To receive a presentation from Flo Panel-Coates, Director of Nursing, Barking, Havering and Redbridge University Hospitals NHS Trust (BHRUT) on facilities and policies for hospital patients with learning disabilities.
Minutes:
The Committee received a presentation from Gary Etheridge, Deputy Director of Nursing at BHRUT on facilities and policies for patients with learning disabilities. Members were asked to note the following:
Following several alarming government reports, a number of new initiatives were being put into place within BHRUT in order to improve the patient experience for people with learning disabilities (LD). During the six months between 1 April 2013 and 31 October 2013, 17 LD patients had been admitted to BHRUT and 223 LD patients had attended A & E. An initiative called Pride had been launched that would focus on the patient’s needs and improve communications and fundamentals of care. A referral was made to the recent CQC inspection where BHRUT were complimented on their safeguarding strategies and delivery of care to patients.
A safeguarding structure had been established with safeguarding children and adult groups reporting to the Trust Board and the appointment of a specialist Learning Disabilities Nurse who would be commencing in March 2014. All staff had a responsibility to report their concerns through “Voice” :
§ Verbalise
§ Openness & transparency
§ Interests of patients come first
§ Confidentiality for staff will always be maintained
§ Excellence in care at BHRUT
In addition, a Patient Champion/Guardian had been appointed to promote a culture of trust, vision, values and mission.
Resources currently being made available were Easy-Read information about complaints and the supply of the PALS leaflet, a Learning Disability Folder available in wards for audit purposes as well as 43 link workers on both hospital sites. There was also a Patient Passport Health Action Plan, the PAS IT system would alert staff by identifying LD patients as well as the provision of training for staff.
In order to ensure that the policies and initiatives were working the following had been implemented:
· Learning Lessons (Mystery Shopper, Patient Stories)
· Easy-read Documents
· Being Open & Transparent
· Patient Experience & Involvement Strategy
· 3 Million Investment - Nursing
· Launch of Mencap Charter
· Appointment of LD Nurse
· DOLs/MCA Authorisation database
· Safeguarding Annual Report
· Learning Disabilities Progress Report
· Learning Disability Action Plan
· Annual Audit Plan (e.g. Safer Recruitment)
· Learning Disability Patient Survey
· Reasonable Adjustments Audit
· Development of Policies & Pathways
· Triangulation of Complaints, PALS & Real-Time Patient Surveys
A number of initiatives had been introduced for LD patients admitted to wards. A link worker would be available for each ward and the Matron would screen and review the patient daily. In addition, a LD pathway would be put in place alongside nursing risk assessments. Relatives and carers could visit out of hours and there would be the provision of overnight facilities. A Discharge Team would oversee transfer of care arrangements.
For LD patients attending A&E, an LD Champion will be available and specialist LD triage will make initial risk assessments. The patient will be checked regularly to ensure their comfort and the Matron or Shift Co-ordinator would monitor the patient in the department. If an LD patient attends Outpatients, prior planning would ensure the appointment runs smoothly particularly for complex cases. Appointment times could also be brought forward if necessary with the provision of a quiet area and link worker to advise.
The Committee were asked to note the future initiatives being planned were as follows:
· Safeguarding Strategy 2013-2016
· Restructuring the team - Safeguarding Lead
Evaluating LD pathway to ensure effective on the job training for staff/Mandatory Training
· Re - launching Learning Lessons Group
· Ratification of a Transitional Policy
· Reinvigorating the LD Champion Role
· Meeting with HAVCare
The Committee enquired about care pathways for Dementia patients and were advised that BHRUT had appointed three Dementia Nurse Specialists so far and that 25%-30% of the workforce had received Dementia training. This was a necessary strategy as it was known that people with learning difficulties develop Dementia quickly in later years and require specialist nursing and end of life care. Further comment was made by members about patients’ nutrition whilst in hospital and it was advised that the Patient Health Passport would highlight any feeding anomalies and that nurses would be available to assist patients. In response to a query regarding complex LD cases, the Committee were advised that this was generally not an issue and that no-one could be an expert as LD patients are very different, however, BHRUT had implemented certain recommendations and the LD nurse followed good practice. Additional nursing would be provided and the patient would be put into a side ward if necessary.
In processing information about LD patients coming into A&E, alerts are created and the Deputy Director of Nursing has access to all alerts and outcomes.
The Committee noted the report which was in response to the Committee having voiced their concerns about how adults with LD were being treated in hospital. Members were further advised that the Health Passport initiative would ensure that there was feedback from clients and carers about their standard of care.