George Eliot NHS Hospital

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

The service did not always ensure people could access treatment when they needed it. Patients were boarding on the wards and there was a lack of availability of bed. The service provided person-centred care and made adjustments to help people access services.

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

During our onsite assessment, we spoke with patients who mostly told us they had been involved in their care and treatment and involved in decision making. We were told there was good support from the physiotherapists and occupational therapists regarding discharge readiness.

The service was inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services. They coordinated care with other services and providers. Wards were designed to meet the needs of patients living with dementia. Staff supported patients living with dementia and learning disabilities by using specific documents. Staff understood and applied the policy on meeting the information and communication needs of patients with a disability or sensory loss. Managers made sure staff, and patients, and carers could get help from interpreters or signers when needed. Patients were given a choice of food and drink to meet their cultural and religious preferences. People were supported during referral and transfer between services and discharge. Staff did home visits where required to ensure they could create a safe environment for a patients discharge home. There were reasonable adjustments made so that people with a disability could access and use services on an equal basis to others. Key staff worked across services to coordinate people's involvement with families and carers. A serenity garden had been built following a fundraising campaign by the patient forum representatives. It had a wooden lodge with a music system which could house a bed, 2 ramps which aided with physical rehabilitation and an appropriate floor for patients to safely mobilise. We were told this was used regularly throughout the warmer months. We saw plants which had been potted by the patients on Felix Holt stroke unit. Patients had also done weekly art classes and painted ‘forget me nots’ which was the dementia symbol and created artwork for the wards. Patients who were at risk of falls were cohorted together within a bay near the nurse’s station with staff assigned to always stay within the bay. Staff made sure their care and treatment remained person-centred, despite requiring the closer supervision.

We did not look at Care provision, Integration and continuity during this assessment. The score for this quality statement is based on the previous rating for Responsive.

Patients told us they were informed about their care. They all knew why they were in hospital and what the next steps were. One patient told us “I know when I am going home, I have had really good care and communication from the nurses and the doctors.” We reviewed some feedback where a relative said “the ward manager on Adam Bede was open and honest and took time to call me and update me on the situation as it evolved as well as the medical team who constantly made sure I was updated.”

Patient identifiable information was not always protected. Dashboards and whiteboards displaying patient information were visible on the ward for all visitors to see. Patient names, safety information, nutritional needs, physiotherapy information and discharge plans were displayed. We were told that relatives used the boards to get updates on the patients. Information leaflets were available on each ward for patients and visitors. Staff had also produced information boards at the entrance to each ward with topics relevant to their ward area. For example, on Bob Jakin ward there was a very visual display regarding how to reduce falls and on Felix Holt ward there was information about fatigue after stroke, diabetes, age concern information and patient alarms.

Most patients we spoke to felt listened to. One patient told us “I think the staff work hard. I have seen the substance misuse nurse who spoke to me for ages and gave me a lot a of support.” A few patients felt staff did not have time to listen and were very busy but they generally felt cared for. A few of the wards had made sure there were weekly slots available for families to book in and see the consultants. For example, on Felix Holt ward they had update meetings for families including the consultant, physiotherapist, nurse, patient, and their family. They discussed progress and discharge plans. We saw feedback where a family was very grateful for this meeting. Following a complaint, a relative felt they weren’t listened to by clinical staff which led to a delay in mental health support for their mother. The relative was invited to the ward managers meeting to share their experience which led to band 7’s having an open conversation about listening to relatives.

It was not easy for patients to give feedback about the service. Managers told us there was a Friends and Family Test but patients were not encouraged to fill this in. There was no other standardised feedback form for patients to fill in. There was a patient experience improvement plan which had actions including improving the feedback system for patients. Information was displayed about how to make a complaint. Most wards told us their main complaint theme was patients boarding. Managers investigated complaints and identified themes. Staff knew how to acknowledge complaints and patients received feedback from managers after the investigation into their complaint. Managers shared feedback from complaints with staff and learning was used to improve the service. Staff could give examples of how they used patient feedback to improve daily practice. For example, on the acute medical unit they had patients complain about waiting for medication to take home. They therefore had their own pharmacy created on the unit with a pharmacist and pharmacy technician allocated to the ward. We were told this had drastically improved the waiting time for medication for patients.

The trust had a clear policy for complaints management and staff followed this. There was a weekly medicine service meeting with complaints to ensure they were completed on a timely basis. The service received 12 formal complaints between November 2023 and April 2024. There was no overall theme with the complaints and they were all investigated and an outcome was determined in line with the policy. Patients had complained about being moved a few times. The service had implemented an alert icon on the ward portal once a patient had been moved 3 times. This is a visual aid to help ensure patients were moved less. This data was also being incorporated into the new ward dashboard.

Patients told us their needs were mostly met. Some patients told us there were delays in their care and they were staying longer in hospital than they thought. All patients we spoke to knew why they were in hospital and what they were waiting for. One patient told us they knew they couldn’t go home but it was frustrating to be waiting in hospital for the help that they needed.

People did not always access the service when they needed it or receive the right care promptly. Patients stayed in hospital longer than they needed to. Managers had implemented several initiatives to improve the flow through the service, but these were not working. Patients were boarding on a number of wards, which was a daily occurrence due to lack of flow into the community. External delays had increased in the last 2 years with on average 55 patients consistently waiting for placements within the community. January to April 2024 there had been 352 delayed discharges and the average length of stay for patients was 9 days and the median length of stay was 100 days. Managers told us they were working to improve this with a new 27 bedded medical ward opening in October 2024 and investment in the frailty team within the emergency department to reduce admissions. The hospital planned for their discharges and aimed to discharge patients earlier within the day. There was a target of 33% of patients to be discharged before midday. We saw in May 2024 that this target was not achieved. There was a complex discharge team who assisted with discharges and were a link into the community services. Managers and staff worked to make sure that they started discharge planning as early as possible. We listened to huddles and ward rounds where early discharge preparedness was discussed. However, due to the lack of beds available in the community, patients still waited for long periods of time on the wards whilst medically fit for discharge. The service had eliminated medical outliers in other areas since 21 April 2024. Patients who had mental health needs were often admitted to the Acute Medical Unit. There were a lack of mental health beds in the community which meant these patients often remained on the unit for longer than 72 hours. Staff felt the mental health support was not always prompt and patients within the emergency department were prioritised.

We did not look at Equity in experiences and outcomes during this assessment. The score for this quality statement is based on the previous rating for Responsive.

Most patients we spoke to had been made aware of their discharge plans and involved in the decisions around where they wanted further care if required. However, we spoke to a patient who did not feel the plan had been well communicated and felt like they were wasting time lying in bed. They recognised they couldn’t manage on their own at home but felt frustrated with the lack of action.

Staff worked well as an effective multidisciplinary team to discuss patients and improve their care. There was involvement from several teams to arrange complex discharges including physiotherapists, occupational therapists, and the complex discharge team. We observed ward rounds where staff made plans for patients discharges but often were waiting funding or beds within the community. The complex discharge team supported complex health assessments and linked into the community to chase placements and funding for patients. They were available 7 days a week to support discharges from the wards. They met virtually with socials services daily to go through patients who were fit for discharge and chase updates. There was input from the palliative care team for patients who were nearing the end of their life. There was learning from deaths and actions created to improve care for patients. We were told respect forms were not always completed well and the palliative care team were having training on how to fill in respect forms so they could support the doctors in completing these.