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‘Enter and View’ Report
Ealing Hospital – Ward 4S
Uxbridge Road, Southall
Middlesex UB1 3HW
,
Healthwatch Ealing
December 7th 2018
1
Service visited: Ealing Hospital – Ward 4S
Address: Uxbridge Road, Southall, Middlesex UB1 3HW
Ward Manager (WM): Gary La-Touche
Date and time of visit: December 7th 2018, 10am – 12:30pm
Status of visit: Announced
Healthwatch Ealing ‘Enter
and View’ Authorised
Representatives:
Francis Ogbe, India Hotopf, Eunice Park and Shabina
Jeganathan
Lead Authorised Francis Ogbe
Representatives:
Healthwatch Ealing contact
details:
Healthwatch Ealing, 45 St Mary’s Road, Ealing W5 5RG
Tel: 020 3886 0830
Email: [email protected]
CQC Rating: Requires improvement
Date of CQC Report: 7th June 2018
Healthwatch Ealing (HWE) has the power to ‘Enter and View’ services in the borough of Ealing.
‘Enter and View’ visits are conducted by teams of trained ‘Enter and View’ Authorised
Representatives.
Purpose of the visit
The Health and Social Care Act allows Healthwatch Ealing ‘Enter and View’ Authorised
Representatives to observe service delivery and speak to patients, residents, staff, relatives,
friends and carers. The visit can happen if people tell us there are concerns, but equally, the visits
can take place when services have a good reputation. We can therefore learn from shared
examples of what they are doing well from the perspective of the people who experience the
service first hand.
‘Enter and View’ visits are not intended to specifically identify safeguarding issues. However, if
safeguarding concerns arise during a visit, they are reported in accordance with the HWH
Safeguarding Policy. If at any time an Authorised Representative observes a potential
safeguarding concern, they will inform their lead. The lead Authorised Representative will then end
the visit. In addition, if any member of staff wishes to raise a safeguarding issue about their
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employer, they will be directed to the Care Quality Commission (CQC) and Ealing Council’s
Safeguarding Team.
On this occasion, four ‘Enter and View’ Authorised Representatives (three HWE volunteer and one
HWE staff members) attended the visit. The Authorised Representatives spoke with patients, staff
and visitors. Recommendations have been made on how to improve the service and good practice
has been highlighted. HWE had liaised with the CQC, Clinical Commissioning Group (CCG) and
the Local Authorities (LA) to create an ‘Enter and View’ Programme. A number of health and social
care providers were selected to be visited. Our reason for visiting this ward was to observe how
the hospital manages dementia patients on non-dementia wards.
Acknowledgements
Thanks to our ‘Enter and View’ Authorised Representatives: Francis Ogbe, Eunice Park and
Shabina Jeganathan.
Thanks to the staff, patients and visitors of Ealing Hospital ward 4S for taking the time to speak
with us.
Background
Ward 4S at Ealing Hospital is a medical ward which specialises in cardiology, and receives a high
number of elderly patients, some of which have dementia.
The ward is split into 7 bays. There are 32 beds in total. 11 are in the High Dependency Unit
(HDU), which treats patients who are acute and require cardiac monitoring. The remaining 21
beds are for step down care patients. The ward is split by gender, except for the HDU bay which is
mixed.
At the time of our visit, all beds were occupied and there were 4 dementia patients on the ward.
One of the main focuses of our visit, was to specifically look at how dementia patients are
managed in non-dementia wards, and whether the ward was ‘dementia friendly’, both in terms of
the care provided and the physical environment. In order to assess this, we consulted the King’s
Fund’s EHE Environmental Assessment Tool prior to our visit.1
The EHE Environmental Assessment Tool outlines a set of indicators used to assess whether an
environment is appropriate for a dementia patient. For the purpose of the visit, we selected several
areas to focus on. These areas of focus and Authorised Representative observations are outlined
in a separate section on page 4.
