Quality Committee

Report to: / Quality Committee / Agenda item:
Date of Meeting: / 22nd October 2015
Title of Report: / Dementia Carers Survey Update
Status of report:
(decision and approval, position statement, information, confidential discussion) / Position Statement
Lead Executive Director: / Michelle Clarke Director of Nursing and Quality
Author: / Viki Marshall, Quality and Safety Information Co-ordinator
Appendices: / None
  1. Purpose of the report

In line with the CQUIN requirements for the Dementia Carers Survey, this report provides results from April 2015to September 2015 of the Dementia Carers Survey.
  1. Recommendations

The Quality Committee are asked to note the content of this report in relation to the Dementia Carers Survey.
  1. Summary of Key Issues for discussion

  • In the first 6 months of 2015/16, 135 short surveys have been sent out to carers of which 40 (30%) have been returned. For the whole of 2014/15, 53% of the short surveys were returned.
Keythemes are;
  • lack of communication between staff and carers
  • staff awareness of management of patients with dementia
  • training in relation to management of patients with dementia
  • In the first 6 months of 2015/16, 7 extended surveys have been sent out of which 3 responses have been received. The feedback is that the carers are genuinely happy with the help and support the patients have received. Due to the low number of responses comparable data for the extended survey is not currently available.

  1. Reference to previous reports

2014/15 Dementia Carers CQUIN Report.
  1. For further information or any enquires relating to this report please contact:

Viki Marshall, Quality and Safety Information Co-ordinator, 01432 355444 ext. 5820
  1. Please confirm, by ticking the box, that you have included or considered the following items in developing your report:

Background

Care Quality Commission Implications

Legal / NHS Constitution considerations

Analysis of Risk including link to the Board Assurance Framework and Risk Register

Resource Implications (staffing & financial)

Adult and Child Safeguarding
Patient, Public and Stakeholder involvement
  1. Introduction

The Commissioning for Quality and Innovation (CQUIN) payment framework enables commissioners to reward excellence, by linking a proportion of English healthcare providers income to the achievement of national and local quality improvement goals. The key aim of the CQUIN framework is to secure improvements in quality of services and better outcomes for patients, whilst also maintaining strong organisational financial stability. A proportion of this value is linked to the national CQUIN targets and the rest is ascribed to local CQUIN indicators.

As part of the national CQUIN targets for 2015/16 Wye Valley NHS Trust (WVNHST) are to ensure carers of people with dementia feel adequately supported. WVNHST must undertake a monthly survey of carers of people with a confirmed diagnosis of dementia. The content of this survey is for local determination and has been agreed with the CCG, it includes a question on whether carers of people with dementia feel adequately supported.

This report provides an overview of the results gathered from surveys undertaken by carers from April 2015 to September 2015 (Q1 and Q2).

  1. Main Body of the Report

2.1Methodology and Reporting

The Quality and Safety Department receives a daily update from the Information Department in relation to all patients within the hospital with a confirmed diagnosis of dementia. Using this data a member of the Quality and Safety Department identifies if the patient is eligible by checking;

  • where the patient lives (only Herefordshire patients are eligible)
  • if the patient has arecent admission
  • if the patient has passed away

The current process ensures that once a patient is discharged from hospital a shortpaper survey is posted out to the carer using their contact details from PAS. If the carers’ details aren’t listed then the short survey is sent to the carer, care of the patients address.

All comments/feedback are sent to the Ward Sisters, Heads of Nursing and Dementia Leads throughout the year.

Response rates and results are shared with Heads of Nursing, Dementia Group and with the Trust Board.

2.2Findings

2.2.1Number of Eligible Patients Admitted to County Hospital

Month / No. of patients / No. of eligible patients*
April / 31 / 24
May / 34 / 22
June / 39 / 30
July / 23 / 14
August / 32 / 22
September / 33 / 24

* Carers of patients that have died or live outside of Herefordshire or don’t have a Herefordshire GP are not contacted or have a recent admission.

2.2.2Returned Short Form Surveys

Month / No. of eligible patients / Percentage of Carers contacted / Total no. of completed short surveys / Percentage of Total Completed
April / 24 / 100% / 9 / 38%
May / 22 / 100% / 8 / 36%
June / 30 / 100% / 11 / 37%
July / 14 / 100% / 3 / 21%
August / 22 / 96%* / 6 / 27%
September / 24 / 83%* / 3 / 13%

*Five patientsare still inpatients and therefore their carer has not been contacted.

A total of 135 short form surveys have been sent out. Forty of which have been returned which is currently a30% completion rate.

2.2.3Results from the Short Form Surveys

In April 2015 the questions were reviewed/reworded and an extra 2 questions were added about communication with staff. Also comment boxeswere added to each question.

