"My time on the Lucy Wade unit"

About: Millbrook Mental Health Unit

(as the patient),

This was my first encounter of any psychiatric ward, I didn’t expect a hotel spa, I was quite prepared for it to be hard, as it is for everyone, but this experience still horrifies me.

The lack of compassion and care I felt was truly terrifying, small things like reading notes didn’t seem to be done, this you would expect to be done whatever hospital you in, psychiatric or not. I felt that the people providing care broke trust with many patients. Keeping the patients happy felt very secondary to themselves,

I felt very much like all care staff were waiting to tick out, and would openly express how they couldn’t wait to go home, the day space was very small, but it was apparent that most professionals would avoid your looks, and avoid you in their stride. Most would congregate in the small office space, sometimes the door was shut, leaving patients feeling abandoned. Sometimes you didn’t know that staff were in until you saw them leave. The day room was filled with colour in pages such as winnie the pooh, basic flowers, and varicose cartoon characters and unicorns, and ironically frustration. I felt this was patronising, and insulting at best.

I arrived in the evening and was later given my ‘night time medication’ I knew that my tablets were blue at night not white, but trusted that they knew what they were doing, it became clear they had mixed the two around. Sertraline is quite a commonly used and prescribed antidepressant, and was what I was started off when working with the crisis team before admission who had given the hospital a fair amount of notes about my referral and difficulties, and medicinal information. the notes highlighted my difficulties in regards to being ignored and unheard, and unimportant, (but I believe all patients are just as vulnerable if not more) and this medicine was given to me at night by a nurse (only a nurse can give medication to a patient as opposed to a health care assistant) any basic print out of this medicine will clearly instruct to take in the morning, never at night.

I was shocked as it is so commonly known, and she should be familiar with the antidepressant. Although I made this clear, and how swapping it around made me feel uneasy, I was ignored, and my input on the matter felt completely dismissed. And they continued to do this for the duration of my time I was there,

I don’t menstruate, so never really looked into the sanitary bin, but a week in to my stay, there was a smell, and insects, and it was full to the brim, and god knows how long it had been there, one woman couldn’t possibly have filled this bin? I asked somebody to promptly move it, as the smell was getting worse, I was assured the problem was resolved, only to find they had swapped the bin with another equally filled bin, and on a few occasion there were ants in the bed.

There was blood and snot from the last patient on the wall, at the top of bed, were the pillow lay, which was distressing enough, as well as being denied my proper medication, but in addition a man at the door of my room, sat eating just staring in, and from time to time reading his book. Countless times being refused any sleeping medication ( which I took in the community anyway ), I was allowed to pace and struggle till hours as late as 5am,

But nobody had read my notes, and didn’t realise that trying to sleep, with a man waiting for me to do so, would only create more trauma,

When you are admitted, you have your blood taken, I had mine taken three times because they had forgotten to test the first 2, and left it sitting over in the lab for 5 days, and the first two were untestable for this reason. I didn’t have ward round, for 2 weeks, although, it is compulsory to have a basic care plan within 48 hours, (I was admitted on a Friday night, and on Tuesday I had still herd nothing)

for me there was no plan, no structure was put in place, and nobody knew anything about me, and I found this difficult enough outside of hospital, and I took it very personally, every time I was promised a review, a different doctor would take me on, and I never met the first two, or I was told I was forgotten. I was frustrated, and nobody even told me if this had happened, so id usually be left waiting until id ask.

Due to no review, I was on high observation longer than a week, although I was being monitored quite highly, I was still watched squirming by members of staff as large, intimidating gentlemen, would sit next to me, as I ate my lunch in the canteen, I was told that I wasn’t allowed my dinner on the wards. And they would still watch me squirm. Again, not doing something as basic as reading notes, I’m sure from as little as I’ve said you can imagine what my issue is. Even if you can’t, you’re not being paid to do so, so that’s okay.

There was no activities board, and no knitting group, despite what they tell you. There was a crafts group on Mondays, where all patients were offered the chance to make crafts, the theme was ‘mad hatters tea party’, we were not allowed to keep these crafts, and they would be decorations for the staff ball. The theme alone feels laughable, due to the circumstances, but was also free labour to decorate a ‘Mad hatters’ themed dance, to celebrate their hard work? it just seemed like another kick in the teeth.

My mum did kick up a fuss when I had explained all of this, I’m lucky that I have someone assertive enough to stand my corner, and know the ins and out of a psychiatric back ground. Who was able to spot all of the wrong, confirm that the level of care was poor, and not be embarrassed to say so, because it wasn’t all in my head?

