Agenda item

Further to recent media coverage of the care received by elderly patients in local hospitals, the Committee is invited to consider:-

 

a)   the issues raised; and

 

b)   the complaints procedure used by local hospitals and how this is monitored.

 

Representatives of University Hospitals Leicester and NHS Leicester City have been invited to attend the meeting to assist the Committee in the scrutiny of these matters and to provide performance information on the care that elderly patients receive in hospital.

The Chair welcomed the members of the public who had attended the meeting for this item.  He indicated that he was willing to let a few of these people speak to the meeting, but would not let the item be debated for too long.  He also stressed that the Committee was not able to discuss individual cases.

 

Carole Ribbins, (Director of Nursing, University Hospitals of Leicester NHS Trust), gave a presentation on Older People’s Care, a copy of which is attached at the end of these minutes for information.

 

The meeting was reminded that there had been a campaign in the Leicester Mercury over recent weeks regarding patient care, and particularly that of the elderly.  97% of patients reported that they had had a good experience with the NHS, but this meant that 3% had not.  These situations were taken very seriously and the issues identified addressed.  To help in this, key targeted interventions had been examined a few years ago, in order to change staff behaviour, so that it became second nature to provide the best care possible.

 

Carole Ribbins drew particular attention to the following points:-

 

·            An interactive training module had been developed, which encompassed the fundamental things that needed to be at the heart of patient care.  All nursing staff went through this and a 100% pass rate was expected;

 

·            Extra hourly ward rounds by a designated nurse for every patient had been introduced in the United States of America in recent years, as a supplement to care.  The experience of patients and their relatives had improved as a result of this and staff stress levels had reduced.  Following its introduction in Leicester, other hospitals in the East Midlands also were considering introducing it;

 

·             “Nurse in Charge” badges had been used in the Accident and Emergency Department for some time.  This had been extended to wards for elderly patients in the last few weeks and had received very positive feedback;

 

·            It was planned to introduce large red badges for Matrons;

 

·            Data was collected from many different sources, but this could result in conflicting reports and sometimes did not give the whole picture of a situation.  It therefore was proposed to include information such as complaints and compliments, and feedback from staff and patients in data analysis;

 

·            It was important to celebrate and recognise good role models amongst staff, but it was equally important to recognise when staff were not working to expected standards of care;

 

·            The roll-out of the proposed interventions would be done in conjunction with other work, such as that being done in dementia care; and

 

·            The University Hospitals of Leicester NHS Trust was committed to making the changes needed to make poor patient experience a thing of the past.

 

Caroline Trevithick, (Deputy Director of Quality, NHS Leicester City), then briefed the Committee on the Care of Older People.  A copy of her presentation is attached at the end of these minutes for information.

 

Caroline Trevithick drew particular attention to the following points:-

 

·            Work was ongoing to ensure that all issues raised by the public were directed to one place;

 

·            A link had been put on the University Hospitals Leicester website to advertise the Patient Advice and Liaison Service for people wishing to raise concerns and complaints;

 

·            The contractual process could be used to reduce themes and trends in complaints.  However, NHS Leicester City did not necessarily want to reduce the number of complaints, as they provided very useful feedback;

 

·            In this context, quality was measured through three elements: patient safety, patient experience and clinical effectiveness;

 

·            The process being used helped the organisation to understand the problems it was facing and see why some things were not progressing as they should be;

 

·            The care of stroke patients was a very important area and showed how indicators could be set nationally to improve standards; and

 

·            Care was taken to ensure that standards were improving across the whole area, not just in a few locations.

 

The Committee welcomed these presentations and the recognition that, while a lot of good work was being done, improvements needed to be made in some areas.  The stories recently featured in the Leicester Mercury highlighted the need for the improvements being discussed, to have mechanisms that ensured that care of the expected quality was being given and to highlight any shortfalls in this as soon as possible.

 

However, it was equally important to ensure that staff morale was good and that the correct staffing levels were being used.  Carole Ribbins assured the Committee that staffing levels were reviewed ward by ward on a daily basis, and formally once a month.  As well as this, a formal review of elderly people’s wards was being undertaken and should be completed by the end of April 2011.  Caroline Trevithick explained that formal quality visits were made as part of the monitoring process and were joined by non-executive directors.  These had been invaluable in ensuring that action was taken where needed.

 

In addition, staff surveys were carried out, from which it had been found that morale on wards for elderly patients was not lower than on other wards.  Although morale was recognised as a potential factor in maintaining care standards, other factors could be equally important, including effective leadership and high standards of nursing care.

 

The following responses were made to points raised by Daren Hines, of Leicester Local Involvement Network:-

 

·            One ward should not be better than another.  Although elderly people could have very complex needs, there could be people who had no-one to speak up for them.

 

Carole Ribbins stressed that all wards should give the same standards of care, even though they could have very different types of patient needs.

 

·            Did hourly visits to wards by matrons mean that something else was not being done?

 

Carole Ribbins confirmed that it had been found that these visits released time, as issues could be identified and resolved before they became major issues.

 

·            Could wards be staffed properly, when new staff were not being recruited and the NHS was having to make significant reductions in costs?

 

Safety came before financial considerations.  Where there were shortages of permanent staff, in-house agency staff could be deployed.  This was working well.

