Tower Hamlets Involvement Network (THINk) Third Party Commentary to the Care Quality Commission

Annual Health Check Barts and the London NHS Trust April 2008 to March 2009

This report represents a consensus view of the membership of The Tower Hamlets LINk. The Tower Hamlets LINk has been branded the Tower Hamlets Involvement Network or THINk.

THINk Interim Steering Group Members From September 2008 THINk has been managed by an Interim Steering Group (an election by the THINk membership is planned for June 2009) made up of 10 resident representatives, five from user groups, and five representing the voluntary and community sector. In addition the Interim Steering Group has co- optees from the main local service providers.

Ten local residents Sybil Yates Resident Amjad Rahi Resident Myra Garrett Resident Clarissa Cairns Resident Nuruz Jaman Resident Lesley Pavitt Resident Gaynor Tenen Resident Jean Taylor Resident Victoria Adophy Resident Peter Nichol Resident Five User Groups Joyce Mangan Older Peoples Reference Group Enayet Sarwar St Hildas Carers Group Gulrook Begum Bangladeshi Mental Health Forum Rita Dove Bow Haven Five voluntary and community organisations Angela Stanworth Disability Coalition Christine Sheppard Age Concern Fazal Mahmood Positive East Charly Elliot Community Options Jo Weller Women's Health and Family Services Non voting Co-optees

1 Jeremy Gardner THPCT Keith Burns LBTH Adult Health and Well Being Motin Uz Zaman Patient Engagement BLT Shanara Martin Health Scrutiny Panel Lynne Overend East London Foundation Trust Behzad Abrishami GP Nick Yard London NHS Ambulance Service

THINk had a membership of 214 as of 15 April 2009. Members have indicated an interest in the following areas of health and social care.

2 SUMMARY:

A). Complimenting Success: Patients Viewpoint

1. Patient safety incidents including SUI are properly recorded and reported to relevant committees; lessons are learnt and improvements made (C1).

2. Patients and visitors are kept safe of Hospital Acquired Infection with emphasis on high standards of hygiene and cleanliness and proper management of Waste disposal (C4).

3. Provision of a High standard of Clinical and Nursing Care under supervision and leadership (C5).

4. Patients, relatives and carers are treated with respect, dignity and compassion. Consent is obtained before contacts with the patients and information is treated confidentially (C13).

5. Clear procedures are in place to register and investigate complaints and patients are assured that their concerns are taken seriously (C14).

6. Food is balanced and there is choice (albeit limited). (C15).

7. Patients are informed of their treatment and the care pathway and participate in decision making (C16).

8. Views of patients and public are regularly sought in order to improve the services delivered (C 17).

9. Equitable access to services and treatment (C18).

10.Patients with Emergency health needs have easy access to services and are generally treated within agreed timescale (C19)

11.The environment in which care is provided is safe, reasonably clean and supports patient’s privacy and confidentiality (C20, C21).

B) Raising Concerns: Users Feedback

1. Domestic services are provided by PFI contractor; their response to repairs is not always prompt.

3 2. Choice of food is good but there is opportunity to improve its delivery and encourage better eating.

3. Hoists for wheel chair users are available but on occasions are not used. Training of new staff needs to be improved.

4. Overbooking in Out-Patients Clinics leads to delay in seeing the consultant. Patients need to be advised of likely delays.

5. The electronic patients’ records system has had a detrimental impact on local resident’s experience of the hospital appointments process

6. Wards are being divided into smaller rooms, which are welcomed by most patients however it can be isolating for others and can put strain on care staff as the workload has increased. Consideration should be given to the perception of staffing levels within the new hospital wards.

This third party commentary is based on:

 THINk members understanding of the relevant primary and secondary legislations, nationally agreed targets, Core Standards, NICE recommendations and the role of Care Quality Commission.

 Intelligence data (relevant to the Core Standards) collected during the year under review including: - announced enter and view visits to the Royal London Hospital involving AW4 Ward and various Out-Patients Departments (24th March 2009) and talking to patients, carers and the Nursing staff at various levels of seniority. - informal visit to PALS offices 24th March 2009 - seven Steering Group meetings attended by an average of 15 local residents and representatives of voluntary and user groups. - 34 comment forms and video comments by residents attending Community Plan Lunch Event 24 January - 11 people completing online comment forms - 84 residents completing survey on priorities for THINk and health and social care providers - two discovery interviews with local residents - a workshop with nine Bangladeshi women carers - discussions and feedback with key voluntary and community organisations

Unfortunately we were only able to carry out a limited number of enter and view visits due to the delayed appointment of THINk Host (Urban

4 Inclusion; Director: Dianne Barham) and undue delay in obtaining Enhanced CRB Checks of our members.

 Inside Knowledge gained from attendance of THINk members at various committees of the Trust including Clinical governance, Serious Untoward Incidents (SUI), Patients information Panel, and Human Tissue Resource Centre. Our members also participated in PEAT Visits.