I felt bad watching those who didn’t have that support, who didn’t really have visitors, or even those who did, but couldn’t fight back, or were not assertive enough. In that sense I’m lucky,

With it being a mixed wards, there were different levels of care and intensive care that had to be met, and I felt like I was being overlooked, god knows how long other patients have felt this way, can they get better here? Has it made them worse? That is what haunts me. The others had it worse, I grew close to some of the female patients,

I watched a very vulnerable female patient restrained and forcibly medicated.

I believe there could have been other ways to resolve this. And if they knew anything about her, they would realise that by even suggesting that, as a form of action to take is so inappropriate.

There was another elderly woman, who had difficulty dressing herself, and being mobile. She had a few problems and I think this would have been helped by staff talking to her and spending more time with her.

On another occasion I heard a nurse talk about the personal details of a patient that had come in, due to lack of care about confidentiality.

This was a temporary stay for me I urged to be moved closer to home, as there is a massive shortage of beds in the country, I really had to push, and this is where I stayed until I was transferred to a hospital in my area. Were the care was amazing, and I learnt that people in the health care system, are not all so cold, and will take every moment of their shift to be with you. You were properly cared for, Nurses and HCA got to know what made you tick, and learnt who you were, and could tell if you were okay or not because of a bond that was made. I spoke to a lady there about my experience. She knew Lucy Wade, and she also agreed that it has brought shame to her name and shared concerns about the care there.

I’m writing this because I feel it’s important to protect vulnerable people. I’m not doing it to shame the hospital. I am urging anyone to just be more aware of this sector of the care system, it’s often overlooked.

I’ve been told that it is compulsory for the hospital reply, so I await in anticipation.

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Response from Nottinghamshire Healthcare NHS Trust We are preparing to make a change

Dear Etiak,

I would like to thank you for your posting and highlighting your experience on Lucy Wade Ward.

Firstly I would like to apologise on the behalf of Adult Mental Health for the dreadful experience you have encountered and would like to assure you that I, as the General Manager, am taking this extremely seriously. The experience you have described is not the caring and compassionate approach the Adult Mental Health Directorate strives to meet and is contrary to our aspiration to provide compassionate, inclusive and recovery focused care, ensuing patients are at the centre of their own recovery pathway.

With this in mind I am keen to hear more about your experience and meet with you to provide further support regarding your experience. I will then investigate your experience to ensure that this experience is not repeated and that lessons are learnt.

If you are willing to meet with me or have a telephone conversation I would be grateful if you would contact me so we can arrange a convenient time to meet or time to have a telephone conversation.

My name is Adele Bryan and my contact details are 0115 969 1300 extension 14910. I am an annual leave form Friday this week so you could also contact Joanne Horsley, the Operational Manager for Inpatient services on 0115 969 1300 extension 14105.

Again, I am sorry to hear about your negative experience and would really like the opportunity to discuss this further. I can ensure you that this will remain confidential and you can choose to be directly involved or not in any investigation that will occur.

Thank you.

Kind regards

Adele Bryan

General Manager

Adult Mental Health Directorate

Local Services.

Response from Nottinghamshire Healthcare NHS Trust We have made a change

Dear Etiak

We are sorry you have not been able to take up Adele Bryans offer to meet or discuss the concerns you have raised by telephone. We are however keen to try and offer some assurance to you with regard to the points you raise and again apologise for your negative experience

All of our acute inpatient staff have access to the electronic patient records for the service users they are asked to provide care for providing them with all relevent clinical details and information regarding care needs and risks. Alongside this there is a handover process between every shift which the nurse in charge is responsible for leading. This process discusses the presentation and need of every service user who is currently an inpatient and will ensure a detailed handover of information for all new admissions to the ward environment this we expect should lead staff to have a good understanding of all service users in their care and I apologise if this wasn't your experience on Lucy Wade Unit.

Staff will often attempt to engage service users in conversations about their lives and the current circumstances with regard to their care in order to build rapport and trust, and to establish the service users health and wellbeing at this time. I am sorry you felt that staff broke trust with service users and would be keen to hear examples of how this had occurred. Staff are expected to maintain the highest levels of confedentiality with regard to sevice users and their personal information and to act as advocates on their behalf. I am disappointed to hear you felt this was not the case.