 

·            There did not appear to be a process that could be followed to determine which agency staff had been working on a ward when a particular problem occurred.

 

Carole Ribbins confirmed that this could be tracked, as the agency staff had to be booked through a central office and an audit trail was required.

 

 Carole Ribbins also advised that the work being done by volunteers was being reviewed.  These people could offer their time for as little as one hour a month, or substantially more frequently, and provided very useful services, such as hand massages, hair dressing, or writing cards or letters.  This was particularly important for anyone who did not have visitors while in hospital.

 

·            Cleaning and catering staff often seemed to know the patients better than the nursing staff did.  Could a system be established where they could be used as a conduit through which patients could raise issues or concerns?

 

If anyone had a fear of complaining to staff on the ward, there already were other ways in which their issues could be raised.

 

The following points were then made in response to questions and comments from the Committee:-

 

·            The number of nurses on each ward depended on the size of the ward.  Approximately 30 – 40 nurses were employed for each ward, including care assistants.  They worked on a shift system, so approximately 8 nurses would be on the ward at one time, although this number could vary depending on the speciality of the ward.  There usually was a ratio of 60% qualified staff to 40% unqualified staff;

 

·            The majority of nurses were employed to work on a specific ward.  Temporary (bank) nurses were the exception to this;

 

·            Lack of cleanliness in hospitals was a major concern to many people;

 

·            It would be very useful if some indication could be provided of the level of complaints now and in the future, so that it could be seen if the new measures introduced were working;

 

·            A booklet had been produced that translated information about raising concerns and making complaints and translators were available, as the NHS wanted to ensure that the needs of the whole population of the City were being met.  However, it appeared that this had not been happening;

 

·            If people were aware of the complaints procedure, more complaints would be made, which would be of benefit to the organisations concerned;

 

·            There was a lack of understanding about what the various organisations were and their respective roles, (for example, the primary care trust, University Hospitals Leicester, Patient Advice and Liaison Service, Patient Information and Liaison Service); and

 

·            Websites needed to be clear and easy to access and consideration needed to be given to which websites the general public were likely to access to find the information they needed.  The driver for this needed to be ensuring that the public knew who to approach and how to use the various processes available to them.

 

At the invitation of the Chair, various members of the public in attendance at the meeting were then invited to address the Committee.  The following points were made and responded to as indicated:-

 

·            If a lot of people were afraid of complaining, many complaints would not be made, even if the procedure for doing so was very clear.

 

Carole Ribbins advised that this was a pivotal issue which the University Hospitals of Leicester NHS Trust was committed to addressing, although it was recognised that it was hard to resolve, as the public generally did not like complaining.

 

·            Why were nurses allowed to work 12 or 14 hours a day on wards with vulnerable patients?  After shifts of this length they had no energy and no interest in what was happening on a ward.  When a complaint about this was made at the Evington Centre this a few years ago, assurances had been given that procedures to avoid this were being brought in, but staff were still working these hours.

 

Caroline Trevithick undertook to check the patient safety reports from the Evington Centre, as this was somewhere from which services were commissioned.  If anyone wished to make a formal complaint about care received there, they could approach the Leicester Partnership Trust.  Alternatively, the Primary Care Trust could investigate a matter on someone’s behalf.

 

Carole Ribbins confirmed that, over a number of years, various shift patterns had been established nationally, which had been supported by the nursing and midwifery councils.  The main driver was patient care, but on some wards it was feasible to do a 12 hour shift, with appropriate breaks, with two shifts being worked over a five day period.

 

If it was found that nurses were not functioning to the standards required for any reason, (not just the hours being worked), they would become subject to the hospital’s disciplinary process.  The final sanction under this was dismissal and this was used where necessary.

 

·            There could be many frustrations involved in getting the care needed.  For example, it could be difficult to get appointments with doctors, there was a known case where a doctor had refused to treat someone because the patient was on a research programme, appointments were often cancelled and some doctors were unaware of how some conditions should be treated.  This meant that, if someone was not able to speak up for themselves, they could have difficulty in getting the care they needed, which was of particular concern for the vulnerable.

 

These points were recognised and assurances given that the importance of focussing on areas where the NHS was not performing properly was recognised.

 

·            What was being done to increase the currently low staff morale?

 

It was noted that it was easy to state that morale was low, but it was important to ensure that there was evidence to support such a claim.  Staff were surveyed anonymously and the results of these surveys were taken very seriously, it being a large part of managers’ remit to analyse them in great detail.

 

·            Consideration needed to be given to the hours being worked by nurses, as 12 hour shifts were designed to meet the needs of the nurses, not the patients.  It also needed to be clear which matrons were allocated to each ward.

 

Carole Ribbins explained that long shift systems were used widely throughout the country and abroad.  Not all nurses were allowed to work these longer hours, as the shift system adopted for each ward had to meet the needs of that ward.  However, staff also needed to have shifts that enabled an appropriate work-life balance to be maintained.  Consequently, staffing was monitored very carefully and, if issues were identified, staffing rotas were amended as needed.

 

The importance of clearly identifying matrons was recognised.  Although they were a tier of management, they were very clinically focused and so had an important role to play.

 

RESOLVED:

that consideration of the complaints procedure be included in the future work programme for this Committee.