 Awareness of Trust’s Core Policies and Procedures available on its web site and access to the minutes of the Trust Board meetings which are held in public and are attended by some of our members. The minutes contain Reports on Quality and Clinical performance, Safeguarding Children, Performance Dashboard (4 hours Emergency Care target, 13 week and 26 week elective access guarantee, 18 weeks Referral to Treatment target etc) Compliance with Care Record System and Information Governance Tool Kit (eg:Information Governance Management, Confidentiality and data Protection Assurance, Clinical Information Assurance, Information Security Assurance), Maternity Service Review, Privacy and Dignity Policy. Care of Older People, Control of Infection, Human Rights and Equality Policy and safer Patients Initiatives. Noteworthy are Medical, Practical and Emotional Support Services for the Victims of rape and sexual assault (young persons’ clinic at the Haven).

 Information received from the Head of Quality (Ms. Jane Canny) and PPI lead (Mr. Motin-Uz-Zaman) at the Trust who have regularly attended our Steering group and subcommittee meetings and where they have provided additional information and answered any concerns raised by THINk members. Prof.K. Riley (Chief Nurse) at the Trust had a meeting with our members on 22nd Dec 08 in which she assured us that the Trust’s services have patient focus and users views are seriously taken.

 The majority of the members of THINk are users of services provided by the Trust and therefore have direct experience as patients in all three of the Trust hospitals

The Assessment

It is difficult for THINk to comment with confidence on all 24 Core Standards for Better Health spread over seven domains. This report, therefore, relates to only those standards that we have directly observed during our visits to various wards and services or about which we have obtained information from past and present patients, their carers, friends or relatives.

5 A) First Domain: Safety (C1 to C4):

1. Evidence referred to above, THINK involvement with various committees of the Trust and discussions with Trust staff indicates that patient’s protection through standard guidelines are being implemented, monitored and reviewed. Policies are in place to monitor SUI. Stringent procedures are in place for the storage and safe disposal of radioactive and other wastes. There is emphasis on high standards of hygiene and cleanliness to prevent health care acquired infection. Reusable medical devises are properly decontaminated prior to use. The medicines are handled safely and securely.

2. Our visit showed the overall standard of cleanliness to be good. A hand washing campaign directed at staff, patients and visitors is working well. However there is a problem with the availability of hand scrub dispensers in areas as they are being taken because of their alcohol content. A system for ensuring that dispensers are secured or locked should be implemented throughout the hospital.

B) Second Domain: Clinical and Cost effectiveness (C5b C6):

1. Clinical care is provided under supervision and leadership

2. There is ongoing problems with the discharge process with patients being expected to take their discharge summary to the GP themselves. Where patients are older, seriously disabled or with learning difficulties this can be a less than effective process.

C) Fourth Domain: Patients Focus (C13, C14, C15, and C16):

1. Patients interviewed on our Enter and View visit were very happy with the high quality of clinical care they received and were complimentary of the nurses, doctors and the support staff. Staff were considered to be welcoming, open and prepared to listen. Overall patients were positive about their experience.

2. We have observed patient’s privacy and dignity policy in practice during our visit. When and where required patient’s consent was taken and confidentiality maintained.

3. Race equality and respect for diversity have permeated into the culture of care and caring.

4. We undertook an informal visit to the PALS office. The PALS staff are popular with patients and provide admirable service however it was noted that:

6  The office needs to be more identifiable  Although patient information leaflets are easily available it isn’t clear exactly how you might go about making a complaint: an electronic version might be an easier option for some patients  There is no interview room that would enable staff to conduct private discussions with people wanting to raise what can sometimes be very private issues.

A THINk member on a PEAT visit did not see any PALs information anywhere throughout the hospital.

5. Food provided is nutritionally balanced and meets clinical dietary requirements. There is Choice (albeit limited) and mealtime is protected. The Menu is regularly reviewed and minority group’s religious and cultural needs are met.

6. Food was still an issue for some patients we spoke to and some felt that the buffet style of service was unhygienic as people talked, coughed over and handled the food prior to their receiving it. Food could also be cold if you were at the opposite end of the ward from where the buffet trolley started. The choice of food was generally considered good.