1 The King’s Fund. 2014. Is your ward dementia friendly? EHE Environmental Assessment Tool. [Online]. [Accessed: 17/12/2018]. Available from: https://www.kingsfund.org.uk/sites/default/files/EHE-dementia-assessment-tool.pdf
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Observations about Ward 4S
Ward area
Upon entering, Authorised Representatives were met by the WM who was friendly, approachable
and accommodating, taking the time to sit down and answer our questions fully.
The ward was clean and well-lit. There were hand sanitisers available at the entrance of the ward,
near each side room entrance and at each bay. There were no hazards and the hallways were
spacious enough to allow passage of wheelchairs and beds.
Information displayed
Upon entering the ward, Authorised Representatives saw a staff board with photographs. There
was also a colour coded Quality NHS Board providing details of audit results. An Authorised
Representative noted that the cleanliness check result had fallen from the required minimum of
95% in October, to 92% in November, though all areas of the ward viewed appeared clean and
odour free.
The ward displayed information about PALS for views and complaints, as well as a suggestion box
and information on patient/visitor feedback with examples of how past issues have been
addressed. For example, we were informed there had been a complaint about a lack of ethnic
foods on the menu, so they had introduced ethnic food options as a result of this complaint.
Also displayed, were various posters related to cardiology, such as a poster with graphic
information about the heart, in addition to several booklets and leaflets detailing various conditions
and treatments.
There was also information about the ‘Treat me Right Passport’ for patients with learning
disabilities which, when completed, provided information to patients on ways to make their stay
easier for them and things they needed help with. This could be given to patients and carers.
Fire safety
There were 2 fire exits clearly marked with fire extinguishers placed in an accessible place at the
entrance to the ward. Fire safety manuals were also on display, as was a fire action escape plan.
Odour and Environment
There were no unpleasant odours detected and it was generally a well-maintained pleasant
environment.
Accessibility to toilets
Toilets were easily accessible for patients and they were clean and well-maintained. There was a
block of 2 bathrooms and 1 toilet on either end of the ward. Toilet blocks were mixed sex, with 1
male and 2 female toilets at one end, and 2 male and 1 female at the opposite end.
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Dignity and Appearance of resident
All bays were gender specific, except for the HDU. All patients appeared well maintained and
appropriately dressed. Each bed had a curtain for privacy.
Visiting times
We were informed via signs that visiting hours are between 11am and 9pm and that there is a
maximum of 2 visitors per patient.
The WM informed us that there is flexibility around the visiting hours, and that in some cases the
ward may issue a “Stay With Me” card. This allows relatives to visit outside of the visiting hours
and sleep over. The WM noted that there are no visitor beds, but there is a “comfortable” chair
used for sleeping purposes.
Observations about ward 4S – Dementia focus
Ward area
The ward was large and uncluttered, helping dementia patients to navigate the ward more easily.
Strong patterns were avoided throughout, and the ward was not decorated using too many
colours, helping to reduce misinterpretation and additional confusion for dementia patients.
Large clock faces were not visible from all bedsides, and whilst Authorised Representatives did
witness a large clock above the desk in the main corridor, no clocks were witnessed in the bays
viewed. Being unable to see a clock face may be disconcerting to dementia patients and cause
additional disorientation.
Signage
There was no clear signage indicating the name of the hospital and ward inside the ward, though
there was a sign outside the entrance.
Whilst there were graphic signs for the toilets, they were relatively small, high up, and were not of
contrasting colours to the ceiling, making it difficult for dementia patients to read. Aside from the
toilet signs, there was no other signage to assist Dementia patients in finding their way around the
ward.
Toilets
There was a sign outside each toilet block and whilst the signs did use pictures in addition to text,
they were white with black writing and did not contrast fully from the white ceiling. They were also
relatively small and placed high up, meaning that dementia patients might struggle to locate the
toilet.
Within the toilet blocks, there was graphic signage indicating whether each room was a toilet or a
bathroom, with a shower or wet room.
