"I am concerned about levels of..."

What could be improved

My concern is with the appropriate care of the elderly, largely manifested in poor COMMUNICATIONS. I was the main carer for my mother during her stays in hospital between November 2009 and May 2010 and have frequently visited friends and relatives over the past 5 years, including during the past few weeks. As my mother's next of kin, I found it extremely difficult to have a conversation with nursing staff - this both in terms of availability, knowledge and understanding, articulation and expression, continuity, and follow-through on actions.

There is no sense of team or working together - as a result I had to instigate a meeting and personally request that the physios, staff nurse OT and social worker sat down together with us to work out the way forward for my mother.

On visiting a relative this week, I had no sense that this has changed.

Anything else?

Evening visiting coincides with hand over/end of shift , thus staff are unavailable for conversation because they are in a meeting, or too exhausted by the end of shift to have a proper discussion.

Patients are moved without relatives being notified so on turning up at the normal ward one is alarmed to find the patient moved elsewhere. Discharges (to eg Richmond Hall) take place after dark which is frightening and baffling for the elderly.

Poor patient knowledge - senior staff are unaware (or not empowered to discuss) of a patient's progress or a likely outcome.

(Seemingly minor but important to the patients) symptoms such as nausea and diarrhoea and rashes, are not dealt with. This exacerbates feeling unwell or creates the feeling of being a nuisance by asking for bed pans, bowls etc. The wait for bedpans can result in accidents, which again makes the patient feel helpless and lacking in dignity.

Patients are left in chairs for long periods by which time they are uncomfortable and sore.

Depression - elderly people feeling low and unmotivated are chided and addressed with very negative vocabulary - eg "we're giving up on you", we're not helping you if you won't help

yourself".

Large portions of food, presented unattractively or in a logistically difficult way, make it even more difficult for elderly people to maintain levels of intake.