbywhatnameIwouldliketobecalledbutitdidnotreallybotherme.”
2. AnewposterdesignedanddevelopedinassociationwithHealthwatchLancashiretoinformhowpatients,carers,relativescanraiseconcernsormakecomments.
TheteamfoundthatalthoughtheposterwasclearlydisplayedattheentranceofthewardalongwithinformationforPatientLiaisonService(PALS)complaintsprocedure,themajorityofpatientsandrelativesdidnotknowhowtomakeacommentandhadnotseentheposter.Anumberofrespondentssaidthattheyhadnoneedtocomplainastheyhadbeenveryhappywiththeirortheirrelativescare.
• Fouroftheelevenpatientsandrelativesaskedknewhowtomakeacommentorcomplaint.• Sevenoftheelevenpatientsandrelativesaskedhadnotnoticedtheposterinformingthemhowto
dothis.“Iwouldwritealetter.”
“IhavemetarepresentativefromBlackburn.”
“Ihavenothadtocomplain,I’mveryhappywiththecaremyrelativeisreceiving.”
“IhavebeencomingtothehospitalforawhilenowandIknowthecomplaintsprocedureinsideout.”
“Ihavebeenhereforthreeweeksnowandnotbeenwellsoitisnotimportanttomerightnow.”
“EverybodyhereisreallygoodandIknowifIhadanissuethestaffwouldguideme.”
3. A‘SleepWell’campaignwaslaunchedonward39.Theteamfoundthemajorityofpatientswespoketosaidthattheywereabletosleepsatisfactorilyatnight.Themainreasonsforsleepdisturbancewereduetothepatient’sownillnessoractivitythathadtobecarriedouttoattendtopoorlypatientsduringthenight.Allofthepatientsaskedwereunawareoftheavailabilityofearplugsandeyemasks,somepatientssaidtheywouldnothelpbecauseoftheirconditionandthosethatsleptwelldidnotfeeltheywouldwantthem.
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• Sixoftheelevenpatientsaskedsaidthattheysleptwell.• Fourpatientssaidtheysleptadequately.• Onepatientsaidtheyhadnotbeenabletosleepthefirsttwonightsonthewardbuthadsleptalot
bettersince.“Isleepokay.”
“Myrelativesleepsaswellashecaninviewofhisillness.”
“IgetgoodmedicationsoIsleepwell.”
“Isleepwell.”
“Mymumisinasingleroomsoshehasnoissueswithsleeping.”
“It’stoonoisy,theactivitykeepsyouawakebecausepeoplearepoorly.”
“Thewardisalwaysnoisyduetopoorlypatients.”
“Beingpoorlykeepsmeawake.”
4. Areviewofstaffingoversevendayswasundertakentoensurestaffingissufficientoverthefullweek.
Theteamfoundthatonthedayofourvisitthewardwasshortstaffedbyaregisterednurseandclinicalsupportworkerduetosickness.Twopatientsalsoneededonetoonecare.AdditionalstaffhadbeencalledintohelpfromotherareasandtheWardManagerwasalso‘handson’.TheLancasterSuite/ward39hasbeendividedintodifferentareasandanewfifteenbeddedelderlyunithasbeencreatedwhichisalsocurrentlybeingservedbytheLancasterSuitestaff.Weweretoldthatthisunitwilleventuallyhavemoreofitsowndedicatedstaff.TheWardManagertoldusthatskillmixcouldbebetterbutthatthisisanationalproblem.Shealsotoldusthatalotofworkisbeingdonetoaddressthisbysupportingnewlyqualifiednursesforeighteenmonthstoacquiretherightskillsandarepilotingaschemecalled‘ListeningintoAction’(LIA).“Ifeelsupportedasastudentnurse.Idon’tfeelunderpressureandIamabletoworkwithinmycompetencieseasily.”TheEnter&Viewteamobservedthatthestaffwereverybusybutthewardappearedtobecalmandwithstaffclearlyvisibleandengagedinpatientcare.Elevenrespondents(patientsandrelatives)wereaskediftheythoughttherewereenoughstaffondutyduringdifferenttimesofday.DuringtheDay
• Sixrespondentssaidthatthereappearedtobeenoughstaffonduty.• Foursaidtherewasnotandonepersonrespondedthattherewasnotenoughtoday.
AtNight
• Fourrespondentssaidthatthereappearedtobeenoughstaffonduty.• Fourdidnotthinkthatthereappearedtobeenoughstaffonduty.• Threedidnotknow.
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AttheWeekend• Fourrespondentssaidthatthereappearedtobeenoughstaffonduty.• Onedidnotthinkthatthereappearedtobeenoughstaffonduty.• Sixdidnotknowastheyhadnotbeeninhospitaloveraweekend.