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Toilet doors were brown wood panelled which did not contrast from the door frames or the storage
closet. There was no clear contrast between the toilet seats, flush handles and rails with the toilet
wall and floor. This might make it more difficult for dementia patients to see and use the bathroom.
In some cases, the seat and rail were dark blue which contrasted with the white toilet and
floor/wall, but this was not the case for all facilities viewed, again potentially causing difficulty for
some dementia patients.
The taps were clearly marked hot and cold and were of a traditional design, alleviating anxiety and
enabling Dementia patients to use them with relative ease.
Additional information and feedback
Average stay
The WM explained that the length of stay varies greatly, depending on the nature of the issue. For
a routine treatment such as an angiogram, a patient might be discharged after just one day, but
more complex cases will stay longer.
Patient referral, handover process and discharge
The WM stated that they usually receive patients from A&E as well as other hospital wards.
Upon admission, staff gather as much patient information as possible, including their contact
details and any needs and preferences.
The member of staff interviewed seemed happy with the handover process. She stated that there
is a detailed one to one handover between nurses specific to the bay, as well as a general safety
briefing at the start of each day.
Regarding the medical records, the WM explained to us that first thing they do is check if the
patient is in the hospital’s system. He stated that the GPs records are not joined up with the
hospital’s, which can often prolong the admissions process.
The WM said that the admissions process can be very challenging, and that in some cases, they
resort to doing patient questionnaires or contacting relatives for information. He also told us that
he thought the implementation of the red bag scheme might improve the admissions process, but
in that in practice, patients rarely arrive with the bag.
An important aspect of the admissions process is the Confusion Care Pathway, used for Dementia
patients and patients with a working dementia diagnosis. This includes the use of a confusion
identifier (a multi coloured donut shaped sticker or magnet), which can be placed above a patient’s
bed or within their medical records, informing staff of their confused state. One staff member
informed us that upon admission, families of Dementia patients are given the Common Core
Principles (CCP) Dementia personalised leaflet, which outlines the care and support that patients
require.
We were informed that the discharge process begins as soon as a patient has been admitted and
that the patients discharge plans are constantly discussed and updated throughout their stay. The
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WM told us that he maintains communication with relatives, social workers and occupational
therapists throughout the entire process.
A member of staff explained that when a patient is due to be discharged, they will be discussed in
the morning meeting that day. There, the staff will discuss the case and confirm that all necessary
arrangements have been made, such as ensuring that the patients care package is ready, and
that home arrangements have been made.
The WM explained that delays in discharges tend to be multifactorial. One factor given was when
patient’s plans for leaving have not been dutifully arranged, for instance if physiotherapy has not
been arranged. Another reason might be if the patient was admitted at a time when the further
necessary care was not available. He explained that this is particularly true for cases when it
concerns an elective care service which is not available on the weekends. A member of staff told
us that in her experience, delays often occur because the doctors do their rounds too late in the
day, and patients cannot be discharged until they have been seen.
The WM stated that if patients require further treatment, they might keep them on the ward longer
instead of discharging and readmitting them, to avoid them having to join the long waiting list for
outpatient treatments.
Staffing & Recruitment
The WM informed us that there are at least 8 trained nurses and 2 healthcare assistants on duty
during the day and night. He explained that most of the ward’s patients have acute needs, and
therefore require a similar level of care during the day and night.
Day shifts are from 7:30am – 8pm and night shifts are from 7:30pm – 8am. Authorised
Representatives were told that staff must work three shifts each week, except for one week each
month where they have to complete 4 shifts. This amounts to a total of 150 hours per month.
The member of staff interviewed described the staffing levels on the ward are “okay”, explaining
that they try their best but there are still staff shortages at times. She told us that if a member of
staff cannot make their shift, a message will be sent out to all staff members to find a replacement
as soon as possible. Another staff member spoke highly of management’s involvement, explaining
that they are “trying their hardest” to address the issue, and that senior staff will pitch in when
there is a shortage.
