A hospital trust chief has issued a rallying cry to nurses to improve the way elderly patients in Brighton and Hove are cared for.
Duncan Selbie, who runs the Royal Sussex County Hospital in Brighton, said: “More than half our inpatients are over 75.”
He said: “Over the coming months our most elderly patients can expect an increasing focus on their needs as the hallmark of what we want to be known for.”
Mr Selbie, chief executive of Brighton and Sussex University Hospitals NHS Trust, did not mention the report published last month by the Care Quality Commission (CQC).
The report is the latest to criticise hospital care for the elderly, although the Royal Sussex was not one of the hospitals inspected.
The CQC looked at 12 NHS hospitals and found that three failed to meet the essential standards required by law. Patients were left hungry and thirsty.
Three of the rest raised issues of concern relating to dignity and nutrition in their care of older patients.
Only six of the 12 provided acceptable care.
Yet ten years ago similar complaints were being aired in a previous report, by the Health Advisory Service, which said that elderly patients were neglected, discriminated against and left hungry and thirsty.
Undercover
And in 2005 the BBC TV programme Panorama screened footage filmed by an undercover nurse Margaret Haywood showing poor treatment of patients at the Royal Sussex.
Mr Selbie said: “While they are with us for an acute health problem the majority also have a combination of pre-existing conditions and complex social care needs which can make their hospital stay and discharge more complicated than for most other patients.
“For our elderly patients it matters especially that when we treat their acute health problem we also care about the whole person.
“Everyone who comes into contact with older people needs to get this right.
“The greater proportion of care is delivered by our nurses and therefore they have the greatest responsibility.”
At the trust’s annual nurses’ conference in May, chief nurse Sherree Fagge described her vision for nursing at the Royal Sussex County Hospital.
It entailed a renewed emphasis on “getting it right every time” and “no more excuses for poor nursing care”.
We have a clear set of expectations in place which focus on the fundamentals of good nursing care
- nutrition
- pain control
- care of property
- privacy
- dignity
- communication
- care of the dying
Mr Selbie said that staff would be expected to focus on getting these right every time.
He said: “We are refreshing much of what we do to make sure this is the experience we offer.
“For example, to ensure patients are more involved in conversations about their own care we are making changes to the nursing handovers which have historically taken place around the nursing station or in the ward office.
“The handover of each patient is being moved to their bedside so that it is about them and with them and also a time to answer any questions they have about their care.”
In addition a “sit and see” initiative is to start.
An observer from another area of the hospital will watch the interactions between staff and patients, record what they see and give immediate feedback to ward teams.
On the five care of the elderly wards in the old Barry Building, from early next month, the trust is adding a qualified nurse on the late shift.
An extra healthcare assistant is being added on the night shift too.
Dedicated
The trust is also looking at ways to create an elderly care ward in the Thomas Kemp Tower to move a ward out of the Barry Building.
Mr Selbie said that in the trust’s Hospital Star Awards this year, elderly care consultant Dr Mark Bayliss won Doctor of the Year.
Mr Selbie said: “The things that were said about him, and about the other 561 people who were nominated, clearly show that most of our people are getting it right most of the time.”
One of the colleagues who nominated Dr Bayliss said: “Over the ten years I have been a nurse I have never met a more dedicated, patient, hardworking, empathetic, nice man and working as a nurse I get to see the things he does that go unnoticed.”
Mr Selbie said: “A better definition of getting it right would be hard to find.”
As a nation we spend a lot of money on our health service and the standard delivered is well below other comparable countries. The role of the Ombudsman is crucial in ensuring the standards we expect are delivered. According to the Ombudsman’s Annual Report, In 2009/10 the Ombudsman received 14,429 health service related complaints of which 180 were investigated and 112 were fully or partly upheld, i.e 0.8%. Such a low level of upheld complaint is symptomatic of either an extremely high performing organisation or a poor performing complaints investigator. I don’t think many would believe that the NHS is a high performer and so the answer is more likely that the Ombudsman is not doing a very good job. I accept that many complaints are probably resolved locally but even so such a low level is extremely suspicious. There is a complaints process but this entails the Ombudsman investigating itself which cannot be considered independent. As a consequence there does not appear to be any independent review of the performance of the Ombudsman and so perhaps we cannot be surprised with the performance of our NHS. I think this is very worrying and if not addressed by Health Select Committe, the health reforms proposed are less likely to deliver the much desired performance improvements we all deserve.
As a user of the national health service for the past 31 years as a renal patient , the last 11 years being under the care of the RSCH, I have seen many changes within the NHS. Some are for the good but many are to the detriment of the patients. Whether it be cuts in staff, cuts in providing essential equipment and the transfer of cleaning to private contractors, all these things impact upon the lives of patients. Many of the nursing staff are dedicated, hard working individuals who are genuinely concerned about the welfare of their patients, however there are, as in most professions, people who should not be there. Some do it because it is job and nothing more. I have seen the best of nursing and been at the receiving end of the worst of nursing care. The NHS needs to get back to basics and put the patient first. That means giving them time, making sure they are warm, fed, comfortable and clean. Ensuring their environment is conducive to their well-being in terms of hygiene and comfort. They need to engage with their patients and understand what the patients needs are and how problems can be resolved quickly and efficiently.
It is sadly, frightening to be admitted into a ward as an in-patient because one wonders whether one will actually get the care that one would need. Dignity of the patient is too often overlooked as well as privacy. Sleep in a ward is nigh on an impossibility because of the close proximity of other patients who may be suffering from dementia and/or be disorientated and in other cases some left in pain, calling for help that takes a long time to arrive. Other times night staff are oblivious to the fact it is sleep time for patients and seem not to care a jot how loudly they talk or what noises they generate. A patients rest is all part of the healing process. On one occasion for example, I was so frustrated that I could not sleep because of the disturbances around me, and being in pain and exhausted I escaped the ward to find solitude and peace in the quiet room on the ward; a room normally reserved for grieving relatives. My absence was not noticed until 10am the next morning when I returned after grabbing much needed sleep.
As a child in the 70’s, I remember that the ward matron was a figure of fear and respect for the patients and staff alike. She would inspect the ward every morning, making sure cleanliness and hygiene were of the standard expected. Patients had to be out of their beds with the beds made if the patient was mobile. Only 2 visitors were allowed at a time and within the designated visiting times. Now it’s a bit of a free for all, with visitors coming and going at all hours and in flocks. Wards are now mixed for both sexes which is all wrong on so many levels and as I have stated earlier dignity is not always given to vulnerable patients. I have seen sights I would rather forget!
While I am on the subject, why do Doctors not wear their white coats any more? Surely it is better hygiene to cover up the clothes they wear outside of the hospital with a white coat than to transfer germs from the wider environment when coming from outside into the confines of the ward?
Yes there are some wonderful staff within the NHS who have saved my life more than once. To them I am eternally grateful and the NHS is a treasure that, as a society, we should be proud of and want to invest in more. However, having said that, there are many, many flaws and too many patients lives are put at risk daily. Whether this is something that can be resolved, only time will tell.