A health watchdog has raised concerns about bed blocking and staffing at Brighton and Hove’s biggest hospital.
In a report published yesterday (Friday 27 March) Healthwatch Brighton and Hove said that during an unannounced visit with Healthwatch East Sussex they found
- 36 per cent of patients across four locations were medically fit to leave hospital but were unable to. This was largely because social care packages had not been put in place. All patients in Overton Ward, an extra capacity ward, were waiting to be discharged.
- 63 per cent of patients in the Acute Medical Unit were inappropriately placed there. Staff estimated that the average age of patients in the unit was 85.
- Staff reported understaffing that sometimes compromised their ability to give comprehensive care, particularly one-to-one support and care for people with dementia.
- The wards visited were not routinely giving patients all the discharge information that they needed, specifically the hospital’s discharge booklet.
- Overall and across all wards staff showed a caring attitude and attention to their patients, particularly at meal times. There were many examples of best practice to be shared within the hospital.
Frances McCabe, Chair of Healthwatch Brighton and Hove said: “Healthwatch Brighton and Hove and East Sussex will continue our vigilance. We also plan more visits to monitor the care of older people at the hospital.
“If you have concerns or experiences you want to share, please contact your local Healthwatch. We are here to listen.”
Healthwatch said that eight people looked at the quality of care, staff attitudes and access to information in four older people’s wards at the Royal Sussex County Hospital
They made their unannounced visit on Monday 19 January from 11am to 3.30pm when they went to Emerald Ward, Overton Ward, Chichester Ward and the Acute Medical Unit (AMU).
The report said that Chichester Ward and Emerald Ward managers confirmed that they were understaffed on the day of the visit.
In Emerald Ward, which is for patients with dementia, two nurses and two healthcare assistants were looking after 16 patients.
In Chichester Ward three nurses and three healthcare assistants were looking after 21 elderly patients.
In Overton Ward three nurses and two healthcare assistants were caring for 13 patients.
And in the Acute Medical Unit (AMU) eight nurses and six healthcare assistants were taking care of 38 patients.
The report said: “Some wards experience their full-time staff being redirected to other locations in the hospital, leaving other wards such as Emerald understaffed.
“Funded psychiatry sessions were also a concern for the staff on the Emerald Ward, as the funding for this was about to be withdrawn.
“We were told that the staff would also like less bureaucracy when transferring people to care homes and care packages at home.
“Some wards and units had higher numbers of people who needed extra support around activities such as eating due to extra support needs such as dementia or language.
“This can vary from day to day. On the day we visited, Emerald Ward had relatively low specialist care needs whereas others had many patients who needed additional support.
“The AMU manager was unable to tell us what the special needs of the patients on their ward were because the handover notes were not to hand at the time of interview.
“And the Chichester Ward manager told us that they were not able to meet the one-to-one care needs of a patient on the day of the visit due to understaffing.
“When working with older people, especially in the case of dementia patients, it is sometimes necessary to do a deprivation of liberty safeguards (DoLS) assessment.
“This should take place wherever a person’s liberty might have to be compromised to care for them properly in hospital
“Most wards had small numbers of people who were being considered for assessment or had already been assessed.
“The manager of Emerald Ward told us that not all patients had been assessed as necessary due to a lack available staff time.
“Another test which can be used with some older people is the Mental Capacity Act (MCA) assessment which looks at which decisions a person is able to make and which decisions may need to be taken by someone else.
“Similarly, only some patients across all wards had received an MCA assessment.
“One of our representatives observed that a number of patients appeared confused on the AMU and may have benefited from a formal assessment.
“Some visitors on the AMU had concerns about strong painkillers being used too readily and others not enough.
“There were some very positive examples of good care. The majority of older people and their carers felt that staff attitude towards them was kind and attentive.
“There were also some examples of poorer communication with patients and visitors.”
“Staff in the AMU, however, informed us that they felt only about a third of patients were appropriately placed there.
“They felt that many patients would be better suited to other locations in the hospital but were unable to be transferred due to a lack of available beds.
“As the average age on the ward was 85 years old, many patients may have benefited from the specialist care available on the older people’s wards we visited.
“The Acute Medical Unit should function as a place for people to go after A&E to be assessed in more detail before moving on within 72 hours.
“In reality the unit has functioned as an overspill for older people’s wards and for A&E and many older people were placed there for longer periods.
“The longest stay in the AMU that was reported to us was five weeks.
“Staff reported that they do not feel like they are operating the unit as it was intended to be run and that agency staff often preferred not to work shifts on the unit as a result of this.
“This is an issue that may require further monitoring by the trust.
“A large number of patients who were on the wards during our visit were designated medically fit to leave hospital.
“In other words, the patients were ready to leave but were unable to do so for non-medical reasons, such as waiting for a package of care, transport or medicine to be arranged.
“This is officially termed a ‘delayed transfer of care’.”
Eleven of the 21 patients in Chichester Ward were medically fit for discharge as were eight of the 16 in Emerald Ward.
All 13 patients in Overton Ward, the extra capacity ward for those with complex needs, were medically fit to leave hospital.
The report added: “In the Acute Medical Unit we also met a distressed family member who felt her elderly father was not yet ready to be discharged.
“He had been discharged recently but had to be readmitted soon afterwards and the family felt this was because he had not been ready to leave in the first place.
“Eventually the discharge was postponed following the concerns of his family being heard.
“Most patients and their visitors felt happy with the service they received in Royal Sussex County’s older people’s wards.
“Overall, on the day of our visit, staff were working as well as they could in an environment which was very busy, unpredictable and in some cases in cramped older wards, often unsuitable for the needs of the patients and staff working in them.
“The central issues, of social care not being in place for older people on discharge and demand on A&E, are putting pressure on the wards we visited by leaving a great many patients in hospital unnecessarily.”
The report also said: “We have seen many examples of good practice which should be celebrated.”
Brighton and Sussex University Hospitals NHS Trust, which runs the Royal Sussex, said that it now had a dementia champion.
About 500 staff had completed either a one-day or three-day course in the past year on top of 300 in the previous year.
The trust also looks likely to appoint a dementia educator to improve the rate of training in this growing area.
The trust said: “Our dementia training is now accessed by colleagues from Sussex Partnership NHS Trust and Sussex Community Trust.”
The trust also said: “Nurse staffing levels have been challenging over the past six months.”
It said that a deputy chief nurse was appointed last September to oversee this area. The trust had even recruited actively in other countries.
Pay rates for bank staff go up next month to try to reduce the numbers of more expensive agency nurses being employed – plus ward staff were being paid overtime.
An improvement plan was in place for the AMU, the trust said, and the unit was under constant review.