This Is the Monthly Patient Voice Report Produced for the Board of Directors. the Main

1. PURPOSE

This is the monthly Patient Voice report produced for the Board of Directors. The main purposes of this report are to:

Inform the Board of Directors of our headline patient experience indicators for the Trust as a whole, for each division and for a specific service.

• To summarise the full breadth of feedback received from service users, carers and staff over the previous six months about the specific service featured and any plans to address the main issues raised.

• To update the Board of Directors on the action taken to address the main issues raised about the service featured in the Patient Voice report three months previously.

The report is part of our approach to Service User and Carer Experience which is a key part of theInvolvement, Experience and Volunteering strategy (2015 – 2018). One of our three involvement aims is to change services by listening and responding to service user and carer views and aspirations.

Our approach is also based on the Trust’s values and aligned to Department of Health priorities. As an NHS funded service we are required to carry out the Friends and Family Test. We must also meet the CQC Standardthat requires us to seek and act on feedback so we can continually evaluate services and drive improvement.

As part of the Trust’s development of its approach and the Francis Report we are continually looking at how we can improve both how we listen and respond to the patient voice. Our feedback website enables the public to leave and view feedback and also able see the changes we have made in response to feedback. The website also enables staff to view feedback about their team.

As part of our approach the Board of Directors receives a quarterly Involvement, Experience and Volunteering Report which looks at key achievements in the Involvement, Experience and Volunteering strategy and outlines our strategic direction and next steps. This Patient Voice Report is a monthly report and focuses on key patient stories and comments raised by service users, patients and carers.

2. EXECUTIVE SUMMARY

The Trust’s Service Quality Rating for November 16 – January 2017is95%. Our Friends and Family Test Score is 96%(this is the percentage of people who would be extremely likely or likely to recommend our services if their friends or family needed similar care or treatment).

This month’s Patient Voice Report focuses onWathwood Hospital, with headline information provided for the Trust as a whole, and for each division. The report also updates onOffender Health Services(featured in November’s report). The report highlights all prominent and/or recurring feedback in the last yearfrom the full range of feedback mechanisms used by Wathwood Hospital, including those targeted at carers and families.The report then summarises the main issues identified and action taken or proposed to address these issues.

The main issues identified are:

• Activities
• Respect (from staff)
• Smoking
• GP and dental services

It also updates on the issues presented in the paper three months previous, focussing on Offender Health Services in November 2016.

These were:

• Waiting times
• Medication

3. SERVICE IN FOCUS: WATHWOOD HOSPITAL

Wathwood Hospital provides medium secure inpatient services to male adult patients with mental disorder, offering assessment, treatment and rehabilitation. Wathwood Hospital aims to reduce the distress associated with mental health problems and promote recovery.

The hospital has a strong vocational approach, with a hospital shop, an on-site restaurant, café, farm shop and horticultural area which provide patients with meaningful opportunities to build skills and confidence in preparation for moving on from the hospital.

Additionally, the Recovery College is well established and continues to co-produce and co-deliver a wide range of courses with both current patients and patients who have been discharged from Wathwood.

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3.1MAIN ISSUES IDENTIFIED IN PREVIOUS PATIENT VOICES REPORT WITH FOCUS ON WATHWOOD HOSPITAL (JANUARY 2016)

Below we update on the main issues identified (and the actions proposed in response) in the previous report which focussed on Wathwood Hospital, which was presented at the Board of Directors in January 2016.