7. The THINk Steering Group members felt strongly that it was preferable to have kitchen and cooking facilities within the new hospital as opposed to the current chill and cook catering.

8. It was noted by THINk members that patients receiving red trays (indicating they required help with eating) were not always getting the assistance they needed. Although this may only happen in a small percentage of case it should never happen as it places already sick patients at increasing risk. Members also felt that patients were not being encouraged to eat where necessary. Trays were dropped off and picked up again without consideration being given to whether the patient had eaten sufficient to aid their recovery.

9. Patients are provided information on the care and treatment they receive. They are also made aware of what to expect and advice is given on aftercare. Patient’s advocacy and translation services are often involved in the process.

Fifth Domain: Accessible and Responsive Care (C 17, C18, C19):

1. We have spoken to patients from various ethnic groups and in their experience they were able to access services equally and treatment was provided equitably. Language line is very good and well used

7 2. The newly implemented electronic patient’s records system has had a detrimental impact on local resident’s experience of the hospital appointments process. Patients have received automated letters telling them that they have missed appointments when they have never had any notification of the original appointment. This has sometimes resulted in their being put back at the end of a waiting list without the opportunity to discuss the issue with anyone. BLT have lost a lot of good will with patients and the community.

Hospital appointments need to be a lot easier to get and a LOT quicker. If you are told you need hospital involvement then waiting months for the appointment will play on nerves and therefore worry more. (Comment from member)

2. THINk received worrying feedback from members concerning inappropriate facilities and services to meet the needs of severely disabled hospital patients. The issues were identified by Disability Coalition - Tower Hamlets through conversations with their members and other disabled people concerning their experiences of hospital stays in Barts and the London Trust hospitals. The problems noted by the Disability Coalition – Tower Hamlets included the lack of hoists to enable disabled people to be lifted from their wheelchair to bed/commode/shower/toilet and vice versa. A disabled patient, recently in the Royal London A&E, said there was no hoist or slider transfer board in the A&E ward. Although a hoist was normally available in the Neurosurgery wards, disabled in-patients’ experience of other wards is that there is either no hoist or the equipment is defective (a hoist with no sling).

3. Toilets and showers were often inaccessible, either because there was insufficient space for transfer from either left or right onto the toilet or shower chair, or because the shower or toilet was too far away (the other end of the ward) and the patient couldn’t get in and out of their wheelchair. It is of concern that the lack of adequate toilet and shower facilities in old and refurbished wards could force disabled people into using incontinence pads or catheters unnecessarily.

We asked the Trust respond specifically to the following questions a) How are wheelchair bound patients transferred to their beds, or examination table in A&E, and what facilities are there to access toilets and showers? b) Are there any reporting mechanisms showing when disabled in- patients cannot use toilets and showers and if they are being unnecessarily catheterised and put at risk of serious infection simply because there are no facilities for them to access toilets and showers in hospital wards?

8 c) If so, is there a plan in place to solve these problems when the new hospital becomes operative.

4. As a result of our raising these concerns BLT have undertaken a review of disability access equipment and services in areas of their hospitals. We are currently awaiting a formal response to our enquiry but have been very happy with the response by the Trust to our concerns and their prompt action in investigating the issues raised.

Sixth Domain: Care: Environment and amenities (C20, C21)

1. As the Trust is operating in an old environment (it will be few years before the new building becomes ready for occupation) there is a tremendous challenge for the Trust. The Trust Smarten up campaign and deep Clean have done much to assure a cleaner and smarter environment with improved standards cleanliness and hygiene in clinical environment. We have also observed during our visit that patient’s safety and security have improved.

2. Finding your way around the hospital can often be difficult and outpatient services are in several different areas. Patients could be sent an updated map of the hospital with their appointment letter indicating where the particular area is they are going to visit. It would also be useful if a map could be produced indicating the easiest disability routes through the hospital

3. Staff, but also patients, have noted that the response of domestic services run by PFI contractor could be very slow. One of the toilets on a ward in AW4 had not been working for a couple of days and staff had to chase the issue up on several occasions.

4. The pedestrian crossing at the front of the hospital can be very dangerous as it can get very crowded and the island in the middle of the road isn’t wide enough for everyone.

5. There is a shortage of parking particularly for disabled patients. There is concern that there is a plan to rectify this when the new hospital is completed.

Signed on behalf of Tower Hamlets Involvement Network Dianne Barham (Host)

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