The WM told us that if there are no core staff available, the ward will use agency staff. When
agency staff are used, an effort is made to use staff that they are familiar with, to ensure continuity
of care for patients. One member of staff noted that hiring agency staff can cause difficulties, as
they require a high level of supervision.
He went on to explain that the ward does have “required” staff numbers, but it could be better. The
WM informed us that some of the approaches taken to improving the staffing situation, have been
to train up their junior nurses and take on nurses who may not have extensive experience, but do
possess necessary qualifications.
The Head of Nursing explained that the trust has several recruitment and retention strategies in
place. These include the International Nurse Recruitment Programme, trust-wide recruitment
promotion, nurse recruitment events in various locations, pre-registration nurse open days for
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students at affiliated universities, the Capital Nurse Programme and Associate Nursing
Practitioner recruitment events. She also stated that the Trust is currently establishing an Trust
wide Nurse recruiting meeting.
Training
We were informed that the induction process takes place at Ealing Hospital, though it also
includes two days at Central Middlesex Hospital. One member of staff stated that they found
travelling to Central Middlesex Hospital to be inconvenient. Another staff member endorsed the
processes in place.
The WM spoke highly of his own induction experience, noting that he tries to provide a similar
experience to his new staff. In his opinion, the current induction process is “good and supportive”.
New staff are given an Induction Book and a two-week shadowing period, during which time they
familiarise themselves with the ward and learn about protocol, routines, infection control,
safeguarding, moving and handling. Afterwards the WM speaks to the staff to assess whether they
feel confident enough to begin working, noting that he will offer additional shadowing time if
required.
The Head of Nursing and Integrated Medicine informed Authorised Representatives that all staff
undergo mandatory training on core topics, including Fire safety, mental Capacity Act, Manual
Handling, Safeguarding, Infection Control and Deprivation of Liberty Safeguards (DoLS). She
stated that dementia training is not mandatory but it is essential and all staff are encouraged to be
compliant. The WM told us that staff can request training and that he is trying to build up interest in
non-essential training related to interpersonal skills.
The staff member interviewed described the training as “adequate”, stating that she has received
training on medication from a pharmaceutical company, but has not received any dementia
training. She also stated that she has made suggestions of training topics, but none have been
approved.
Authorised Representatives were informed that dementia training is not mandatory. The WM
stated that he encourages staff to undertake training and informed us that “some” of the nurses
have had dementia training, including training around the Mental Capacity Act. He said that he
was glad of this, because there has been an increase in the number of dementia patients being
admitted to the ward. He also explained that he can contact the manager of the dementia ward or
the dementia nurse, if he has questions or requires assistance with a dementia patient.
Another staff member informed us that staff are actively encouraged to complete online Dementia
training, as it covers important topics such as how to de-escalate situations where Dementia
patients are distressed.
The WM told that he ensures all staff are aware of the Mental Capacity Act and follow the
procedures closely, noting that staff can come to him if they are unsure of anything.
Supervision and Appraisal
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According to a member of staff, appraisals are done on an annual basis. A staff member explained
that everyone has their performance reviewed against a scale, their competencies identified, and
their priorities and training needs assessed.
One member of staff interviewed seemed unhappy with her last appraisal, stating that it was not
done face to face and involved her filling out a checklist which was returned to the WM. Another
staff member spoke highly of the appraisal process.
A member of staff seemed satisfied with the supervisions, explaining that they are “on-going”, with
regular communication between staff and management.
Staff meetings
A staff member informed us that staff meetings occur at least once a month. Another member of
staff informed Authorised Representatives that they take place every two months. There are also
daily huddles before each shift.
Audits and checks
Authorised Representatives were informed that the ward receives independent, unannounced
visits, in addition to the CQC visits. The WM explained that he thought independent visits were
good, as they avoid bias.
