‘Enter and View’ Report

Ealing Hospital – Ward 4S

Uxbridge Road, Southall

Middlesex UB1 3HW

,

Healthwatch Ealing

December 7th 2018

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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: info@healthwatchealing.org.uk

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

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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.