Please note that for questions 2, 3 and 4 the report shows comparable data for 2014/15. Also 1 carer completed 2 surveys one for each ward that the patient stayed on.

The responses to all the questions asked are depicted below in relation to our performance as an organisation;

39 of carers took the opportunity to answer the Friends and Family Test question, 66%of carers said that they would recommend the Trust, this is the same percentage as the carers who were questioned in 2014/15.

15% of carers said that they were neither likely or unlikey to recommend which has decreased since 2014/15 (17%). This is also the same comparison for carers who would not recommend WVNHST.

Any negative responses received from October 2015 will be annoyamised and sent directly to the ward sister to review and identify any actions that need to be undertaken to improve the service they provide to patients with dementia. Ward Sisters will be encouraged to share the annoymised feedback with their staff at their ward meetings. The Patient Experience Team are to log as a concern. Also negative responses will be forwarded to the Patient Experience Team to be logged as a concern.

28 (68%) of the carers questioned felt that the patient was looked after adequately whilst in hospital, this continues to be a high percentage compared with 2014/15 (71%).

Comments from the carers for this question are below (N.B. the comments listed in this report are taken directly for the surveys);

Very good, great care.
You cannot generalise dementia it is caused by different conditions and cannot be treated in isolation. Mentally she was treated well by a handful of staff in Ross, but there was no understanding how her Parkinson's impacted on mental state.
Was very happy with the care that was given. Staff very friendly and helpful.
Staff always polite.
Staff tended to take answers to questions verbatim despite Alzheimer’s.
All staff was very good.
She was treated with much respect and dignity.
As said it is a busy ward, it was quite a job to get any information.
The efficient way she was processed through A&E was great and then into Redbrook Ward was first class.
It was good that I was allowed to stay with pt.also my daughter was allowed to stay and my son and we thought it essential that one of us should be with him to help with feed and drink etc.
Medically the care from nursing and clinically was a very high standard. However Mum suffers with severe dementia and nursing staff struggled to manage Mum's dementia needs.
For his medical needs not his mental needs.
7 1/2 hours wait in A&E for a doctor to take 2 mins consultation before admitting her.
Very confused by being moved so many times.
Considering the high levels of activity and generally the demands upon staff, the degree of excellent performance of duties was unique.
Sadly my father developed a hospital acquired pressure sore whilst in Monnow Ward.
Pressure sore developed further at Hillside.
Mum has vascular dementia and was put in a side ward initially and was rather confused. She was moved to a 4 bed ward with a bed overlooking the car park and was fascinated by all the movement thinking it was a park, because they cleaned the ward she was moved again to an inner bed and was confused again.
She was not washed or dressed most of the time and twice she was sat in her own toilet mess.

28(68%) of the carers questioned felt that the patients’ needs were met during their stay, this is a slight increase compared with 2014/15 data.

Comments from the carers for this question are below;

Very good.
Again my mother has Parkinson's and Lewy body Dementia. These conditions impact on each other. Consultant had to go to Teme Ward and 'put them straight'.
Needs meet at all times during stay.
Procedures explained.
Hearing aids were not missed on transfer from A&E - lack of communication between depts.?
My mother's complicated needs were met as far as possible. She had to be transferred to Charlton Hospital in Cheltenham.
I brought all her medicines in and was surprised and very disappointed that she was never given any according to daughters and the effects were noted when she arrived home.
In respect of staff handling a patient with a medical condition (fractured hip) and dementia this needs addressing. Members of family attended each day during Mum's stay on Redbrook ward to assist with keeping her calm and give her reassurance that she should allow staff to nurse her.
It is a very busy ward and pity they can't have more nursing staff.
I explained to staff how limited my mother’s communication was, also her ability for eating , drinking and self-care but there still seems to be very little understanding.
Because my wife was so uncooperative, she was well cared for under the circumstances.
Information difficult.
When you have 4 patients in a ward there will always be problems i.e. constant coughing and loss of sleep etc. But care always good.
Basic needs assessed.
Difficult to comment due to my dad not liking Hillside and became withdrawn and depressed.
Every day she seemed to have a different nurse - mum didn’t know who was who.

24 (59%) of the carers questioned felt that they were supported as a carer. This is comparable to the 2014/15 responses received.

