Arrowe Park Hospital: Ward 38
Wirral University Teaching Hospital Foundation Trust
Arrowe Park Road, Upton, Birkenhead, CH49 5PE
Elaine Evans, Tina Fiddies, Piara Miah, Mary Rutter
Healthwatch Wirral would like to thank Wirral University Teaching Hospital Foundation Trust for welcoming Healthwatch Authorised Representatives who visited to view the facility and talk to staff, patients and visitors on 12/09/18.
Please note that this report relates to findings observed on the specific date and time of the visit. Our report is not a representative portrayal of the experiences of all service users and staff, only an account of what was observed and contributed at the time.
What is Enter and View?
Part of the Healthwatch Wirral’s work programme is to carry out Enter and View visits. Local Healthwatch representatives carry out these visits to health and social care services to find out how they are being run and make recommendations where there are areas for improvement.
The Health and Social Care Act allows local Healthwatch Authorised Representatives to observe service delivery and talk to service users, their families and carers on premises such as hospitals, residential homes, GP practices, dental surgeries, optometrists and pharmacies.
Enter and View visits can happen if people tell us there is a problem with a service but, equally, they can occur when services have a good reputation – so we can learn about and share examples of what they do well from the perspective of people who use the service first hand.
General profile of the service that was entered and viewed
Ward 38 is a 37 bedded respiratory ward with 10 lung support unit beds. The ward provides inpatient services, specialist outpatient clinics and sleep studies.
Purpose of visit
To verify service user feedback.
The visit was conducted as a direct result of feedback received from patients. The feedback contained negative issues; which are being addressed separately.
Type of Enter & View visit undertaken
The visit is not designed to be an inspection, audit or an investigation, rather it is an opportunity for Healthwatch Wirral to get a better understanding of the service by seeing it in action and talking to staff, service users and carers/relatives. Healthwatch Wirral seeks to identify and disseminate good practice wherever possible. However, if during a visit Healthwatch Wirral identifies any aspects of a service that it has serious concerns about, then these concerns are to be referred to the appropriate regulator or commissioners of the service for investigation or rectification. Any safeguarding issues identified will be referred to the Local Authority or Commissioner for investigation.
The rectification of less serious issues will be directed to the service provider.
The Enter & View visits are a snapshot view of the service and findings are reported based at the time of the visit.
Enter and View visits are conducted in a way that works in accordance with Merseyside Safeguarding Adults Partnership Board’s principles and procedures. Information will be shared accordingly in order to safeguard adults at risk on Wirral and promote quality of local services.
Discussions, findings and observations
Healthwatch Representatives were met on arrival by the Ward Sister and Matron. We were escorted to the office to have a discussion about the ward. Healthwatch Authorised Representatives informed senior staff about the aims and objectives of the visit.
The Ward Sister and Matron welcomed us and responded to the declared reasons behind our visit by informing us of local management changes over the last 4/5 months. They were both eager to share successes the new team had generated and openly talked about ongoing challenges. They reported that staffing levels were sometimes a challenge, especially at night when levels consist of a mixture of ‘permanent’ and rotational staff.
We were informed that the ward is always very busy and provides treatment for both male and female patients in bays and side rooms. The ward was at full capacity at the time of our visit. It was reported that mealtimes were protected and visiting times were currently from 2pm to 7pm.
Staff and staffing levels
- Early – 7 RGN plus 5 CSW
- Late – 6 RGN plus 4CSW
- Early – 5 RGN plus 1 AP and 4 CSW
- Late – 4 RGN plus 1 AP and 3 CSW
It was reported that staff receive annual appraisals
Medication is managed by trained nurses who wear a red tabard when dispensing medication and medicines are securely stored in a locked room.
Healthwatch Authorised Representatives were informed that all patients are made aware of the Matron Helpline and that there are notices above patient’s beds about the complaints procedure.
Ward Sisters also are available to deal with complaints or concerns. Any issues identified are discussed in Ward ‘huddles’ and are reported in the hospital newsletter.
Nutrition and Hydration
Healthwatch were informed that:
- Ward 38 uses the MUST Tool (Malnutrition Universal Screening Tool)
- ‘MUST’ is a five-step screening tool to identify adults, who are malnourished, at risk of malnutrition (undernutrition), or obese. It also includes management guidelines which can be used to develop a care plan. It is for use in hospitals, community and other care settings and can be used by all care workers.
- Fluid and balance charts are completed
- The Nutrition board is completed and a meal time co-ordinator is appointed daily
- Patients are prepared and supported during meal times
- Red trays, beakers and adapted cutlery are used when required for people who require assistance at meal times
- Diabetic plans are completed if necessary
- Patients are offered a choice of sandwiches at lunchtime. A choice of hot meals are offered in the evening
- Ward staff monitor and records food intake
- Patients are offered hot drinks and water during the day
- It was reported that most of the time the patients get the meal of their choice
- At the time of our visit the ward was awaiting the delivery of a snack fridge for patients
Falls are managed by putting high risk patients in a ‘falls’ bay and using bay tagging. Patients are risk assessed, falls mats may be used and staff have a weekly ‘Falls’ meeting.
