"The B word"

About: Southmead Hospital / Older people's healthcare

(as a carer),

I will say first I despise the term Bed Blocker and the concept of bed blocking but on this occasion I honestly cannot think of a meaningful alternative.

My father was brought in to A&E a couple of weekends ago and after being assessed was placed on Ward 28a with four other gentlemen with enhanced care needs. (It was a four bed bay but there was massive pressure that weekend and staff showed great enterprise and energy in dealing with it).

1. My father was found medically fit for discharge on Monday rounds and this is where the major difficulty started. I found subsequently that the chain of events was that, despite numerous phone calls and conversations with staff asking that my father's discharge be expedited a referral was not made to social work until Tuesday and then sat unheeded. I even suggested that I would be happy to take him home as per ward policy and come back for any investigations/check ups he might require but this was ignored. Meanwhile my father, who is on immunosuppresants and only mildly affected by dementia, was occupying a bed on the ward. By Thursday I am afraid I lost patience and closely questioned the delay. When I was told to speak to the duty desk social worker I did and she did her very best to expedite my fathers discharge, however by Thursday evening his TTAs were still unavailable so I waited overnight. On Friday I was told that they were not ready and conceivably would not be ready that day either. I ascertained that there had been no significant additions or subtractions from his dossett, and came to the ward and took him home. I simply do not understand how this delay of 4 bed nights, 5 days, could have been allowed to accrue.

2. A secondary issue I had was that mobility was severely discouraged and there was massive reluctance to my getting my father mobilised with a walker. Whilst I appreciate the inherent risk for very many people with dementia my father and I have been managing his health for many years now and immediate and effective mobilisation is crucial in preventing deconditioning. I do not understand the resistance I met and feel this is far too close to defensive practice for comfort and may be harming people who would benefit from less passive care.

3. He lost a hearing aid. This happens all the time at home (the reason he only came in with one) and probably was caused by it being wrapped in tissue and thrown away. I find that confusion is severely aggravated by loss of spectacles and hearing aids. I don't honestly know how it can be avoided but just wanted to flag up the importance of these things.

4. I don't know what the policy is regarding use of personal mobile phones during shifts but I was concerned that on every occasion when I visited the member of staff on permanent station in the enhanced needs section made quite extensive use of their mobile. Four men with enhanced needs are a never ending source of need for conversation, interaction, attention to personal care needs and I think that use of mobiles in such circumstances is to be regretted.

I love the new hospital. I appreciate the environment and as always the staff in A&E and MAU give a really first class service for which Dad and I continue to be grateful. However judging by a poster on the wall talking about delayed discharge issues being escalated to management and a gentleman on the ward phone who was up and about and desperate to go home complaining about delays (obviously I have no idea whether the delay was anything to do with hospital process but the coincidence was concerning) both point to our experience not being a total exception.

When there are complex issues to be resolved to get people safely home I can see how delay is better than undue haste, but when there is a long history of house adaptations and a committed and experienced family carer prepared to stay with someone until their care package kicks back in (which I did over the weekend because it was too late for the agency to pick back up, incidentally! ) I struggle to understand and accept the delay. Someone other than my father needed that bed and that excellent care. Next time it might be him stranded in need because someone else is not experiencing appropriate expedited discharge. I hate to characterise this as a complaint, but I would like to know that the issues are going to be addressed and any material outcomes from it.

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Response from Steven Sykes, Advice & Complaints Team Manager, North Bristol NHS Trust We are preparing to make a change

Dear Candy 56 – thank you for posting your comments about your father’s care and discharge at Southmead hospital. I was pleased to learn that the staff on Gate 28A worked hard to provide your father with appropriate care and other staff provided a first class service. Your kind comments have been fed back to the teams concerned.

It is difficult to comment on the circumstances which led to the delayed discharge for your father, as we do not have his details. If you are able to contact the Advice and Complaints Team at Complaints@nbt.nhs.uk and provide these, we will be very happy to arrange to look in detail at his delayed discharge and address your concerns more fully.

As you may have seen in the local news recently, timely discharges are a challenge to acute hospitals in Bristol, and we have specialist teams and processes designed to support well-timed but safe discharges. We would therefore welcome the opportunity to learn any lessons we can from your father’s poor experience.