ISSUE / DETAIL / ACTION TAKEN/PROPOSED
DISCHARGE /

• ‘Get people out quicker.’ Rehabilitation Ward (SUCE survey)
• ‘Quicker access to leave.’ Lodges (SUCE survey)
• Get you out quicker when risk has been eliminated.’ Lodges (SUCE survey)

/ Reported in January 2016:
Patients’ progress, access to community leave and discharge is informed by thorough clinical risk assessment via ward rounds and planned CPA (Care Programme Approach) meetings.
Further consultation with the patients regarding this issue is planned. This will be via the Patient Forum and the hospital Advocacy service.
Update (February 2017):
All patients were consulted and offered a questionnaire by Advocacy. 26 questionnaires were completed and reviewed by Advocacy.
Information given to patients about the hospital has been reviewed. The hospital information packs given to patients on admission has been updated to provide clearer information.
ACCESS TO PERSONAL AND SHARED RECREATIONAL EQUIPMENT /

• Patients requested access to their memory sticks after 8pm (Community meetings, Patient’s Forum)
• Patients have requested more access to sports channels to watch football matches etc. (Patient’s Forum)

/ Reported in January 2016:
There are now weekly and monthly magazine subscriptions in the library.
Increased number of CDs allowed in patients’ rooms on Continuing Care ward as requested.
Update (February 2017):
Sky TV is available in the main hospital but it has not been possible to install in the Lodges due to there being no reception. However, Lodges patients can go to the rehabilitation ward to watch Sky and join in sport events organised within the hospital.
Recreational equipment and technology continue to be regularly discussed within the patient forum.
ACTIVITIES /

• Raised as fifth most prominent issue in the SUCE survey over the last year

Recurring issues relating to sports equipment (Patient’s Forum) / Reported in January 2016:

• Football is now offered by the Sports Team.
• Themed events now take place every month.
• A schedule of film nights is now planned on the calendar.
• New groups are now offered as part of the weekly programme, including a walking group, Breakfast Club, a horticulture group and a Motivating Monday exercise group.
• There is also now a weekly DJ workshop (as well as music production equipment) and a drama group.

Update (February 2017):
There continues to be a wide variety of activities available for patients provided by a variety of disciplines.
LOSS OF PERSONAL PROPERTY / Issue raised in two complaints during the last six months / Reported in January 2016:
In both complaint investigations, it was difficult to establish the extent of the missing property, or its location. No issues were upheld in relation to the safety of personal property while at Wathwood. No further action necessary.
Update (February 2017):
No update required.
QUIET/PRIVATE ROOMS FOR VISITS /

• Patients stated they would like to have the choice of where their visits were held and would like the option to use the quiet rooms for visits rather than the ward communal areas.

/ Reported in January 2016:
All patients have been informed that quiet rooms/alternative spaces are available for visits if they wish. They can request this via their ward manager/nursing staff.
Update (February 2017):
Quiet rooms continue to be available for patient visits should they wish to use them. There are regular reminders about this in ward meetings so as to ensure new patients are informed about this. Feedback from the Quality Network Peer Review in November 2016 noted this was no longer an issue raised during their review.
ACCESS TO THE INTERNET (at The Lodges) /

• Extra internet sessions requested during the week on continuing care ward (Therapy Programme evaluation)

• Patient’s requested access to Skype to communicate with their families and friends (Community meetings)

/ Reported in January 2016:
An independent phone line is needed to enable the Lodges to connect to the internet. A feasibility study is currently underway to establish costs etc.
Policy has been amended to enable patients who have been risk assessed in The Lodges unsupervised internet access.
In the meantime patients can continue to access the internet via the patients’ library.
Update (February 2017):
An independent phone line has now been connected in the Lodges to enable internet access. Due to a security incident within the hospital, internet access is not being facilitated within the Lodges. However, patients are able to access internet and Skype within the main hospital as per local procedure.

3.2 DIRECTORATE HEADLINES

Data collected from the Service User Feedback survey:

*Forensic Services survey at six monthly intervals. Wathwood Hospital surveys in Quarter 1 (April – June) and Quarter 3 (October – December). Headline information is therefore provided for the last two surveying periods.

