On a ward that had been open a relatively short time to deal with winter pressures we received comments from four people that indicated that they did not feel respected and their dignity had not been maintained.

One person said ‘The staff were busy, reasonably polite but on one occasion they were not very nice. They didn’t always talk quietly and this made the person feel cross and feel like shouting back.’

Another person told us ‘They didn’t feel as if they could talk to anyone, not very friendly but staff usually explained things. They felt that the would have liked to know more but felt the staff didn’t have much to say.’

Another person said ‘They were satisfied in the main but were concerned about the length of time they had to wait before being taken to the toilet. They had spoken with staff and it had improved since.’

The fourth comment was about the attitude and behaviour of one particular staff member. We fed this back to the Trust for them to monitor as we were not told who the individual was.

Other evidence

The Patient Environment Action Team (PEAT) assessment scores for the Heart of England NHS Foundation Trust from early 2010 rated Good Hope Hospital overall as “good” for dignity and respect.

Between June 2010 and January 2011 we had received two concerns relating to the care of people in Good Hope Hospital.

During our visit we saw staff treating people with respect. They spoke to them about things other than their needs on the ward. They were asked if they wanted to be assisted with their personal hygiene, if they were sitting comfortably and if they were happy with the care they had received. This showed that people’s views about the care they received were valued.

Staff were mindful when providing personal care to ensure that the privacy curtains were drawn and toilet doors were closed. In a side room the curtains at the window had been partially drawn. This ensured a relaxing environment for someone who was quite poorly.
We observed that although curtains were drawn to ensure a patient’s privacy other people in the ward could hear what help they needed because staff voices could be heard. For example, a nurse was heard to say that the patient would have to be turned to ‘have their pad changed’ whilst they were explaining what they were doing to the patient. Staff needed to be mindful that the curtains did not provide complete privacy.

On some occasions people were not treated with respect and dignity. Examples of this included a comment to a confused patient. They were told to sit down in case they fell adding “We need to see to other people. While we’re with you we can’t see to other people”. Staff were also heard talking about the discharge of one patient whilst assisting another and asking another staff in a loud voice “Has X been done?”

Staff told us that they supported people to make choices such as at mealtimes, asked them what they preferred to be called and where they would prefer personal care to be carried out. Although preferred names, likes and dislikes were not always recorded in assessment records people told us that this happened.

We saw the records of one patient in another patient’s file. This meant that the individual’s personal information was not maintained safely and confidentially.

The majority of people were able to reach their call bells but one could not. We were told that sometimes people had to wait for several minutes for assistance. During our observations we heard the call bell sound. It took three minutes to be responded to. Doctors and nurses present in the bay did not respond to the individual.

People were regularly asked if they were happy with their care. Any concerns raised were addressed at ward level but if this was not possible people were given information about the complaints procedure and the patient advice and liaison service.

Bedside lockers were available for people to store their belongings in on both the wards we visited. This respected each person’s right to privacy.

The structure of the wards ensured that privacy and dignity for people was maintained. There were only female people on ward nine. On ward ten there were both male and female people. Males were allocated one wing and females the other. Toilet and bathing facilities were available on each wing.

Nursing staff told us they had received training in privacy and dignity during their nurse training. They felt that once they had received it they didn’t forget it.

Our judgement

People were helped to make choices in the treatment and support they received. Sometimes their privacy and dignity was not maintained because other people could hear what help they were receiving through the privacy curtains. People sometimes had to wait for assistance when they asked for it and were not always spoken to with respect.

A relative told us that they came twice a day to help feed their father and the food was “excellent” and they couldn’t fault the staff.
Other evidence

The Trust was rated much better than expected when compared with other similar trusts in respect of people receiving help and the quality of food.

The PEAT survey for Good Hope Hospital for early 2010 rated them as ‘excellent’ overall in respect of menus, choice, availability, quality, portions, temperature, presentation, service and beverages.

Good Hope Hospital was rated similar to expected when compared with other similar services in respect of availability of equipment for measuring people, existence of a trust nutritional screening group, proportion of wards that were using a nutritional screening policy and proportion of wards that operated a protected mealtime policy.

Between June 2010 and March 2011 we had received three concerns about the way in which peoples’ nutritional needs had been met in Good Hope Hospital.

A clinical quality review group report by HEFT indicated that the trust had carried out a catering audit of food in January 2011. This report showed a steady improvement from the patient experience surveys carried out in November 2010.

