"Poor organisation in Adolescent Unit"

About: Nottinghamshire Healthcare NHS Foundation Trust / Child and Adolescent Mental Health Services – Community(City)

(as a parent/guardian),

My son has been an inpatient at Thorneywood and the unit has certainly kept him safe. He has been diagnosed with asperger's syndrome. So far none of the medication has been effective in any way. He has just started lithium - we've only been waiting a year for this to happen, (as an outpatient and on other units).

My main concern with the unit is its poor organisation, the following are examples:

1) Patient going on home leave, TTO's not ordered, we had to wait for 3 hours for them to arrive from the pharmacy.

2) AS above, TTo's not ordered - they had to be sent to our home address by taxi - a round trip of 50 miles.

3) As above, because he was going on home leave a day early, fortunately I had enough TTo's at home to do without.

4) Attending 'Step ahead' to get feed back from MDT, person I was scheduled to see had gone home sick. I sat waiting for an hour, no one had realised until I started asking why I had not been seen. Also booked in on several occasions for a certain time, but was either not booked in or booked in at the wrong time.

5) Cognitive behavioural therapy, rarely backed up by practice due to staff not getting round to it.

6) Hospital appointment. Staff took my son an hour late. They told me there had been an incident on the ward and they couldn't spare the staff. I found out later that there had been no incident on the ward, the staff thought I was taking him, even though no one had asked me to do so. Appointment therefore had to be rescheduled for a Wednesday, I received a phone call from unit on the Saturday before from saying appointment had been rescheduled for a Monday and could I take him as he was on home leave. We travelled to the QMC, a round trip of 50 miles, only to find out he did not have an appointmen. The appointment was on Wednesday. They don't do paediatrics on a Monday. When I explained how far we'd come they fortunately managed to find us a cancellation.

This last incident has been the final straw. I don't know where the unit got this, information from. So many times have their disorganised, feckless behaviour left me fuming. They say they have procedures, but they obviously do not work. I have suffered from their unprofessionalism.

So perhaps the powers that be could look into this and sort it.

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Response from Michelle Handsaker, Integrated Service Manager, Specialist Services Directorate, Nottinghamshire Healthcare NHS Trust We are preparing to make a change

Dear Poff,

Thank you for taking the time to post your story as it is important for the service to receive feedback both good and bad.

I would like firstly to apologise for any distress felt by you and your family. I have now had the opportunity to discuss your concerns with the ward manager and hope that my response reassures you that we take every effort to make someone's stay with us a positive one and where this isn't the case then we reflect and put in improvements where needed.

You are quite right there was a delay with the ordering of your son's TTOs -unfortunately these had not been written on the appropriate card and therefore could not be ordered. This has since been raised with the medical team to prevent this from reoccurring. I understand the ward manager apologised for this at the time.

The unit made the decision to send the tto's to your home address via taxi in order to prevent you and your son having a prolonged wait for them on the unit. It was useful that you had enough tto's at home as I understand your son went home a day early and any tto's issued by the unit have to be ordered in advance however it is good that he was able to take his leave early.

Times for attending step ahead are approximate although the staff make every effort to keep to these delays do occur unfortunately.

CBT: this is becoming more frequent but currently there are limited numbers of staff trained in this we are looking to develop this. Unfortunately the unit had been very unsettled during the night on the day of your son's hospital appointment and there was unexpected staff sickness on the actual day.There was also some technical problems with the transport ordering system so a taxi had to be ordered which I believe took some time to get to the unit and despite best efforts of the staff caused your son to be late for his appointment and I apologise for that.

There seems to have been some confusion over the new appointment offered and we are not sure if this was changed by QMC. I am pleased to note though that you did manage to get seen.

I hope you have found my response reassuring.

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Update posted by Poff (a parent/guardian)

The error was not at their end.

According to staff they do not have a computer system to automate administration, so they have to do everything by hand. This is because Nottingham NHS Trust will not fund it. Humans are notoriously bad at administering with the aid of bits of paper - look at the case of the Yorkshire ripper in the 70's - and computer systems are brilliant.

So until the Trust changes its mind, administration is likely to remain chaotic and the staff will continue to get it in the neck from parents.

Response from Michelle Handsaker, Integrated Service Manager, Specialist Services Directorate, Nottinghamshire Healthcare NHS Trust

Dear Poff,

Thank you for your response and I have noted your comments.

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Update posted by Poff (a parent/guardian)

I have just received a call from Nottingham NHS Trust, although the problem hasn't been sorted, it is good to actually be listened to - something which I have never experienced before.