"My mother's care from social services and Good Hope"

About: Good Hope Hospital / Accident & emergency Good Hope Hospital / General medicine West Midlands Ambulance Service NHS Foundation Trust

(as a carer),

During late May, my mother developed a bad chest infection and went "off her legs". I am an only child and had been caring for her for around six years. We managed to get a carer privately last August so that took some of the pressure off. I called the doctor who came on the Friday morning he said she had a very bad chest infection and should be in hospital. I told him she didn't want to go to hospital as she was frightened of them. She had said for a number of years that hospitals kill you if you are old. He asked about our care arrangements and said that we needed help and that he would contact social services. I forgot to say that she had also had some water blisters come up on her legs a few weeks before and these were being dressed by the district nurses twice a week. We did not hear from social services over the weekend and it was really difficult trying to cope with my mother who was doubly incontinent. My husband was helping to change her as I couldn't lift her by myself. It was taking over an hour and a half to change her. On the Monday morning I received a call from social services. I explained that we needed equipment to help lift her as we couldn't get her off the settee. He offered me a stairlift. I said I couldn't get her off the settee. He offered me a walk in shower. I again said I couldn't get her off the settee and really needed a hoist to lift her and a hospital bed preferably. He again offered me a stair lift I again told him there was a more pressing problem. I asked for a carer's assessment and told him I had previously had one carer's assessment which had been ignored. In this carer's assessment I had put down that I felt despair but no one ever took any notice of it. He said he would get a social worker to contact me to do an assessment of my mother. I said I needed occupational therapy to do an urgent assessment of my mother's needs he didn't seem to know how to go about this.

The Tuesday morning came and I had spent the night at my mothers, my husband arrived and the carer and a friend of the carer. It took all four of us to change my mother. I stayed with my mother on the Tuesday morning and mid morning she said she wanted to go to the toilet so I tried to lift her. Every time I managed to get her up she sat down again. Eventually I got her to stand up for long enough to put a disposable sheet underneath. She sat down again, I stood her up and managed to pull down her trousers and disposable pants. She sat down again. I stood her up again. She started weeing and sat down again. We were both exhausted. I phoned my husband who was at work and he got someone to drop him to my mothers. We eventually managed to change her although it took around an hour. In the afternoon I phoned the doctor to try and get some equipment. The receptionist was very good and took down all the details but explained that the doctor who had seen my mother was not in until the Wednesday but that he would phone me. The district nurse arrived and said that my mother couldn't stay on the settee and that the bed needed to be bought downstairs. I explained that I had really pulled my back that morning and I was in a great deal of pain from that and not only that but the bed was so low that it would be even worse to try and get her up to change her. She said she would get in touch with intermediate care to try and get us some help and that she would order a hoist and a hospital bed.

On the Wednesday morning again it took four of us to change my mother. The doctor phoned and said he would get onto Social Services again, I had heard nothing from any social worker at this stage five days after the doctor had phoned. During that morning I received another call from a nurse from the intermediate care unit saying they wanted to do an assessment of my mother. We arranged to meet. They said they had no one who could help me but that they could assess the situation. They asked me to show them how I lifted my mother and then said they could see that I couldn't lift her on my own. They said that they would have a word with their manager to see what could be done and would get back to me. I got upset as no one seemed to be able to give any help at all. On the afternoon I met up with the nurses again who said that the best solution would be for my mother to go into respite care so that the equipment could be ordered and got in place. It would probably be for a week to ten days. They got me to explain to my mother what was happening but I am not sure she was listening.

We carried on for the rest of the week with four people changing my mother every day and intermediate care coming in "to assess the situation". Still no assessment of myself or my mother. On the Friday the social worker turned up and asked my mother if she would go into respite care, she said no. She phoned me and told me, I asked for help she said there was none, I asked for equipment she said she would have to get occupational therapy to assess, I said this was urgent, I was exhausted, my mother was exhausted. I asked about my carer's assessment she said she would put one in the post - this has never arrived.

On the Saturday another intermediate care nurse arrived to assess the situation. I had by this stage read the notes the previous two nurses had left. The notes were full of glaring errrors which I pointed out. They had put down that my mother had her own teeth (she had had all her teeth out in 1943), she wore a hearing aid (She was partially deaf and had no aid), she wore glasses (she had macular degeneration and was registered blind) she had had no falls ( she had had a number of falls over the last few months) and that she had a good appetite (she had hardly eaten anything for a week and I was spoon feeding her)

On the Sunday we got the bed downstairs, as I had suspected it was much worse, it now took us nearly two hours to change my mother. We tried to sit her up in bed to feed her and give her something to drink but she kept sliding down the bed. The intermediate care nurses arrived to assess and I burst into tears. It was so stressful. One of the nurses called for an ambulance. The ambulance arrived and they bundled my mother into a chair as the stretcher wouldn't go through the door. My mother was very frightened and as they moved her she cried out (in pain, I think) One of the ambulance drivers told her to be quiet and to stop making a noise.