He explained that there are also mock in-house audits, where the ward partners up with another
ward and the matron from each ward will carry out the visit on their partner ward. The WM stated
that he feels there is an issue with bias in the mock audits, as different wards are familiar with
one another.
After each audit, issues are highlighted, and action plans are formulated. The details of these
action plans are then communicated with all staff.
The ward also conducts monthly Key Performance Indicator (KPI) and the WM carries out weekly
walk-about checks, mainly to oversee patient care and check that the confusion identifiers are
being used correctly.
Safeguarding
A staff member informed us that in the event of a safeguarding issue, the safeguarding team is
contacted. She stated that she had experienced a safeguarding issue recently, explaining that
the process was “easy” because the safeguarding team responded quickly and were “very
supportive”.
The WM also gave us an example of a safeguarding issue. He explained that patients are free to
leave the ward, and that recently one of the patients left for a cigarette break and did not return.
He informed us that the necessary procedures were followed – informing security, thoroughly
checking the hospital and alerting the police. The situation was resolved.
One visitor raised a potential safeguarding concern regarding patient confidentiality, explaining
that she has overheard staff speaking loudly about patients on several occasions.
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Views collected
We were informed that views are collected via FFT (Friends and Family Test). All FFT feedback
is reviewed by management, who identify common themes and bring them up in the staff
meeting. The WM explained that staff give out FFT forms on the discharge day, noting that they
encourage people to fill out the forms digitally, but that the tablet often freezes and is not user
friendly. He stated that the ward has collected feedback from 48% of patients this year and that
the feedback is mixed.
Complaints procedure
The WM informed us that complaints are either received via PALS (Patient Advice and Liaison
Service) or informally, noting that he encourages individuals to complain to him directly. He also
stated that when a complaint has been made, his focus is not to refute the claim, but to gain an
understanding of the issue and apologise if there have been any wrong doings.
He told us that there have been several noise complaints recently, due to bins closing loudly and
staff chatting during their night shift. To address this, the ward has made changes to the bins and
the issue has been brought up at staff meetings, to ensure that staff try to keep quiet during the
night shifts.
Patients and visitors seemed happy with the complaints procedure, with many informing
Authorised Representatives that they felt comfortable raising issues informally with staff.
Activities for patients
The ward day room had been converted to another bay to address bed pressures, so patients
have no real social space or place to go other than their bed. The WM raised this as one of the
issues on the ward, noting that he is in the process of recruiting volunteers.
Meals
The WM informed us that meals are made with patient needs accounted for, usually with the
advice of a dietician and the doctors. Patients can request vegetarian, kosher or halal foods.
Patient’s hydration is closely monitored, and hot and cold drinks are regularly offered to patients.
Patients interviewed by Authorised Representatives seemed relatively happy with the food, with
one describing it as “okay” and another stating that it was “good”. A visitor interviewed informed us
that her father often complained of the food being “bland” and “repetitive”. Consequently, she had
begun bringing him homemade meals. She noted that he was Pakistani and was used to food with
“stronger flavour”.
The ward uses the “red tag” system to keep track of which patients require help eating and
drinking, to ensure that they receive assistance.
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Winter Pressure
The WM stated that the ward has not experienced much noticeable winter pressure this year. He
noted that there have been many diversions of patients from Northwick Park Hospital to Ealing
Hospital, suggesting that this may be that main reason for the ward being fully occupied.
BSL/Interpretation services
The WM informed us that there has been no reason to focus on providing care to patients with
disabilities, but that the team is very resourceful and if a disabled patient was admitted, they would
do research to assess appropriate tools for communication.
He stated that the ward caters for all cultural and religious needs, noting that there is a multi-faith
room next door to the ward, which patients are free to visit. Patients can request menus in different
languages.
Interview Feedback
Nurse Authorised Representatives spoke with a
nurse who has worked at the hospital for 7
years. She told us that she likes her job
because it allows her to make relatives and
patients happy, noting that she loves “putting a
smile on their face” and acting as their
advocate.