This report also highlighted a six point check to be carried out by staff before meals were given to those people who needed assistance. These points included the positioning of people before meals, the appropriate positioning of tables, people being assisted where needed, people being offered hand washing opportunities, the use of a red tray system to identify people at risk and the protected meal time being implemented. We found that these points had been implemented

A protected mealtime was in place on both wards we visited. Protected meal times meant that all staff were involved in the mealtime to ensure people received their meals and any assistance they needed. On one ward we saw that the doctors’ ward round continued into the protected meal time thereby impacting on the meal time for some people. We also saw that only people on ward nine were offered hand cleaning opportunities before their meals.

People were given choices at meal times even though different systems were in use on the two wards. On ward nine people were offered choices from the available meals on the trolley. On ward ten people had ordered what they wanted the day before and their meals were plated up as ordered. On ward ten the pudding was served with the main meal but on ward nine it was served after the main meal had been eaten.

A third person told us “The food was horrible” and their family brought food in for them.’

A relative told us that they came twice a day to help feed their father and the food was “excellent” and they couldn’t fault the staff.
Other evidence

The Trust was rated much better than expected when compared with other similar trusts in respect of people receiving help and the quality of food.

The PEAT survey for Good Hope Hospital for early 2010 rated them as ‘excellent’ overall in respect of menus, choice, availability, quality, portions, temperature, presentation, service and beverages.

Good Hope Hospital was rated similar to expected when compared with other similar services in respect of availability of equipment for measuring people, existence of a trust nutritional screening group, proportion of wards that were using a nutritional screening policy and proportion of wards that operated a protected mealtime policy.

Between June 2010 and March 2011 we had received three concerns about the way in which peoples’ nutritional needs had been met in Good Hope Hospital.

A clinical quality review group report by HEFT indicated that the trust had carried out a catering audit of food in January 2011. This report showed a steady improvement from the patient experience surveys carried out in November 2010.

This report also highlighted a six point check to be carried out by staff before meals were given to those people who needed assistance. These points included the positioning of people before meals, the appropriate positioning of tables, people being assisted where needed, people being offered hand washing opportunities, the use of a red tray system to identify people at risk and the protected meal time being implemented. We found that these points had been implemented

A protected mealtime was in place on both wards we visited. Protected meal times meant that all staff were involved in the mealtime to ensure people received their meals and any assistance they needed. On one ward we saw that the doctors’ ward round continued into the protected meal time thereby impacting on the meal time for some people. We also saw that only people on ward nine were offered hand cleaning opportunities before their meals.
People were given choices at meal times even though different systems were in use on the two wards. On ward nine people were offered choices from the available meals on the trolley. On ward ten people had ordered what they wanted the day before and their meals were plated up as ordered. On ward ten the pudding was served with the main meal but on ward nine it was served after the main meal had been eaten.

On ward nine one person who requested salad was unable to have it as there was none left.

On the day of our visit special diets were catered for ensuring cultural and dietary needs were met. We were told that there were limited choices for people requiring pureed meals as these needed to be pre-ordered and could not be chosen from the trolley on the day.
People who were at risk of poor hydration and nutrition were identified through the assessment process on admission and feedback from the multidisciplinary team (MDT) members. The assessment records had sections for recording nutritional likes and dislikes but these were not always completed. Weight records, food and fluid intake charts were reviewed regularly providing information about whether people were receiving adequate nutrition and hydration. Nutritional assessments were kept under review but the scoring did not always correlate to patient’s clinical conditions.

People refusing to eat or if they appeared to be losing weight were referred to the MDT. Dieticians decided if people needed to have supplements or intravenous assistance to prevent dehydration. This ensured that people’s changing needs were identified and planned for.

Sometimes people’s drinks were left on their tables without sufficient prompting to ensure they were drunk.

Staff had received training in food hygiene and nutrition. Some senior staff had received further training to undertake swallowing assessments. Speech and language therapy specialists were available for support. This enabled people to be supported to eat safely.
Food charts did not always indicate accurately how much people had eaten or drank. The Heart of England NHS Foundation Trust had identified this and a new food chart enabling more detailed information to be recorded was being introduced.

Our judgement

People were provided with hot, nutritious meals each day and support to eat if they needed it. There was not always sufficient food to ensure that everyone had access to all the choices available. Protected mealtimes were not observed by all professionals. Hand washing facilities were not made available to everyone. Nutritional assessments were generally well managed but individual preferences were not always recorded.