October – December 2016 / April – June 2016
Service Quality Score / 76% / 79%
Friends and Family Test (FFT) / 68% / 68%
SUCE survey returns / 42 / 49
Patient Opinion postings / 2 / 0
`Service made a positive difference’ score / 76% / 81%

3.3 DIRECTORATE MAIN ISSUES AND ‘BEST THING’

Data collected from the Service User Feedback survey:

Current rolling year
(January 2016 – December 2016) / Emerging issues
(October – December 2016)
ISSUES (based on 53 responses to the ‘What could we do better’ question)
Activities (Category: Care/Treatment)
The comments cover all the wards. They all seem to relate to insufficient activities, especially outdoors. / 10% / No emerging issues
Respect (Category: Staff/Staff Attitude)
The comments cover all wards at Wathwood. They relate to general inconsistency of respect on wards. / 10%
Smoking (Category: General)
Comments mostly relate to Continuing Care Ward. They all relate to not being able to smoke. / 7%
COMPLIMENTS (based on 61 responses to ‘What did we do well’ question)
Being Listened to (Category: Communication) / 21% / No emerging compliments
Quality of Care/Service (Category: Service Quality/Outcomes) / 21%
Respect (Category: Staff/Staff Attitude) / 7%

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3.4 COMMENTS FROM THE SERVICE USER AND CARER EXPERIENCE (SUCE) SURVEY WHICH ILLUSTRATE TO THE MAIN ISSUES RAISED:

Activities

• More activities, like sports, football, biking and walking. Give leave to patients so they can be active. (Continuing Care Ward).
• More outdoor activities, more craft sessions and that sort of thing. (Wathwood - Lodges).
• More activities on a weekend. (Rehabilitation Ward).

Respect

• For staff to work and patients to work on better relationships with each other. I feel that some staff don't fully listen to patients. Again some staff don't show respect, I have had issues. (Continuing Care Ward).
• Nobody wants to be locked up and have less rules. Some staff I find can be very disrespectful & rude. (Continuing Care Ward).
• Have staff not to moan and be negative around patients or about each other. I have intrinsically developed, psychology has helped but the books I read help me better. Some staff don't show you respect (Wathwood - Lodges).

General (Smoking)

• Let us smoke. More activities, like sports, football, biking and walking. Give leave to patients so they can be active. Let patients be part of the leave plan, if they not happy to stay. (Continuing Care Ward).
• More one to one time. Not allowed to smoke. (Continuing Care Ward).
• Allow us patients to smoke. (Assessment Ward).

3.5 PATIENT OPINION (FEBRUARY 2016 - JANUARY 2017)

WATHWOOD HOSPITAL
Number of postings / 4
Number of postings without a response / 0
Number of postings responded to within two working days / 1
Number of postings rated as moderately critical or above / 0
Number of postings with change planned/completed / 0

Below we include a sample of the postings received, and links to the postings on the Patient Opinion site:

• ‘I think the standard of care here at Wathwood is ok. Some staff are disrespectful to patients and are sometimes offensive.I think the level of care sometimes gets lost and becomes risks and risks management’.

• ‘I attended a Recovery College course at Wathwood called "understanding Psychosis" I feel the help and support was brilliant and the course gave me much more insight and understanding of my illness. The best thing about the course was the person who co-produced and co delivered the course was an ex patient of Wathwood now living in the community. I found this inspiring and gave me hope for my own recovery journey. I hope to be doing the same when I am ready.’

3.6 COMPLAINTS

Between February 2016 and January 2017, Wathwood Hospital Medium Secure Services has been the subject ofsix complaints. Of these complaints, four cases were not upheld and two were resolved directly with the patients.

Rather than highlighting any general areas of dissatisfaction with the service, each complaint was been specific to the circumstances of the patient. For example, a patient complained about not being able to access certain items of his property and another patient was unhappy about the use of restraint on one occasion.

Action points have been highlighted in two cases but the action required was, again, specific to the needs of the patient and not related to any area of concern within the hospital.

In addition to the complaints, three further issues were raised via PALS. Of these three issues, one was contact from a family member about the location of her relative; one was a patient questioning the reasons for him being at Wathwood Hospital and the final one was a compliment: a family thanked the hospital team on the care of their son.