“TheyalwaysappearshortstaffedbutIhaven’tsufferedbecauseofit,theyworkveryhard.”“Icanalwaysspeaktoamemberofstaff.Ihavefeltwellsupportedbythem.”(Relative)“WhenIvisittherealwaysappearstobeenoughstaff.”
5. Reiterationoftheprofessionalresponsibilitiesofallstaffwhencaringforpatients.TheEnter&Viewteamfoundthatstaffwereprofessionalandcaringintheirapproachandmaintainedpatients’dignityatalltimes.AmemberoftheEnter&Viewteamobservedasituationwherebyanursehadtoresolveasituationwithavisitorthatwascompromisingthepatient’sdignitywhencarryingoutpersonalcare,thiswasexacerbatedduetoalanguagebarrier.Therelativehadcomplainedthattheirrelativehadbeenleftfor30minutesonacommodeandwascrying.TherelativekeptopeningcurtainstoseetheirMumwhilstbeingattendedtobytwonurses.Thenurseexplainedthattherelativecouldcomeinbutmustkeepdignityinmindandnotkeepcominginandoutopeningthecurtains.Thiscreatedadifficultexchangebetweenthenurseandrelativebutthenurseremainedprofessionalthroughout.AmemberoftheEnter&Viewteamhadobservedthesamecallbellforlessthan10minutes.Allothercallbellsappearedtobeansweredwithinatimelymanner.AmemberoftheEnterandViewteamwasaskedtoprovideproofofidentificationandtoverifywhytheywereonthewardbyanurse,whichshoweddiligenceandprofessionalresponsibilitytothevulnerablepatientsinhercare.ItwasobservedbytheEnter&Viewteamthatthewardappearedcalmandwellorganisedalthoughthestaffwereobviouslyverybusy.
• Feedbackfromtenpatientsandrelativesconfirmedthatstaffwereveryprofessionalandcaring.• Onerelativehadcomplainedaboutthetimeittookfortheirlovedonetobeattendedtowhen
requestingassistancewhichwasworseatnight.
“Myrelativeisaskedtowaitallthetime.”
“Thestaffaredoingafantasticjob.Itisveryshortstaffed.Theyareverycaring.”
“Theyareveryprofessional.Thestaffhavebeenexcellent.”
“I’mverypleasedwiththestaffandteamandthecaremyrelativehasreceived.”
“Theystaffaregood,theyalllovetheirjobanditshows.”
“StaffaresounderstaffedandIfeelsorryforthemastheyaredoingagreatjob.”
“TheNHSneedstobecomplimentedontheservicetheyprovide,Icomefrom(country)andwedonotgetanythinglikethisthere.”
“Thestaffhavetomultitaskandthisisnotgood.”
“Ihavenoissuesatallhere.”
“Thestaffherearebrilliant.”
“ThestaffherearesoniceandIcanonlycomplimenttheservicetheyprovide.”
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StaffViewsWehadanopportunitytospeaktosevenmembersofstaffabouttheirexperienceofworkingontheLancasterSuite.Twoofthestaffwespoketohadbeentakenfromotherwardstocoverforthetwostaffoffsicktoday.Summaryofresponses
• Mostofthestaffsaidthattherewereusuallyenoughstaffwhenonduty.“Staffingissuesareanationalproblemandnotspecifictothisward.”“Staffinglevelshaveimprovedtenfold.”“Igenerally,feelthereisenoughstaffandgetsupportfromotherwardsifitisneeded.”“Normallystaffingisnotanissuebuttherearedayswhenstaffarenotwellandnotinwhichcanaffectstaffinglevels.”
• Moststafffelttheskillmixwasusuallyadequatewhenonduty.
“Thereisagoodmixofband5andband6onduty.”“InordertogettherightstaffnumberstherehasbeenaneedtorecruitinternationalnurseswhohaverequiredadditionalsupporttoworkingintheNHS.”
• AllthestaffwespoketofeltthattheLancasterSuitewasanimprovementfromthepreviousward39“Ihaveworkedonbothwardsandcanseeabigdifference.”“It’sgettingbetterbutmoreworkcanbedone.”“Ithinkthewardhasimprovedandifwecangetthestaffingrighteverydayitwouldbeevenbetter.”“ThisisthefirsttimeonthiswardsoIcannotcomment.”“Alotofefforthasbeenmadetoimproveteamworkandmoraleandasaconsequenceweworkmuchbetterasateam.”“Theinterpreterservicecouldbeimproved.”
• Staffreportedbeinghappyworkingontheward“Thewardisahappierplacenow;overthetwoyearstheteamhasgrowntogether.”
• Allstaffsaidtheywouldbehappytorecommendthiswardtoacloserelative.“Iwouldbehappytohavearelativecomehere(iftheyneededtheservice).”“Ihavehadmyrelativehereandhewasverywelllookedafter.”