She described management as supportive,
stating that they are always “willing to pitch in
with care”. She seemed relatively happy with
the training and induction, though she
complained that she had to travel to Central
Middlesex Hospital for part of her induction.
The staff member also seemed disappointed
by her latest appraisal, which was not done
face to face.
Clinical Sister The Clinical Sister came across as happy and
satisfied with her job and has worked at Ealing
Hospital for 13 years.
She spoke highly of management, describing
them as “approachable” and endorsing their
teamwork. She explained that they are “trying
their hardest” to address the staffing issues,
noting that senior staff will often help during
shortages.
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She seemed happy with the processes in
place for induction, training, appraisals and
feedback meetings. Whilst she was aware of
the formal complaints procedures, she stated
that she is often able to resolve issues
informally.
She informed us that the hospital’s use of
agency staff makes her job more difficult, as
they are unfamiliar with the ward and HDU,
requiring a high level of supervision.
Patient We spoke with one patient who complained
about a lack of communication. The patient
had been informed that she would be taken for
her angiogram and was not allowed fluids as
part of the preparation. This occurred over four
successive days. Whilst she appreciated the
pressure that the ward was under in terms of
servicing A&E as well as ward patients, she
felt that she should have been kept informed of
her condition. She told us that by the time she
had the angiogram, she was dehydrated.
Aside from this issue, she seemed happy with
her experience, stating that the staff were
“lovely”, and the food was good. She told us
that she eats in bed and did not require extra
assistance in terms of eating or personal care.
She seemed happy with the complaint’s
procedure, explaining that she could speak
freely with the nurses.
Patient Authorised Representatives spoke with a
patient who had been on the ward for three
weeks. The patient seemed happy with her
experience, speaking highly of the staff. She
found the food “okay”, noting that she was
vegetarian, and her food preferences were
accommodated. She told us that she eats in
bed and did not require extra assistance in
terms of eating or personal care. She seemed
happy with the complaint’s procedure, stating
that there was no need to make formal
complaints as she could speak with the nurses
about any issues.
Patient (Confusion care Pathway) Another patient interviewed told us that he did
not feel comfortable and was not sleeping very
well, due to staff speaking loudly at night, and
that he had complained about this. Aside from
this, he seemed relatively happy with his
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experience, stating that he was treated with
respect by staff.
He found the food to be “okay” and was happy
with the available choices. He did not require
any additional assistance in terms of eating or
personal care.
Visitor We spoke to one visitor whose father was
preparing to undergo a bypass and had been
on the ward since the 27th November. Overall,
she seemed happy with the experience, noting
that her father was treated with respect and
monitored closely. She described staff as
“friendly”, noting that she felt comfortable
approaching them.
She told us that she brings her father home
cooked food for every meal, explaining that he
is Pakistani and prefers stronger flavoured
food, telling us that he had described the food
as “bland” and “repetitive”. She told us that she
didn’t mind doing this and that the staff had
told her they were unable to cater to her
father’s food preferences.
Her main concern was poor communication
with the doctors. She explained that they do
not always explain things slowly and clearly,
and often use “medical jargon”. When she
asked a doctor to explain a piece of
information more clearly, they told her they
“didn’t have time”. She also had worries
regarding patient confidentiality, as she had
overheard staff discussing patients loudly. She
felt that there should be an effort for staff to
develop bonds with patients, though she also
said that it was understandable that they could
not afford to do so, due to the shortages.
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Conclusion
During our visit, we saw that staff were friendly and attentive towards patients, treating them with
dignity and respect. We also witnessed a positive relationship between staff member and
management. Overall, we found the ward to be a clean, well maintained environment where
protocols were followed.
Regarding the treatment of dementia patients, we found that staff were relatively well informed
with most having received some form of dementia training, although one staff member interviewed
had received no training. The ward also used the Confusion Care Pathway and had access to a
dementia nurse who they could consult and involve in the admissions process. Whilst bright
patterns and colours had been avoided, there seemed to have been no concerted efforts made to
ensure that the ward was ‘dementia friendly’, in terms of the physical environment.