I am sorry that your father was not assisted more often to mobilise with his walker, it would be helpful to know more to enable us to respond more fully.

Thank you for flagging the issue of your father’s lost hearing aid. Lost personal items, such as false teeth, and hearing aids do present a challenge as sometimes patients can store theses in unlikely places, such as under pillows, and as you observe wrapped in tissues. We do have processes to record and check for these, and some are recovered from the laundry services, but the issue is then locating who they belong to. Nevertheless Southmead staff continue to try and prevent any losses due to the impact this can have on a patient’s recovery and personal dignity.

The use of personal phones whilst on duty is against Trust policy, but some staff do have official mobile devises to assist with their roles, however, this should never be the case when providing enhanced care in the four bedded bay. Our enhanced care project is reviewing and refining the care delivered for patients with enhanced needs. The dementia matron is leading some of this work, providing activities and improving resources available for patients with dementia.

Once again I apologise for your father’s, and your own, poor experience. Your post will be used as a point of learning and I reiterate that we would welcome you providing more information to enable this to be maximised, as clearly safe, smooth and timely discharges are an important part of any patient’s care and ongoing recovery.

Kind Regards – Steve Sykes

Advice and Complaints Team

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Update posted by Candy56 (a carer)

Thank you for your response, Steve. I have emailed as requested with my father's details.

My father was on 28a and I was told that mobilisation was not possible without a full physio assessment for risk of falls and a properly measured zimmer. However in the event one was found and I mobilised Dad whenever I visited. I appreciate that many patients with dementia are much more at risk than my father but restricted access to walking frames does seem a step too far as the risks of non mobilisation can very well exceed the risks of mobilisation in terms of loss of function.

"The use of personal phones whilst on duty is against Trust policy"

I can only repeat that I saw more than one allocated nurse using their mobile phone for extended periods of time. There is always a gain to be made from paying attention to patients with dementia as we saw whenever the worst affected patients had visitors who engaged with them. It is good to hear that provision is under review and any resources which can be used to engage people would be welcome. Whilst not appropriate at the moment for my father the lady who sits in the reception space making "fiddle muffs" (I'm sure this isn't the correct name but is the best I can come up with) was delightful and was producing lovely items that I'm sure many people find useful.

That response is good to hear and is absolutely what I wanted in filing our story. I'm delighted to say Dad is home, settled and doing well.

Response from Steven Sykes, Advice & Complaints Team Manager, North Bristol NHS Trust

Dear Candy 56 - thank you for saying you will provide the additional data. I have been checking the mailbox and unfortunately I cannot see we have received this yet. Could I please ask you to resend to.... complaints@nbt.nhs.uk..... and also copy me in at..... steven.sykes@nbt.nhs.uk.

Many thanks in advance - please be assured ward 28 a have been alerted and we will endeavour to provide you with a quick response once we receive your fathers details.

Kind regards - Steve Sykes

Advice and Complaints Team

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Update posted by Candy56 (a carer)

Hi Steve. I have checked and the original was acknowledged so I'm not sure where it has gone. I have resent it to both you and the complaints inbox. Thanks for contacting me.

Response from Steven Sykes, Advice & Complaints Team Manager, North Bristol NHS Trust

Thank you for resending - I understand the Ward Matron will contact you directly to advise of their findings and agree a way forward on the investigation and how they will then update you on how the issues have been resolved.

Kind regards - Steve Sykes

Advice and Complaints Team

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Update posted by Candy56 (a carer)

Thanks Steve. Do you think it would be possible to contact me by email? I will be phoneless for a week. Thanks.

Update posted by Candy56 (a carer)

I still haven't heard from Matron Kenny Gale (have emailed since returning from holiday). I know it is a big ask and things are very busy but I would like to complete the process, give feedback and know what has resulted from the initial post. Thank you!

Response from Steven Sykes, Advice & Complaints Team Manager, North Bristol NHS Trust

Dear Candy 56 - thank you for your further contact. If you have any further concerns could I request that you contact the hospital via the email address complaints@nbt.nhs.uk as this will ensure a quick response.

I have passed on your request for contact to the Matron concerned and they will be in touch shortly.

Kind Regards -

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