Enter and view: Senior Health Wards at St George's Hospital

Healthwatch Wandsworth undertook enter and view visits in September 2017 to the Senior Health Wards at St George's Hospital.  They spoke to 23 people.

Most of the verbal evidence we obtained from patients was positive, some of it unreservedly so. Healthwatch had ample opportunity to observe the difficulty of providing nursing care to people who are confused or experiencing cognitive impairment and the dedicated efforts of the staff to meet their needs. They were particularly impressed by the clear leadership of the matron, and the commitment to improvement shown by her and other clinical staff they spoke to. 

But Healthwatch both observed and heard of some lapses in care or in nursing standards relating to respect, tolerance, interaction, support with eating and even basic hygiene. Many of these seemed to bear out what they were frequently told, namely that despite apparently generous staffing ratios nursing staff, particularly in the daytime, are constantly busy if not overstretched. Generally high standards of respect for patients' dignity and privacy are maintained but these aspects, together with the ability to give elderly and confused patients the time and attention they sometimes need, seem particularly vulnerable to pressure. In the case of Amyand and Rodney Smith wards the pressure of time was exacerbated by the limitations of space.

Healthwatch were told of and observed systems in place, such as the Butterfly scheme and the red trays, to ensure that particular attention is paid to the needs of patients with dementia, delirium or having other special needs. They did not feel able to make an overall assessment of how well these systems were being applied but we encountered examples of both good and less good practice.

The fact that the overwhelming majority of patients on these three wards are living with dementia or suffering from a temporary impairment of their mental capacity suggests that the principles and practices of care required for such patients are not to be seen as "extras" but as the default situation. 

It also has implications for the treatment of the minority of patients who although physically frail remain in full command of their mental faculties. Healthwatch found some such patients who felt that in one way or another their situation was not being fully respected. Some thought may need to be given to how the interests of this group of patients might be better protected, particularly on the longer stay wards. 

Also on the longer stay wards Healthwatch were concerned about the apparent lack of activity and stimulation for patients who could benefit from it. Some carers had concerns that not enough attention may be being paid on these wards to maintaining patients' mobility. Perhaps understandably, carers were more inclined to notice lapses and raise issues about care than the patients themselves. 

Although relatives and carers felt welcomed in the wards, several of them had what sounded like justifiable concerns about the lack of or fragmentation of the information available to them about the functioning of the ward and about the progress of their relatives’ condition. Several carers, some of whom had travelled some distance, were not aware of the possibilities of flexible visiting times. On Amyand Ward in particular, where patients can be discharged after quite short stays, Healthwatch were concerned to hear that partners and other carers (many of whom are likely to be elderly or infirm themselves) were not routinely being involved in discharge planning and might not be contacted until a discharge decision was taken.

Healthwatch felt that the limited evidence we obtained on discharge planning on Heberden and Rodney Smith wards also indicated some weaknesses in providing reassurance to patients and carers. The fact that the role of discharge coordinator rotated on Heberden as apparently no one wanted to take it on might also be a weakness. Some carers were not happy with the treatment of their relatives in the AMU which the Enter & View team did not visit on this occasion.