I am also disappointed to hear your comments about the attitudes of staff members. I can assure you that there is a regular senior staff presence on the wards including operational managers and matrons who would challenge any such behavour immediately and would encourage such concerns to be raised with them at the time to ensure that this sort of behaviour could be directly challenged with the staff involved. I would like to assure you that our staff teams are committed and dedicated to caring for the service users in their care On occasion this involves them having to engage in professionals meetings which may leave them unavailable for periods of time but is work entirely focused on ensuring clinically excellent care is delivered. We also ensure our wards provide information on which staff are on duty for each shift in public areas of the ward and would expect staff who were new to the area to introduce themselves to all the service users in this area. Again I apologise if this did not occur during your stay on Lucy Wade Unit

Our ward environments at Millbrook now offer improved access to occupational therapists who support the delivery of a variety of options for actvitiy and occupation while an inpatient alongside our now well established Millbrook live project which works with service users and staff on improving the millbrook environment and community for users of the service. As I am sure you can appreciate we care for service users from many diverse backgrounds and experiences and as such aim to have a wide range of activities available, not all of which will be of interest to every service user. I am sorry you felt that the theme of the activity was inappropriate and have fed back to ward staff these concerns for them to be more mindful with regard to planned activities in the future and the potential impact of themes on service users. I have also asked that your points about not being allowed to keep your work be highlighted to ward teams and to ensure in the future that this is not the case if such a request is made.

With regard to medication prescribing and administration. Initial prescription and the timing of the same this is the responsibility of the admitting doctor and should occur in discussion with the service user and nursing staff. Any concerns with regarding to the timing of prescriptions or about extra prescribing, for example to aid sleep, should be brought up with the medical team by the nursing team on behalf of the service user and I apologise if you do not feel this occurred in your case.

During medication administration all dispensing is checked by two professionals to ensure that any mistakes are quickly picked up and rectified without detrimental impact to the service user and we have clear escalation processes in place relating to any errors in prescribing or administering medication.

I am sorry to hear you felt our inpatient areas were not hygenic all of our inpatient areas have regular domestic staff who are on the wards daily and also whose work is spot checked by there managers on a weekly basis. Our Matrons also conduct regular audits of inpatient environments and act immediately to rectify issues or concerns brought to them by service users or noted on their checks.

Often when service users require levels of observations we do have to ensure that staff members are able to keep people within their eyesight at all times. This should be used by staff as an opportunity to engage with service users and offer support when appropriate unless it is a time when sleep hygiene is trying to be encouraged. We have recently undertaken a review of our observation policies and practice and will be implementing clearer staff guidance with regards to our expectations of staff I apologise if we fell short of these standards during your time in our care.

We out source our blood testing and results service to a local general hospital and I apologise that delays in this testing led to further blood tests being necessary.

The development of a care plan is the role of the named nurse and should be a collaborative process with the service user. We do audit all of our inpatient areas to ensure this occurs and manage staff accordingly who fail to meet this requirement. I am sorry this failed to occur in your case.

All new inpatients are now reviewed by a consultant psychiatrist within 72 hours of admission so that a clear clinical plan can be developed and we monitor adherence to this closely.

All service users placed on high observations are now subject to a daily multidisciplinary discussion which should clearly outline the rationale for continued high observations, this should also be discussed with the service users involved. I apologise that you did not feel involved in these decisions during your stay on the ward.

I am sorry you felt overlooked during this experience I want to assure you I expect all staff to be dedicated and committed to meeting all aspects of a service users care needs and am unhappy to hear this did not seem to be the case in this instance. Your thoughts and feelings have been discussed in staff supervision sessions as feedback to staff and they have been asked to reflect on their own practice.

I am sorry to her you felt other patients care needs were not best met. While I cannot discuss specific patients I can comment that we have been leading in the implementation of the 'No Force First' agenda, introducing a collaborative approach to managing risk and challenging behaviour and minimising the need for restraint. This is already achieving very positive results and outcomes.

We are also measured on meeting service users physical health needs and aspire to always support people to maintain hygiene privacy and dignity throughout their time as an inpatient.

We also take breaches of patients confidentiality very seriously, all staff are trained as a mandatory requirement with regard to this matter and any breaches of the same are thoroughly investigated when brought to our attention.

In summary I am very sorry that you had such a negative experience on Lucy Wade Unit. I want to assure you that service developments have taken place to improve some areas you have highlighted and your concerns have been discussed with the staff team. I would be very happy to meet and discuss this experience and improvements and changes made in more detail should this be helpful

Kind Regards

Debbie Dolan

Operational Manager Acute services County North 0115 9691300 EXT 14040