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EnterandViewobservationsandadditionalinformationTheEnter&Viewteamfoundtheentrancetothewardwassecurewithakeypadsecuritysysteminplace.Usefulanduptodatesignsandnoticessuchas,acomplaintsprocedure,consultationpostersfortheundergoingchangesandproposalsandaMissionStatementwasclearlyidentified.Ahelpfulnoticeboarddisplayedinformationsuchasstaffinglevels,keystaffnames,identificationofstaffuniformsandthenumberofcompliments(15)andcomplaints(0)forthepreviousmonth.TheHealthwatchEnter&Viewposterwasobservedontheentrancedooraswerevisitingtimes.Informationwasdisplayedaboutdementiafriendlyinitiativesthatwereinoperationontheunitsuchas,a‘butterflyscheme’whichidentifiedpatientswhomaybeaffectedwithmemoryproblemswithabutterfly.Twoquietroomswithcomfyseating,tables,magazinesandatelevisionwasavailableforrelativestouseattheentrancetothewardandwasoccupiedwhenwearrived.Thecorridors,bathroomsandclinicalareasappearedtobeveryclean,withapleasantodour.Handhygienemessageswereveryprominentthroughoutthehospital,butthesoapdispenserwasemptyattheentranceoftheLancasterSuite,thishoweverwasreplenishedpriortousenteringtheward.Staffnamesweremarkedonthedoorstothebayswheretheywereworkingforeasyidentification.InitiallythecorridorsinthehospitalandontheunitappearedclutteredbutweweretoldbytheDeputyMatronthatthiswasdeliverydayforstockandequipmenttoclinicalareas.Thecorridorsbetweenthebayshadtoaccommodateliftingequipment,emergencyequipmentandpatientrecordtrolleysforeachbaysothiswasunavoidable.Therewasclearsignagetoroomsandfacilities.Patientbayswereverytightintermsofspacebetweenbedsandthereappearedtobebarelyenoughroomforvisitorstosit.Chairsalsohadtobestoredonthecorridorsoutsidethebaysforvisitorsuse.TheWardManagertoldusthatthewardwasstillundergoingchangesandbuildingworkwhichwillbecompletedbyJuly2016.Thewardwillthenbereducedto29bedswhenthenewCardiologywardiscompleted.
WeweretoldbytheWardManagerthatscoresonanationaldatabasecalled“Iwantgreatcare”hasincreasedacrossthehospital.Thescoresarecurrentlyverygoodat4.6outof5.Patientsandvisitorsaregiventheopportunitytocompleteaquestionnaireforward39whichistheninputontothenationaldatabase.Theseresultsarereviewedatthemonthlygovernancemeetings.HealthwatchLancashirehavebeenunabletoaccessanyresultsorfeedbackforward39ortheLancasterSuiteonthewebsiteiwantgreatcare.orgusingtheformprovidedanduniquecodeotherthantheoverallratingsfortheRoyalLancasterInfirmary.
LeylandHouseLancashireBusinessPark
CenturionWayLeyland
PR266TY01524239108
HealthwatchLancashireLimitedRegisteredinEnglandandWalesNo8430248Registeredoffice:POBox78,CountyHall,PrestonPR18XJ
FEEDBACK FORM FOLLOWING ENTER & VIEW BY AUTHORISED REPRESENTATIVES
Healthwatch Lancashire values any constructive comments that would help to enhance our practice of the Enter & View process. Could we therefore ask the service provider to use this form to provide feedback to help us evaluate our effectiveness?
Organisation Address Premises –if different University Hospitals of Morecambe Bay
The Lancaster Suite @ Royal Lancaster Infirmary
Contact Name Telephone Number and/or email Lisa Winn
01524512353
Name of Healthwatch Enter & View Authorised Representatives
Linda Brown (lead) Michele Chapman Ilyas Patel Neil Greenwood (volunteer)
Date & Time of Enter & View 19th May 2016 10.30am -12.00pm & 1.30pm – 2.45pm
Were you happy with the Enter & View Arrangements prior to the visit? Comments- Yes – Poster provided to advertise forth coming visit Email clarification and reasons for visit provided
Please outline any Positive aspects of the Enter & View visit. Comments- The ward was very busy at the time of the visit and the appreciation from the team visiting was very understanding and accommodating to this need. The team spent a length of time explaining what they were going to do and asked advice as to how this would fit around the workings of the ward. Please outline any Negative aspects of the Enter & View visit. Comments- No – very useful informative visit which the staff appreciated
Please use this space to comment on how you think we could improve your experience of our Enter & View visit. Your views are very important to us at Healthwatch Lancashire and we appreciate, in anticipation, your time to complete this form. No – I felt that the team on the day were very supportive and understanding of the operational issues that are involved when managing a busy acute area. Completed by Lisa Winn Position Ward Manager Date 23.6.16
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