Essence of care is a department of health initiative which provides guidance on standards of care which should be delivered to patients. The standards include:
Since beginning the campaign, we have been swamped with calls from people with relatives in hospital, some in tears for fear of their relative's welfare, all these people reporting the same problem. Neglect.
A similar theme too, is the response from the hospital to each of these complaints - often something along the lines of "Issues are being addressed as part of the Essence of Care benchmarking".
During the eight weeks we stayed at the hospital, time and time again we witnessed staff who didn't communicate with the patients. They didn't seem to care if some patients got better, they never asked "how are you feeling" or even said "hello". Meal trays would be placed and returned unopened without the patient even knowing it was there. Patients were often washed in silence apart from their protestations when their hair had been caught or they had been knocked when being hauled into the chair. When two staff were needed they would chatter above the patient to each other (usually ward politics). This happened one day whilst a patient was being sick. She'd been really poorly all night and on waking up she was violently sick. It was terrible I have a really queasy stomach for vomit and felt terrible too. I'd had no sleep myself and felt really groggy. The staff continued with their conversation after passing the poor patient a bowl. They then left her, the bowl full of vomit, chair bound. Off they hurried to the next room to carry on with dragging older people out of their beds and making the bed. If they had one aim it was to make the beds by a certain time. For some, it was their priority for the day they then ran to the nurses station to announce they had completed their share of the beds first. Merely a game between the staff.
Some of the nurses on the ward were the opposite. Their priority was to care, the Florence Nightingale School of nursing. After eight weeks on the ward we met all the staff and I can assure you there was a lot of very poorly trained and uncaring staff on that ward. You could tell there had been several staff members who had once cared, but they had given up. Others didn't give a damn they took their moods out on patients and it was common to hear certain staff shouting at elderly confused patients. I wasn't sure if they knew other people could hear them, or if they didn't care. What was evident was that communication was a real problem for some.
Communication with confused patients was more of a problem. Several of the staff had real problems with this group of patients.
Some of the staff seemed to have little understanding or training on how to care for a patient who has a dementia or is confused. They shouted at them and caused the patients to become more aggressive which was very frightening for all the other patients. There were times when I became frightened particularly at night. On several occasions patients (particularly confused males) would wander into my Mothers bay. One afternoon we were advised by a sister to all stay with our relatives as one gentleman had become so aggressive the staff were unable to manage the situation.
This was quite common during the 8 weeks I stayed on ward 11. The problems seemed to occur over the weekends, when a new patient was admitted. Weekends always seemed even more stretched for staff and yet this seemed to be the busiest time.
One night I was woken by shouting and crying and went into the next bay which was for the males. One patient had pinned one of the nurses up a wall and several elderly ladies were trying to help her. One lady was on a zimmer frame herself.
They seemed to manage these situations by calling for the porters who restrained the patients while the doctors administered a sedative. The patient spent the next day in his own bed, zonked but usually the next night they were confused and aggressive again. The cycle continued, the patient wanting to go home and the nurse telling them to get back into their bed.
I cannot begin to tell you how often patients went without meals and were denied fluids, in those eight weeks. If patients needed feeding, they weren't. Relatives helped, but the staff who cared enough to help feed, were often too busy. Intravenous fluid lines were left for hours and hours without being replaced. My Mother amongst others, waited hours for lines as the procedure or should I say palaver to get intravenous fluids administered was farcical at times. My mother had very thin veins and yet they always seemed to send trainee doctors who needed the experience but surely they should not train on poorly patients who were already covered in bruises. Very often they gave up and a series of attempts would be made by other trainee doctors. When the phlebotomy staff were used they were confident and never seemed to have a problem. Sadly they only worked for a few hours a day another short sighted cost cutting exercise.
Buzzers sounded all day and night and as one was attended to another would sound. A patient would often wait hours for their line to be cleared it never seemed to be a priority.
What suprised me the most was the night routine. The night care staff would come along and remove everyones water jugs often leaving patients without a drink at all. I never understood this until I was told that it is one of the night auxillaries duties. To remove and wash out the patients jugs, I presume to return them but they never did until the next morning, once night medication had been given they were removed. One night I woke up to find the patient opposite drinking out of a vase of flowers.
My Mother hadn't eaten for over two weeks due to an enlarged hiatus hernia her first meal from the staff was a cup of spicy tomato soup. Although we asked for an alternative nothing was available. I even asked if I could go home and bring her in some soup from home. A senior nurse told me this wasn't allowed due to health and safety as I could scald her. I'd only been caring for her for a number of years.
Several of the letters I received mentioned that the fluid and feeding charts that their relatives had were often marked with "refused" despite them not knowing or wanting to refuse.
During our stay confused patients wandered the ward exposed. The poor souls were oblivious to it. Staff, sometimes senior staff, passed them in the corridor unbothered.
Patients rang for 30-40 minutes for toileting, they often had an accident and apologised. Some staff told them not to be so daft, a few apologised for being so long (the nightingales), and others ignored rushing them back to bed. On some occasions patients were returned back to a wet bed and you could then hear them moan and repress the buzzer, for another 40 minutes wait. I never quite understood this, as the staff then had to return and make the bed. I suppose some particularly the confused elderly slept in the soiled bed not bothering to disturb them again.
I dreaded disturbing some staff and often tried to distract Mum to wait a little longer. Another patient, her daughter, Abi, and I often helped to toilet a couple of the other patients on the ward. You couldn't not, before we helped out they would often end up on the floor and it was only a matter of time before they hurt themselves. We would try to distract them, but it often didn't work and you had to help.
Male and female patients shared the same toilets and washing facilities on ward 11. For 2 of the weeks of my stay the door to one of the toilets was off (a confused patient had pulled it off) but the confused patients on the ward were oblivious to this and used the toilet regardless of everyone being able to see them.
To make matters worse staff would dress patients in the hospital gowns which left them exposed at the back. You could hear several patients asking for their own nightclothes to be got out of their lockers but this seldom happened.
I'm not sure how they intend to improve on record keeping. I would like an improvement in the truth of their record keeping too.
During my stay drug records were constantly being lost not only for my Mother but for the other patients on the ward. When they were found vital information had not been recorded. Last weeks progress was often discussed in ward handovers and ward rounds as information had been mislayed.
When a complaint is made there is an investigation, an independent investigation and not the very staff who have been complained about. We want honest and accurate records used and not altered to distort evidence.
I'm not quite sure what the response from my complaint means. It certainly hasn't helped the poor souls who are now on the ward as I have had relatives on the phone in tears. I believe it means nothing; senior members of staff are aware of the poor standards and have done nothing. Letters I have received tell me that other people have reported the same things to senior staff for months and nothing has yet been done. I suspect it will mean the setting up of another group to discuss what can be improved, but nothing does.
We can do nothing alone but together I believe we can help to improve the care of our older and vulnerable members of Staffordshire.