George Eliot NHS Hospital

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

We reviewed kindness, compassion and dignity; treating people as individuals, independence, choice and control; responding to peoples immediate needs and workforce wellbeing and enablement as part of the caring key question. We found caring remained good. Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We spoke with 1 patient and 1 relative. They were both positive regarding the care provided. They told us they or their relative were cared for in a kind and compassionate manner by staff. Our own observations supported this. Staff understood and respected the personal, cultural, social and religious needs of patients and how they may relate to care needs.

Staff knew the procedure for approaching relatives for organ donation when treatment was being withdrawn. Staff told us they received training and a good level of support from the organ donation team. Staff showed a good understanding of end of life care and explained how they would support families and speak to them regarding their preferences and try to meet these, for example, moving patients approaching the end of their life into a side room.

We observed staff treated patients with dignity and respect for their privacy. During all interventions, staff pulled curtains around patients or closed the door to the side room. Patients were kept covered with sheets and blankets. We observed interaction between a nurse and relatives. They gave a clear explanation of why their relative had been sedated and provided reassurance. Staff provided bedside support to relatives and a bereavement team was available to support families. Band 7 nurses offered follow up meetings. Mental health referrals could be done online with the mental health team based on the emergency department. We observed staff explaining tasks before performing them on the patient to reduce anxiety. Staff would give reassurance to patients and relatives and offer their support.

Doctors discussed treatment with families and explained deterioration or changes to treatment sensitively and compassionately. We observed a sensitive multidisciplinary discussion led by consultant about a patient who had deteriorated. The team considered the patient’s family, and the patient’s wishes as well as the treatment limitations that were already in place.

Staff told us they coordinated care with other services and providers where possible. Patient records showed and staff told us that they engaged with other providers and professionals about the care and treatment of patients who presented with acute mental health needs and/or learning disabilities. This included making prompt referrals to mental health teams as and when required. Staff told us they felt able to support patients with dementia and learning disabilities. We saw evidence that nursing care plans included assessment and interventions for patients with dementia, learning disabilities and delirium.

Staff responded compassionately to pain, discomfort, and emotional distress in a timely and appropriate way. We observed caring interactions with patients whilst they were being repositioned or assisted with feeding.

A patient and relative we spoke with said they were fully involved in their care decisions. This included discussion of the risks and benefits of treatment. They said they knew who to approach if they had issues regarding their care, and they felt able to ask questions. Patients and relatives had opportunities to speak with the consultant in charge of their care. Staff kept patients informed, explained why tests and scans were required and did their best to keep patients reassured. Managers were visible and relatives and patients were able to speak with them if required. During the inspection one patient on the unit was able to drink. Water was available for the patient and within reach.

Patients that have had a prolonged length of stay in critical care were invited to a post-discharge critical care outpatient clinic appointment. The critical care department worked in partnership with 2 other neighbouring NHS trusts to deliver care and improve the timeliness and access to treatment for patients in the geographical area. Staff had access to a dietetic service, a dietitian visited the unit daily and staff could request a review of a patient. We were informed a speech and language therapist attended the unit when required.

The service had a relatives’ room which included a sofa which could be converted into a bed. Relatives who stayed longer were offered food and vouchers from the canteen for hot food requests. A patient told us nurses ensured they were turned regularly to prevent bedsores.

Staff told us there was a referral process for patients who required enteral feeding and dieticians could see all patient referrals on a clinical portal and a dietician inbox. A decision to refer a patient for a total parenteral feeding (TPN) had to be agreed by 2 clinicians and a prescriber. Patients on TPN had a dedicated line portal (lumen) for their feed and staff were trained to use them. Clinicians checked blood results and adjusted TPN feeding regimes accordingly.

Dietitians were available onsite during weekdays. An emergency feeding regimen was available over the weekend and on call pharmacists took charge of these in agreement with a nutrition consultant, the nurse in charge and a speech and language therapist. The service used a Richmond Adapted Sedation Score (RASS) which was incorporated into the falls assessment and care plan. Staff were required to complete these within 6 hours of admission into critical care. Patients were required to have a sedation score of 4 or less. We saw this had been completed in the nursing notes of a patient who received sedation. There was an intensive care unit specific patient assessment form in place. We reviewed a patient record and found this had been completed by physiotherapist and included record of a physiotherapy plan and the next date to review the patient.

Staff told us they generally enjoyed their role. They told us they were able to apply for annual leave through their phone and leave was generally approved. We spoke with 2 staff members who worked flexibly on a part-time basis. They said this had improved on their work-life balance. A suggestion box was in place for staff to make suggestions. Staff met out of work and had various opportunities to discuss well-being. Staff held well-being debriefs at the end of the day. A well-being board which included phone numbers and links was available on the department. Staff also had access to a psychologist.

The trust had a number of policies and processes in place to support the well-being of staff. These covered practical ways to helping staff lead healthier lives and how to manage pressure. These were implemented by managers of the service. There were processes in place to ensure that staff were supported with their well-being which enabled them to continue in their roles of providing care and treatment to patients. Staff well-being was covered in the monthly Clinical Support Services Quality Governance Meetings which also covers the critical care services. As part of the process in place, newsletter and posters were posted around the service for staff to review. There was signposting information which staff could access for further support. Examples of the posters and newsletters were reviewed during the onsite assessment stage.