George Eliot NHS Hospital

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

We reviewed kindness, compassion and dignity; treating people as individuals, independence, choice and control; responding to people's immediate needs and workforce wellbeing and enablement as part of the caring key question. We found caring remained good. Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We spoke with 24 patients and all patients told us they thought staff were kind, caring and helpful. Patients told us they chose to have appointments at the service as they felt supported. Patients told us they felt they were able to ask questions in relation to their care and they felt that staff listened to them and then explained information in a way that they could understand. Patient told us staff “make me feel at ease, and they listen to me,” another patient told us “You can’t fault the care.” The service provided evidence of patient's feedback where they were asked to explain their care and treatment, these were generally positive, however, there were some comments stating where patient’s feel where the service could improve. Examples: Positives, care very good, people listened to me and met my needs. The negatives were communication needs to be better, and there were concerns relating to the car park not having any spaces and how busy this was.

Staff told us there was a positive culture in the service and staff worked well together to ensure patients had a high standard of care and treatment. Staff told us they felt supported by the new leaders in the service, and they felt they could approach them with any concerns they may have. Staff maintained dignity and respect by all clinics taking place in separate rooms and with the door closed, so procedures and conversations were confidential. When speaking with staff they spoke passionately about patients care and ensuring patients have time and feel listened to in relation to their care and treatment.

We observed staff treating patients with kindness, compassion, and dignity. We saw staff leaning towards patients during conversations so patients could hear and did not need to raise their voice to be heard to help maintain their dignity. We also observed staff holding difficult conversations with patients and family members, this was done with empathy, understanding, dignity and respect. We observed staff directing patients around the department with kindness and patience. and taking time with patients within clinics. This meant that sometimes appointments overran. However, staff maintained their focus on the patient and ensuring they had time to process information that was given to them relating to their care and treatment. We observed a patient catching his foot on a chair as their name had been called, and the staff member, took time to steady the patient and to also ensure they were ok before they continued to the clinic room.

Patients were given a choice of which hospital they could attend and a range of appointment dates and times to attend. The patients we spoke to told us they were given a range of treatment options to choose from rather than a single treatment option. They were also given the opportunity to ask questions, so they understood the decisions they were being asked to make.

Staff told us they asked patients their preferred name and this was then used by all staff throughout their time in the department. Staff told us the different forms of communication they use to support patient whose first language was not English; this included a translation service, and the service were able to print leaflets in the chosen language. The service also supported patient who were non – verbal with picture exchange communication system (PECS). Staff told us they were trying to improve the environment to meet the needs of patients living with dementia and other cognitive and sensory concerns. The service used purple footprints on the floor to help patients with dementia navigate the department. Signs for toilets were on luminous yellow backgrounds to assist people with dementia and people with sight problems locating them. Staff gave examples of support they have provided to patients in relation to personal, social needs and how they have signed posted the patient to gain additional support, including: homelessness, financial worry, and concerns about their family environment, including domestic violence.

We observed medical staff and nursing staff working well together to meet the needs of the patients. We observed staff welcoming patients and introduce themselves to them. We observed staff delivering bad news to patients where treatment had not been working, whilst doing this they showed compassion, kindness, and gave the patient and family members the time they needed before ending the appointment.

A patient told us they were able to choose the date and time of their appointment as well as the trust where to have their appointments. They said treatment options had been explained to them in detail to enable them to decide which option to choose. Patients told us they had discussions with the doctors about their care and treatment and were given choices and were able to take control of their future treatment. Whilst observing a clinic a patient had been given 2 leaflets in relation to 2 types of medicine that could be prescribed for them. The doctor explained the medication and then advised the patient to review the information before they started any treatment.

Staff told us patients were able to choose the hospital they were treated at, this included hospitals at other trusts. Patients had the independence and control over their appointments which included the date and time of the appointments which they booked through the electronic booking system. Staff told us this had contributed to the reduction of patients who did not attend their appointments. Staff told us they encourage patients to bring in carers/ family members with them for support. Staff told us they were planning to expand the opening times of the central booking office, so people have more flexibility with making, cancelling, and rearranging appointments. However, the number of clinics being cancelled at short notice was high, this has an impact of people’s ability to access treatment and was inconvenient for people who had booked time off work, arranged childcare, have arranged transport etc. The service had posters located in the waiting rooms to promote healthier lives, and to help them with wellbeing. This included posters about where to get support to lose weight, stop smoking and reduce or stop alcohol use. There was also information about joining a diabetes course to help learn about and manage the condition.

Patients told us they felt staff communicated with them well and in a way they understand. Patients told us they to have their care at this trust as the staff were kind and appointments were always on time, and they received written documentation following their appointment. The service worked in partnership with a third-party provider to support patients being referred from OPD to surgery to get fit for their operation, including support to lose weight, stop smoking, and stop or reduce their alcohol consumption.

Staff told us they reviewed patients' needs and what support they would require when attending their appointment. An example of this was ensuring that a translator was present for a patient whose first language was not English, they had access to an interpretation service for patients and their family. Staff told us it was important to listen to patients, to ensure needs were met. Examples provided by staff included where staff checked on a patient before giving them food to see they were diabetic. Staff told us they ensure the oncology clinics in the department booked more patients than they had capacity for every day. This was to ensure all the patients who needed treatment could access it. However, this meant staff were working over their allocated hours because the department needed to stay open longer to ensure patients were seen. As the pharmacy requirements were outsourced to a different trust, staff told us there was sometimes a wait for chemotherapy drugs to be made. Staff ensured patients that were impacted by this were given appointments at certain times of the day to ensure the medicines were prepared in time.

We observed good communication between patients and staff. Staff were willing to help and support patient's needs. We observed staff calling patients into their appointments and taking time with patients whilst showing them to the clinic rooms, and not rushing, also ensuring the patient was ok. We observed a conversation between a doctor and a staff member from a different department, discuss the patients' needs who was on a ward within the trust, this was relating to the care and the next steps of treatment for the patient as the doctor had previous knowledge of the patient, and their care and treatment.

Staff told us the trust promoted many of the wellbeing strategies in place. Within the department we saw posters on the back of staff toilet doors outlining some of the wellbeing services and events that were available to them. The posters contained QR codes so staff could easily find out more information. Staff received a monthly wellbeing newsletter which included tips on wellbeing as well as details of the wellbeing support available. The staff had access to information which emphasis on staff wellbeing, and there were self-referral facilities available for physiotherapy and counselling. Staff had a staff room where they were able to take breaks and be able to look after their wellbeing. Staff told us that local managers were visible and approachable and there was an open-door policy where they could approach a manager at any time to seek advice or support. Staff told us that currently morale within the department was positive. Everyone supported each other and there was a generally positive culture within the team. Staff told us that they attend daily huddles, and they discussed supporting each other within these meetings.

There were processes in place to ensure that staff were supported with their well-being which enabled them to continue in their roles of providing care and treatment to patients. Staff well-being was covered in the monthly Clinical Support Services Quality Governance Meetings. As part of the process in place, newsletter and posters were posted around the service for staff to review. There was signposting information which staff could access for further support. Examples of the posters and newsletters were reviewed during the onsite assessment stage.