Please see below for examples of good practice and recommendations for improvements. The
provider response is written in bold.
Good practice
1) Throughout the visit, Authorised Representatives witnessed patients being treated with care
and compassion and heard positive feedback from both patients and family members
regarding the level of care provided.
Good practice: staff treat patients with compassion and care, ensuring that dignity is
maintained, and a good level of care is provided.
2) We were informed that ward 4S organises independent visits and mock in-house audits, in
addition to the CQC visits and standard audits.
Good practice: this demonstrates a concerted effort to seek feedback and discover areas
requiring improvement.
Recommendations
1) Ward 4S receives a particularly high number of dementia patients, and whilst most staff
have received some form of training, Authorised Representatives were informed that
dementia training is essential but not mandatory. Healthwatch feel that the staff could all
benefit from mandatory training, to ensure that each member is comfortable providing care
to patients with dementia.
Recommendation: the trust may want to consider introducing dementia training into the
mandatory training curriculum.
Provider response: there appears to have been a misunderstanding. Tier 1 dementia
training is of course essential for all clinical staff with refresher training every 3
years. The ward aims for 100% compliance, staff records are monitored and staff are
given protected time to complete the training.
2) There do not seem to have been any efforts made to ensure that ward 4S is a ‘dementia
friendly’ environment, despite the high number of dementia patients admitted.
Recommendation: the trust might consider consulting the EHE Environmental Assessment
Tool and making some changes to the ward, such as increasing the size of the toilet signs
14
and changing them to a contrasting colour and introducing more pictures and signage to
help patients find their way around.
Provider response: Dementia Steering Group to put together a bid for charitable
Funds for pictures and signage that is Dementia friendly. Ward manager to order big
faced clocks for the bays once funding has been secured.
3) During the visit, a member of staff seemed unhappy with the annual appraisal process,
stating that her last appraisal had not been face to face and simply consisted of her
completing and returning a checklist.
Recommendation: management should try and conduct the annual appraisals in person
Provider response: The Ward manager and Matron have been advised to follow the
Trust’s Appraisal and Personal Development Policy when conducting Appraisals.
Managers should ensure that they have protected time with staff to facilitate face to
face appraisal.
4) During the visit, we were informed that the ward’s day room has been converted into an
additional bay due to bed pressure. Both staff and management brought up a lack of patient
activities as an issue.
Recommendation: the trust may want to introduce some activity materials such as books
and card games for the patients, as well as recruiting some volunteers to come in and do
activities.
Provider response: Heart Link Charity support group visits the ward every week and
engages with patients. Ward manager to request some gaming material. They usually
bring in magazines and books for patients which they leave on the ward. Dementia
Nurse also supports the ward by taking medically stable patients up to level 5
Dayroom for activities twice a week.
5) Some patients and visitors raised poor communication as an issue that they had
encountered during their stay. One individual found it difficult to understand their doctor, as
they spoke quickly and used medical jargon. Another stated that she was not adequately
updated on her treatment plan.
Recommendation: management should relay this feedback to their staff and continue
pushing for interpersonal skills training.
Provider response: Recommendation communicated to Lead consultant, matron and
ward manager. Nursing staff to check with patient’s understanding of their condition
and treatment plan. Consultant to remind junior doctors not to use medical jargon
when speaking to patients and also ensure that patients understand.
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Formal provider response
Thank you for this very helpful report. It was a pleasure to welcome the Healthwatch teams to
Ward 4S. The staff and patients enjoyed the experience. We were delighted to receive such a
positive report and such useful recommendations.
Disclaimer This report is a representative sample of the views of the staff members that Healthwatch Ealing spoke to
within the time frame. This does not represent the views of all the relatives and staff members at Ward 4S.
The observations made in this report only relate to the visit carried out on the 7th December 2018.