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Inspection report

Date of Inspection: 15 March and 13 April 2011
Date of Publication: 6 June 2011
Inspection Report published 6 June 2011 PDF

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People should be treated with respect, involved in discussions about their care and treatment and able to influence how the service is run (outcome 1)

Meeting this standard

We checked that people who use this service

  • Understand the care, treatment and support choices available to them.
  • Can express their views, so far as they are able to do so, and are involved in making decisions about their care, treatment and support.
  • Have their privacy, dignity and independence respected.
  • Have their views and experiences taken into account in the way the service is provided and delivered.

How this check was done

Our judgement

People who use services usually have their dignity, privacy and independence respected, and are involved in making decisions about their care and treatment.

User experience

We visited two medical wards and spoke with five patients and four visitors. The patients told us they are given a chance to say how they would like to be treated and that staff listen to them. Most knew about relevant facilities such as a room where they can use a mobile phone, how to order a daily paper, the hospital shop and chapel. There were numerous displays of information about facilities, meal times, healthy eating, hospital policies and clinical conditions and procedures. However, some leaflets were difficult to reach as they were wedged in high wall racks, and some posters were difficult to read, for example blue type on a green background with text superimposed on an image.

Patients told us that staff ask before helping them with personal care and explain what they are doing when carrying out tests or procedures. They told us their needs were met quickly enough and care was given respectfully most of the time. We saw staff taking time to listen to patients and responding appropriately, using good communication skills such as keeping eye contact and listening attentively. Patients told us procedures are generally explained to them, although staff may talk a little too fast, but if they ask questions staff will answer them. We observed relatives and carers being involved in discussions about patients’ care needs, for example a pharmacist explaining a change in tablets to a patient and their daughter.

Although we observed staff behaving in a way that respects patients’ dignity and privacy most of the time, we heard staff at the nurses’ station discussing patient issues loud enough to be heard in the near-by patient areas. On one ward there were large whiteboards that list the patients by surname and record their nutritional needs, conditions such as dementia or diabetes, and therapeutic input such as occupational therapy. This information was in full sight of anyone visiting the ward, so that patients’ privacy and confidentiality were not maintained.

Other evidence

Between March and December 2010, there were thirteen patient comments on the NHS Choices website relating to respect and involvement: six reported positive experiences of being treated with care and respect, and seven described negative experiences of poor communication. The National Cancer Patient Experience Programme 2010 survey found that whilst the trust scored very well for patients’ confidence in staff and privacy for discussions, they were rated poorly for providing information and explanations about treatments. This was a trust-wide survey and not specific to Newark Hospital, but the findings are reflected in the trust’s own survey of nearly 200 patients at Newark Hospital for the period May 2010 to March 2011. The vast majority (more than 95%) said they were involved in decisions about their care and treatment and were given enough privacy, but nearly a third (29%) did not feel they had enough information about medication side effects, nor whom to contact with any concerns after leaving hospital.

The findings from Patient Environment Action Team (PEAT) inspections (self-assessments managed by the National Patient Safety Agency that check the non-clinical aspects of patient healthcare experience) in early 2010 and March 2011 rated the hospital as excellent for facilities relating to maintaining modesty, dignity, privacy and respect. The Department of Health produces “Essence of Care Benchmarks” with which healthcare providers can assess and improve the quality of care, ensuring the fundamentals of care are at the centre of the patient experience. Recent hospital audits in line with the benchmarks for respect and dignity found the majority of in-patients felt their dignity and privacy was respected.

Due to recent changes in admissions to the hospital, on the day of our visit the wards were quiet with a quarter to a half of beds occupied, so patients could be spaced out in the bays increasing their privacy. The wards were divided into male and female “halves”, so that each had single sex toilet and bathing facilities and each of the larger six-bedded bays had their own toilet. The hospital has carried out significant work over the last three years to meet the Department of Health’s “same sex accommodation” requirements. We did not observe problems accessing toileting and washing facilities, although the accessible toilet on one ward was used for equipment storage (a commode chair) making it less accessible to an independent wheelchair user.

We spoke with medical, nursing, allied health and support staff, who told us it is important to communicate well with patients, asking them about their needs, without making assumptions. If patients lack capacity or are very frail staff discuss their care needs with their families or carers. They also use non verbal means of communication such as body language and picture boards, or request help from a speech and language therapist (SALT).

Staff told us they work well as a team and do their best to meet patients’ needs, making sure patients feel able to talk to them and raise concerns. We saw that patients had call bells within reach if they needed them and we always saw staff respond in a reasonable time. We heard staff explaining things to patients clearly and in a reasonably detailed way. One of the nurses described their role as being an advocate for the patients, taking part in ward rounds and making sure afterwards that the patients understood what was discussed with the doctors.

We asked staff about their training on privacy and dignity, independence and human rights. They told us they attended mandatory updates that included these topics. Most of the qualified staff told us this had been included in their basic training and that they were updated through written and online professional guidelines and codes of practice.

Staff told us they identify people’s usual needs or activities of daily living (ADL) on admission and discuss with them what type of assistance they need