All incidents are documented and recorded.
Pressure ulcers are managed by staff conducting skin inspections on all patients transferred to the ward. Patients are regularly repositioned and the ward uses the PUP care plan.
This ward has a dedicated ‘pressure ulcer’ nurse.
The Ward monitors the quality of the service it provides by:
- Patient feedback through Friends and Family test (FFT)
- Patient feedback by letters and thank you cards
- Matrons Audits
- Ward Accreditation
- Daily huddles
- Infection control audit
- Clinical incident reporting
After our discussion the Matron and Ward Sister invited Healthwatch Authorised Representatives (AR) to view the facilities.
We were given free access to the ward, patients and staff.
At the entrance to the ward there was a ‘Welcome to Ward 38’ notice along with a board declaring ‘ideal’ staffing levels per grade and per shift; against actual staff on duty over the current 24-hour shifts. Most grades were low at some point in the shift patterns.
The entrance signage was clear and the area was clean, tidy and smelt fresh.
The mechanism on the door appeared to be faulty which meant it didn’t close automatically.
The ward itself was very large, with several bays and side rooms. It was well presented, bright, clean, neat and free from clutter.
There was plenty of information displayed for the benefit of staff, visitors and patients.
Hand washing facilities were available in each cubicle and bay. Hand cleansing gel dispensers were abundantly available throughout the ward.
The signage throughout the ward was dementia friendly.
The area was neat and tidy with no visible trip hazards. The Notice Boards were up to date and provided comprehensive information for patients and visitors.
Handrails were positioned along the wall to support patients to move around safely.
The Dementia Awareness Board gave information about communicating with patients with dementia including the use of picture cards. Relevant information, including British Lung Foundation leaflets, were also displayed.
Cleaning schedules were also displayed in this area.
The room had a TV, was comfortably furnished, clean and pleasant.
Bays and Side Rooms
The bays and side rooms viewed were clean and tidy and patients looked comfortable. Water was available and was within reach at the bedside. There was plenty of room for patients and staff to manoeuvre around safely.
However, the ambient temperature through the ward seemed high. A number of staff reported that the ward can get very hot and uncomfortable at times. We were informed that fans had been ordered.
Bathroom and Toilet Facilities
We viewed several bathroom/toilet facilities and, apart from residual faeces in one toilet bowl, they all appeared to be clean. The doors had clear dementia friendly signage. Call bells, handrails and appropriate equipment, such as shower chairs, were available in the shower rooms and toilets.
It was noted that the red pull cord in the disabled toilet was on the opposite side of the room to the toilet which may be difficult for patients to reach easily if necessary. A tap in the bathroom next to bay 6 would not turn off and a number of call bell cords were short in length and appeared to be dirty.
The domestics’ room was cluttered and dirty. The door was propped open and the floor was in poor condition. There was an unused toilet situated in the room. This was reported to the Ward Sister at the end of our visit.
This was small but clean and tidy. It was adequately furnished and equipped.
This room appeared to be clean, tidy and organised
The bins were used correctly and were not overflowing.
Staff observations and feedback
Staff appeared to be very busy during our visit, but despite this, they were observed treating patients with dignity and respect. It was evident that a number of patients had been an inpatient on several occasions and staff appeared to know them well and have a good relationship with them.
Staff largely responded to us in an open manner.
The staff who spoke to Healthwatch Authorised Representatives reported that they enjoyed working on the ward.
Staff agreed that the new management were very supportive and had brought improvements so that staff now worked as a team. However, a few staff said that at times they were short staffed which made them very busy and unable to spend as much time with patients as they would like.
Staff informed us that as the ward is on the top floor, it remains hot, even at night, and this can be stressful for patients with breathing problems and chronic lung conditions.
Healthwatch Representatives asked whether staffing levels at night were a problem. The day staff we spoke to reported that they had not heard of any specific problems and said ‘sometimes staff are stretched when there are admissions or someone is poorly but at other times they sit and chat.
Healthwatch Representatives spoke with several patients who said that they were extremely happy with their care. They reported that the staff are lovely and caring, even though at times they are short staffed. 1 patient spoke of the light not working over his bed but felt it wasn’t the nurse’s fault as it was maintenance’s job.
Several patients reported that the ward was too hot.
One patient said it would have been nice to have access to a TV, and did not realise that they could have paid to use the one in their room.
A further patient reported that a night time staff member was on their phone, but did come over when needed.