She was admitted to A + E, she was assessed after about an hour and a half by a nurse, then put into a cubicle to wait for the doctor. She was seen by the doctor after about three hours. The doctor said her chest was very bad and that she also had a UTI and that she would be admitted. She was given a drink. There was a shift change at around six. The nurse in charge came round and I asked if there was someone who could change my mother because she was doubly incontinent and that she had been at the hospital around four hours now. I could also smell that she needed changing. The nurse in charge said that they didn't have that sort of thing in A + E. I said I would go home and get some of the incontinence pants if she wanted me to. She said that wouldnt be necessary and that would just put something between her legs to catch the drips

She was eventually moved into the acute medical assessment ward. At around nine they asked me if she wanted anything to eat such as a piece of toast so they got that for her with a cup of tea. The doctor arrived at around ten and examined her. She had been crying out so I told the doctor this and she said she would get something for the pain. My mother was lying very awkwardly and her head was nearly against the side of the bed near the pull up side. I asked if she could have another pillow and was told that the hospital had a policy of one bed one pillow.

The next day we visited and the staff nurse said she had had some porridge for her breakfast. We bought some food in and gave her that the food trolley also arrived so I got her something off that to which I spoon fed to her. The staff nurse came over to check her observations and seemed very concerned. She put a line in to put fluids in and got her on oxygen and because she seemed in pain gave her some morphine. I again asked about a second pillow and was told that that wouldn't be possible. I asked if I bought some pillows at a shop and bought them in would that be ok and I was told it would. We stayed till around three returning at five. We again fed her and then the staff nurse came and said that they would have to put a catheter in her. The doctor came at around eight to see us and told us my mother wasn't very well but that the antibiotics sometimes had a very good effect on the elderly. We left around nine thirty.

On the Tuesday when we visited we arrived to find that someone had left a yoghurt on her side table with a spoon. As she couldn't feed herself this was ridiculous. We fed her with some of the food we had bought from home. They had also left water with a straw which we tried to get her to drink. She was on a machine which was monitoring her heart rate, oxygen leveles and breathing, this kept going red but no one seemed to take any notice. My mother kept pulling the oxygen mask down so I went to see one of the nurses who was closest, she said it would be better if she didn't do this. I could see from my mother's legs that the dressings on her legs hadn't been changed, so I found the staff nurse and told her that the district nurses had been coming twice a week and one of the days was Tuesday to change the dressings. She said that they didn't have the right sort of bandages on the ward, I said there were some at my mother's house that they district nurses had left and that I could bring them in. She said that this would be a help. Later that day we returned with the bandages, two new pillows and some more food. At around eight she was moved to ward ten. I left the pillows and the bandages in her new ward. The next morning I phoned and they said she had had a comfortable night. About an hour later the hospital phoned and said although it wasn't visiting hours we could come at any time. We went to the hospital straight away. I am not sure she recognised us We started feeding her the food we had bought in then the food trolley came round so I got her some fish pie. I fed her this. A few minutes later she stopped breathing, then she started again then stopped, there were no nurses in the ward so I went to the nurses station to tell them. They came and called the doctor. The doctor asked us to go and sit in the patients rest room. She then came to us and told us that my mother was dying. I asked her how long it would take she said about an hour and said that we could sit with her. We did this. I was told to phone up the bereavement office the next day to arrange for collection of the death certificate.

The next day I phoned the bereavement office, the woman who answered the phone said in a cursory manner that she offered her condolences but that the death would have to be referred to the coronor because of the circumstances of the death. I asked her what she meant, my mother had been in hospital for three days when she had died. She said it was because of the pressure sores. When my mother was admitted she had a type one pressure sore in the sacral area which I had told the hospital about. There was also the problem with her legs requiring dressing which again I had told them about. The attitude of the woman at the bereavement office made me feel like I was being accused of neglect. The next day the coroner's office phoned and said that she had a couple of questions, I had nothing to worry about and that she was not sure why the bereavement office had referred it. On the Monday she phoned again and said that the bereavement office would be able to issue the death certificate. I arranged to go and collect it. The woman I had spoken to on the phone gave me the certificate, I looked at it and said to my husband "oh she died of pneumonia". The woman from the bereavement office said "oh didn't you know - the coroner should have gone through all this with you, I will have to refer it back" I thought this is just getting worse really but she then said I could take the certificate away. She handed me a sympathy card with a survey on care inside.

I really feel that social services and Good Hope Hospital badly treated my mother during her last few days of life. There seemed to be very little actual nursing or caring being done by the staff on the wards, with the exception of one ward sister. I think my mother was right and I will always regret her going into hospital.

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Response from Hospital Director, Good Hope Hospital, Heart of England NHS Foundation Trust

We are very disappointed to hear of these complaints and take feedback very seriously. Our doctors and nurses aim to provide the best possible care for all of our patients and we would urge this relative to contact us directly so we can investigate the issues raised immediately. Please contact Jamie Emery at Jamie.emery@heartofengland.nhs.uk or on 0121 424 2657.
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Response from West Midlands Ambulance Service

I am sorry to hear of your experience with the Ambulance Service and we would welcome the opportunity to discuss your concerns. Please consider contacting me, Marie Tideswell, Regional Head of Patient Experience on telephone number 01384 246366 or by email.
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