Comments from the carers for this question are below;

Great feedback. Could phone at any time.
Had to organise discharge from Ross myself. Not informed ready for discharge, just guessed! Assumed ready from then on community care arranged. We had no idea about Virtual Ward. One person had heard of it but not fully informed as to what it comprised of.
Senior nursing staff and Dr talked and explained progress.
Doctors and Nurses communicated information well.
I was fully in the picture.
I had to approach staff I wasn’t told anything.
The staff were kind both to me and my husband. There was general and comforting care (even when they didn’t really have time).
The staff at the hospital were understanding.
Mum needs a great deal of one to one care in respect of her dementia status. Mum is easier to handle if she is with carers and family members she knows, or people to talk to her to keep her settled and calm.
Was not offered any support but didn’t ask for any.
Lack of information.
I tried to stay in the background as much as possible. Leave it to those who know best. Very satisfied with the conversations.
Issues were identified within Monnow in that the next of kin was no consulted prior to decision of transfer, consent to procedure in light of my dad's dementia. A question raised have capacity been assessed?
Good communication from the Doctor who spent time explaining. Also from the diabetes team and hospital social services.
There was no support at all.

16 (39%) of the carers questioned felt that their views were taken into account. This question has been reworded for clarity and therefore cannot be compared with 2014/15 data.

Comments from the carers for this question are below;

As a family we tried, but was frequently told 'we can't do that, it depends on what physio say'. ? When did physio become god. Same handful of staff in Ross v.good and where allowed to use an element of common sense and treated people like humans.
The question was not required, happy with treatment.
No-one approached me to discuss this. As it happened I felt patient was being looked after well.
Again wasn’t approached!
I don’t know what the staff from Lynhales (home) say - they seemed to have been a little on the 'distanced' but always willing to stop and answer my requirements.
I did not have a great deal of conversation but was quite satisfied that the way she was being lovely after was ok.
Only on one occasion (telephone) did I have the opportunity to explain in detail Mum's dementia management. Problems arose in A&E and the ward.
Was only for 48 hours.
It is very hard to say as the ward was very busy.
I was unable to get adequate information.
Again the staff were very professional and caring. Gave much confidence.
Again difficult to answer as the next of kin not always consulted 1st, personal questions approach to other family members.
I waited with mum on the ward until she was booked in so that I could express any concerns I had.
Not applicable as he was allowed to go home the next morning.
No-one to talk to!

Please note that 1 carer ticked both yes and no for this question.

33of the carers questioned felt that they were not given the opportunity to discuss concerns with staff on the ward.

Comments from the carers for this question are below;

But nearly always at my instigation and you felt like you were interrupting.
If there was someone who could speak english and understand english very well. Then yes it was good, but most of the time no.
Staff were very helpful and always so nice to mum, which she really appreciated.
It should be policy that there is a conversation between family and staff. I always had to seek out the people responsible for my husband when found they were easy to talk with.
Always busy! Only Dr told me what to expect. Unfortunately my mum passed away in June.
Had I found a need - the question as what is happening next could be clearer.
Telephone - conversation - face to face conversation. Questionnaire for dementia patient when admitted to a general/surgical ward in hospital.
Was not approached by anyone but found a Dr to speak to.
More staff would be helpful.
On Monnow Ward I had to reinforce that I was next of kin mot my daughter.
Never given opportunity, requested meeting to discuss discharge planning.

19 (46%) of the carers questioned felt that communication from staff could be improved. This is a common theme from the feedback.

Comments from the carers for this question are below;

Ross CH - poor communication between staff. One shift did not appear to know what had happened previously. Had to keep referring to notes for info. (when it was documented). One S/N (apart from drug rounds) never appeared to leave nurse station. Another S/N was rude on telephone with ongoing community care (from two different sources).
My questions were answered.
It should be policy that there be a conversation between family and staff. I always had to seek out the people responsible for my husband when found they were easy to talk with.
Communication can always be improved. The staff were excellent and under huge stress.
By telling relatives who the nurse is looking after your loved ones.
It was warm, kind - did seem to have my husband's needs in hand.
Had I found a need - the question as what is happening next could be clearer.
It would be good if staff had more time to talk to patients (or perhaps volunteers).
Staff need more dementia management training when they are dealing with surgical/medical admissions. Approach in a calm, non-challengingmanor when dealing with dementia 'in pain' more attention needed.
Because my husband is a retired GP and appears rational to talk to people do not seem to realise he quickly forgets what he was been told or gets very muddled. It is important that carers should be made very aware of decisions re treatment etc. and not leave it to the patient with dementia to inform them.
I felt if there was someone who understood dementia better on the ward things may have been better.
Care planning.
More staff needed.
Most definitely.
Most definitely.
By having continuity with just one or two nurses. That way they get to know the patient better.

Even though the majority of carers felt the patient and themselves were looked after well whilst in hospital, the issue of communication continues to be a concern. This will be addressed in the action plan.

Full comments from the carers are available on request.

2.2.4Extended Survey Results

All carers are given the option to complete an extended survey to provide more feedback.

Seven carers requested the extended survey, 4 extended surveys have been returned. N.B One carer returned a blank survey and one carer has completed the survey after their relative has died.