Enter and view: East London Foundation Trust Mental Health Wards - Joshua Ward

Healthwatch Hackney visited Joshua ward to evaluate the quality of care, focusing on patient experience, staff feedback and overall ward conditions. This report presents our findings and recommendations for improvement. The ward was visited twice, in January and May to gather sufficient feedback for a comprehensive portrait of their experience on the ward.

Patients have mixed opinions about safety on the ward. While some feel safe, many are worried due to incidents of violence, theft, and loud noise. The noise, particularly at night, makes some patients feel scared and anxious, disrupting their sleep. Additionally, the absence of a fob system for room entry and instances of theft leaves some patients feeling vulnerable and frustrated. 

 Patients' experiences with staff vary widely. Some feel respected and supported, while others are frustrated and concerned. Although some patients feel well cared for, issues with staff attitudes, cultural sensitivity, and consistency of care are common.

Patients with specific cultural and religious needs have noticed shortcomings in the availability of religious materials and personal care products. 

Activities are often disrupted by staff availability and some weeks there are no activities at all. Overall, patients have a clear desire for more flexible and engaging activities, including opportunities for external interactions, relaxation and outdoor time.

Patients' experiences with food on the ward are mixed. While some patients are satisfied, many others were unhappy with food quality and portion sizes. Complaints include bland, processed food, lack of fresh options and meals being served cold. Some patients reported finding objects in their food. Despite some efforts to improve, there is a clear need for better food quality and variety.

Patients' experiences are generally positive. Patients can vape outside if escorted by staff, although staff availability can be an issue. Additionally, a dedicated team is available to help patients quit smoking. 

Some patients have their own phones and the ward provides an iPad for those without smartphones. Internet connectivity is a problem due to poor WiFi quality on the ward. 

Patients' experiences with visits vary. Some are satisfied with visit arrangements and times, while others believe visiting times are too short. 

Patient feedback highlights significant gaps in discharge communication and planning. Housing instability is a main concern, impacting patients' readiness for discharge and highlighting the need for comprehensive support services to address these barriers effectively. 

Staff provide information on how to make a complaint in welcome packs and notice boards. They believe that patients generally feel comfortable approaching them. However, patient feedback showed that some patients are unsure about the process and others question its effectiveness.

The ward provides information about benefits and access to Independent Mental Health Advocacy (IMHA) in welcome packs and notice boards. While patients value the People Participation Group for better communication with staff, challenges remain in accessing advocacy services, mainly due to availability issues with the external provider Rethink. Patients expressed confusion and uncertainty about their entitlements to benefits, highlighting the need for clearer guidance and support in navigating these matters.

Staff generally feel supported by their managers, who understand the demanding nature of the ward. Managers try to help by giving extra time for paperwork when there are enough staff. Relationships within the team are described as positive, contributing to a sense of confidence in leadership. Despite this support, staff agree that they often don't have enough time to settle in, complete training and engage fully with patients due to high workload and staffing shortages. 

Staff receive induction and annual refresher training but there's a clear desire for more comprehensive training in important areas including cultural awareness, diversity and inclusion, wellbeing and understanding specific religious practices such as Ramadan and Shabbat. Lack of training in these areas can negatively impact interactions between patients and staff.

Staff often come to work even when unwell due to pressure and sick leave policies. This risks their own health and potentially exposes others. High levels of violence from patients also create a dangerous working environment, causing physical injuries and psychological distress for staff. 

Working next to seclusion rooms, where patients can become violent and loud, takes a severe mental toll on staff. Constant exposure to distressing incidents leads to high stress, emotional exhaustion and safety concerns, affecting their overall wellbeing. 

The ward has problems with mice and cockroach infestations, which negatively affect both patients and staff. Staff have adapted by avoiding leaving items on the floor to prevent attracting mice. This normalisation of rodent presence shows a concerning environment that undermines dignity and creates discomfort and unease.

Staff are victims of racism from patients who are frustrated at being “cared for by immigrants”. A patient we spoke to referred to staff derogatorily as "bloody foreigners" and added “they don’t belong to here”. This can demoralise employees and affect their mental wellbeing, lead to decreased productivity, and undermine efforts to maintain a diverse workforce and inclusive culture. Over time, these comments can erode trust within the team and affect the quality of care provided to patients.