A number of patients said that the food was declared as OK but ‘it must get boring when you are here longer than a few days and you have to be realistic when you are in hospital’
Another patient reported that they were discharged too soon on a previous visit and were re admitted. They felt they were not ready to be discharged last time. They also wished that there were more fruit/veg/salad on the menu. This patient was diabetic and for that reason would have liked a choice of sugar free meals and snacks.
Another patient expressed concern about the poor availability of diabetic products. Biscuits, jam, marmalade were not available and the match up of Insulin to meal times was poor.
A big frustration for patients appeared to be the poor quality of tea and the length of time that patients went between their last and first hot drinks. The last hot drink is offered just before day staff finish and first one is offered at about 7:30am.
One person declared that the League of Friends for the hospital had agreed to fund air conditioning 2 years ago. They said that the equipment had been ordered and arrived but remained in stores to date. They were aware of installation problems but didn’t know what they were.
However they did confirm that, in the interim, the League of Friends had received a request for bedside fans from the new management team.
Three patients, who were returning customers, said that they had every confidence in the ward and their care.
It is noted that a meeting is being arranged with night staff to discuss the issues and concerns raised.
Patients, visitors and staff were all happy to share their thoughts and experiences with Healthwatch Representatives.
Staff were very helpful and informative, they listened to our concerns in a manner that was professional and open minded, and they were obviously upset that a few members of staff were letting the ward down.
Most of the patients Healthwatch spoke to were very happy with the care that they were receiving.
Some patients reported issues around nutrition and hydration, staffing levels and ambient temperature on the ward.
Staff also reported issues around staffing levels and the high temperatures on the ward.
Healthwatch will contact the hospital for an update on the outstanding Air Con issue to establish why this has not been rectified; given that this is detrimental to patients with respiratory conditions.
Recommendations and Considerations
- Consider reviewing staffing levels
- Follow up the air conditioning issue
- Instruct staff to report maintenance issues or problems more promptly
- Inform patients about the facilities available to them ie Prepaid TV
- Improve the nutrition and hydration issue identified in this report
Post-visit supplementary feedback from the provider
Thank you for visiting ward 38, we as a ward pride ourselves in ensuring best patient care is provided even at the most challenging of times.
We have had a successful recruitment drive and have recently recruited into both vacant registered nurse post and clinical support worker posts. Our Divisional Director of Nursing is currently working alongside the Deputy Chief Nurse to increase the staffing levels further within Ward 38 due to their high acuity at times. Due to the speciality involved with respiratory medicine this can result in extremely poorly patients who require lots of support and care, we also have many patients who are at the end of their lives; we honour ourselves in giving exceptional end of life care to patients and outstanding support their relatives.
The trust has been working hard with new menus to ensure 2 hot meals per day will be offered, with more choice for patients. There has been a tasting session for the new menus and feedback was good. We have spoken to the catering team and this will start in the New Year they have no date available as yet. Catering have also confirmed that the marmalades and jams available on the ward are suitable for diabetic patients and plain biscuits are suitable for diabetic patients. There are also diabetic snacks available to order on the menu. Moving forward we will ensure that our patients are fully aware of the options available to them to meet the dietary needs.
We have not received any update as of yet with regards to the air conditioning within the ward environment, however we have successfully secured charitable funds with the help of the league of friends to order fans for our patients on the ward.
A meeting was held with the night staff to share concerns raised about out of hours care, and staff were understandably upset upon hearing the details of the concerns raised. However moving forward they will escalate any concerns to a senior nurse on night shifts or ward sisters during working times, to ensure all patients receive exceptional care and high standards that we expect for all patients within the Trust. We have asked the night staff to ensure additional drinks for patients are given as required to ensure that our patient’s comfort and hydration needs are met at all times. The nursing management team will do out of hours un-announced visits to the ward to ensure this process is occurring.
It has also been reiterated to all staff that it is not acceptable to use a mobile phone in the clinical area, and if staff are found to continue with this unprofessional behaviour, they could be managed via the disciplinary process if required.
The broken light on the ward was reported twice by the staff and this is documented within our works to be carried out requisition book. The staff appreciate that any outstanding repairs can be frustrating for patients at any time, however we would like to assure you that they have followed the correct procedure in regards to reporting faulty equipment. The lighting within the ward has now been repaired and is fully functional.
Healthwatch follow-up action
Request an update from the Trust following our conclusions and recommendations. (April 2019)
- AP – Advanced Practitioner
- CSW – Care Support Worker
- CQC – Care Quality Commission
- MUST – Malnutrition Universal Screening Tool
- RGN – Registered General Nurse
Distribution of Report
Healthwatch Wirral will submit the report to the Provider, Commisioner and to CQC.
Healthwatch Wirral will publish the report on its website and submit to Healthwatch England in the public interest.