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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