3.7 LOCAL MECHANISMS FOR FEEDBACK

WATHWOOD CARERS FORUM

This is a quarterly meeting to which all carers are invited. Recent issues that have been discussed within the forum are:

1. The Healthy LifestylesGroup, and how carers can support their relatives with health promotion, especially from a physical health perspective.
2. The information provided to them when their relative is admitted to Wathwood Hospital. Written information is sent out to carers and they reported that they felt the information provided about restricted items was confusing. This information has been since been reviewed, changed and updated to make it clearer and easier to understand.

PATIENT FORUM

This is a fortnightly meeting open to all patients across the hospital. Service users chair this meeting and nursing, occupational therapyand advocacy staff consistently attend the meetings. Other services’ attendance (hotel service, sports, finance, horticulture, education) is planned in regularly through the year. Volunteers from Rosewood and the Yorkshire and Humber Network Involvement Leads also attend and support the forum.

Over the last few months, few issues have been raised within the forum. The main issues have been:

• Technology related requests: requests for new technology, for example PS4 and other items, wide screen TVs, virtual reality equipment.
• Issues regarding the GP and dentist have been a recurring theme, in particular dissatisfaction with this service.
• Frustration with not being allowed to smoke.

QUALITY NETWORK PEER REVIEW (NOVEMBER 2016)

In November 2016, Wathwood Hospital was subject to a very positive peer review. The official report is expected imminently.

The peer review team provided initial feedback that suggested there was a sense of strong positive relationships between staff patients and carers. They were complimentary about the resources and opportunities available to patients as part of their recovery.

Forty patients completed the patient survey and 17 carers completed the Friends and Family Survey. Within the patient survey there are questions about staff; 36 patients felt that staff treated them with respect and 35 felt staff listened to their views and concerns.

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4. MAIN ISSUES FOR THE SERVICE AND ACTION TAKEN OR PLANNED

In the table below, we highlight the most prominent issues (selected from the range of feedback presented) raised by patients and their carers’ and families over the last 12 months, and the actions taken or proposed to address these issues.

ISSUE / DETAIL / ACTION TAKEN/PROPOSED
Activities
Source: SUCE survey / Comments – section 3.4 /
Despite being a reoccurring theme within the survey, there continues to be a strong provision of activities across the hospital site which is monitored through ward and community meetings, the patients’ forum, occupational therapy programme reviews and off duty review meetings.
The annual events planner continues to run which ensures a range of leisure, social and cultural themed events occur throughout the year.
Each ward continues to have a full and busy programme of activities. The sports, horticulture, education and occupational therapydepartments provide activities during the evening and at weekends. Ward based activities are also provided by ward staff on a weekend.
Activity provision and uptake are routinely monitored through service audits and evaluation.
Respect
Source: SUCE survey, Patient Opinion / Comments – section 3.4
“Some staff are disrespectful to patients and are sometimes offensive. I think the level of care sometimes gets lost and becomes risks and risks management. (Wathwood)” – Patient Opinion / There are mixed views reported by the patient group regarding staff attitude, some positive and some negative.
All staff undertakea full induction and receive monthly supervision and an annual appraisal.
There is managerial presence on the wards and at handovers and senior staff are quick to address any issues as soon as they arise.
Patients have weekly 1:1 meetings with named nurses and regularly meet with other members of the MDT (Multi-Disciplinary Team)where they can raise and discuss any issues.
Smoking
Source: SUCE survey / Comments – section 3.4 / This is frequently raised by patients in the forum.
Smoking is not allowed on the hospital grounds or during escorted community leave. Patients are offered Nicotine Replacement Therapy and supported by staff along with regular reviews in multidisciplinary team meetings.
GP and dental services
Source: Patient forum / Patients have raised concerns about the GP and dental services – expressing dissatisfaction with these services, and the lack of access to a GP or dentist when it is needed. / All patients have been consulted by Advocacy and asked about the GP and dental services. Analysis of feedback identified three individual issues which have been addressed and resolved.
More generally, service improvements that are being actioned are increased service provision from the dentist to ensure it meets patient needs. Also, primary health staff have implemented a triage system to assist with workload priorities and management, and ensure patients with the most severe concerns are seen first.

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