By listening to our patients' stories, we can understand more about what really matters and, where needed, improve the quality of our services.
This is why we have introduced patient and carer stories to all our Trust Board meetings, and at a variety of Trust meetings and training. These stories seek to:
- Provide a focus on patient and carer experience prior to decision making
- Improve knowledge relating to patient and carer experience
- Gain assurance that the Trust is learning from patient stories in order to benefit the wider patient audience.
This is the story of Issy McGowan and her experience with the START (Support Transition and Recovery Team).
The service user was assisted in providing the story by Rachael Pankhurst, Patient Experience Facilitator.
This is Kate’s story about her journey, her experience and time with the Children & Young People's Chronic Fatigue/ME Service (CYP CF/ME) – Dorset County Hospital. Kate wished to tell her story and wanted to highlight and give hope for other young people, like herself, diagnosed with CFS (Chronic Fatigue Syndrome).
Kate had all but lost hope when her thyroid surgery did not work. However, she was given renewed hope and could again envisage her future thanks to the service. The care she received was high quality, personalised treatment. The care and support she and her family received led to an emotional discharge from their care and to living her best life.
In October 2017 I fell ill with an over-active thyroid, I was in year 11 at school and unfortunately missed the whole year. I had my thyroid removed in May 2018. I was told I would feel better almost instantly, but soon after my surgery I was still feeling ill. As a family we explored different scenarios as to why I was still unwell and underwent an MRI of my brain.
Eventually I was referred by my GP in September 2019 and come to know about the CYP CF/ME at Dorset County Hospital.
I was seen in November 2019 where I was officially diagnosed with Chronic Fatigue Syndrome.
My first experience in the CYP CF/ME clinic was excellent. I met Dr Newman and Emma Haynes and they were both so welcoming and friendly, they made me feel very at ease and welcomed. My appointment lasted an hour, and I did not feel rushed whilst there. After my first appointment I was then solely under Emma’s care and I felt very comfortable with this. I felt the whole experience was very positive and well organised. Although it took two months to be seen in clinic, this did not matter as I was on medication and still under my doctor’s care.
Throughout my whole experience with the Children’s Therapy Department, I did not encounter any major difficulties. There were a couple of times we called my doctor’s secretary, she was very difficult to get hold of, this is the only issue I had. I had no troubles with CYP CF/ME clinic.
Throughout the course of my personalised treatment Emma was very open and honest, she gave me and my parents information on CFS and was always there to help and answer any questions we had. When Emma gave me information, or things to do, she would always make sure I was comfortable and happy with her approach.
I had a huge amount of trust in the staff involved in my care. Every single person I had contact with was friendly and did all they could do to help. Every member of staff I met was kind and caring. Emma made me feel cared for and important and I wouldn’t have changed the experience for the world. Emma made me feel safe in the clinic and gave me hope that one day I would be better. During my treatment, I felt safe 100% of the time. Emma would always be there for me on the phone, via email, or in the clinic. When Covid-19 happened we would talk face to face virtually.
Everything the staff did for me was excellent. Every member of staff from the doctors in the Children’s Therapy Department to the Children & Young People's Chronic Fatigue/ME Service was amazing, I felt very cared for and looked after.
Being ill was the hardest time of my life including my family’s life. We are an active family but the impact of my CFS affected everyone, the journey has been hard and an emotional one for us all, but I will always remember the care and treatment I received from the CYP CF/ME because it was wonderful. I have formed an extremely special bond with Emma in the team and going through the journey of discharging me was emotional for everyone.
I haven’t a bad word to say about the service, however, I do have an observation. My in-clinic appointments with Emma were all in the Children’s Therapy Department in Dorchester. Being 17, I was always the eldest in the waiting room, I did not mind this, but it was a bit strange having me and my father in the waiting room along with toddlers. I don’t know if it would be possible to create a waiting room for teenagers/ older children as some people may feel embarrassed being in the child's waiting room.
Feedback from Emma Haynes,
Children and Young People’s Chronic Fatigue Service Lead, Dorset HealthCare
It was an absolute pleasure working with Kate and her family and I’m so pleased that despite the challenges she was facing, she feels that she had such a positive experience. We are a small team and are very passionate about supporting children and young people with CFS/ME. We have seen many young people make excellent progress and we are really motivated to support others on this journey.
From Kate’s story, you get a sense of the challenge that this diagnosis can present to young people and the resilience that they need to develop in order to make the changes that will enable them feel more confident about their health. It’s a real privilege to work alongside them as they take these steps and it’s rewarding when you know that they have developed the self-awareness and skills that they need to carry on independently, getting on with doing the things that they love.
I’d like to thank Kate for taking the time to share her story. I appreciate that it can be difficult to look back to those days when things were so tough but I’m confident that her experience can provide inspiration and hope to others in similar situations.
In terms of the waiting area in the Children’s Therapy Department, at DCH, the CYP CFS/ME service shares the space with all the other clinic users. Kate is quite right in that there can often be quite an age range. As she mentioned, that may be embarrassing for some and I’m mindful that others may find it frustrating as the little ones can sometimes get quite lively. I’m not sure what we can do as space is quite limited. Equally, since Covid-19, practically all of the C&YP CFS/ME appointments have been carried out using Attend Anywhere, so it may be that shared waiting areas for some clients is a thing of the past.
Children & Young People's Chronic Fatigue/ME Service - Feedback
Department/Ward/Unit: Children & Young People's Chronic Fatigue/ME Service
Triangulation data: 30/04/2020 - 30/04/2021
Friends & Family Test
100% would recommend the service.
No complaints were received during this period.
Compliments & categories
The most frequent category of compliment was Good care provided to the patient (general, medical, nursing).
*compliments can cover more than one category.
Survey Comments Sentiment Analysis
Survey Comments - Sentiment
Examples of comments
The majority of comments are positive.
Service Developments and improvement due to patient feedback. (YSWD)
No service developments have been recorded during 2020/21.
NHS Choices Reviews/ Online Comments
March 2021 Covid-19: Health Visiting Poole
Jen’s Story – A Family Perspective
After our many experiences of the NHS throughout my Mother’s 91 years, I wanted to highlight the wonderful level of care that she received at Bridport Community hospital, and the reasons why I felt that care was vastly better than any other NHS facility that we have visited over the years.
In November 2019, my mother was now very frail, had dementia and could hardly see. After a big fall, she was taken to the local District General Hospital and, due to lack of beds, was on the acute ward for a couple of weeks, then moved onto Bridport Community Hospital in December 2019.
Whilst at the local District General Hospital there were issues around illegible handwriting and a lost “This is Me” document which caused us some concern and lost time with my mother. I will reflect on this at the end of my summary of the care she received.
When I arrived at Bridport Hospital, I was greeted by a senior member of staff who was friendly, kind and approachable. She invited me into a side room, made me a drink and sat me down asking me to tell her all about Mum and her needs. It was clear from the start that they were treating the family and not just the patient at Bridport. She also asked me to complete another ‘This is Me’ document, as the previous one had been lost whilst in transit from the local District General Hospital. However, this time I was permitted to complete my documents electronically and email it back to her. She then ensured this emailed version was shared with all staff who would be involved in Mum’s care. Whilst it was frustrating to have to spend more time filling in forms when I could have been spending that valuable time with Mum - and especially after having to fill in the document at the local District General Hospital, which was subsequently lost - I was encouraged by this one being electronic.
They then did a handover of staff really thoroughly, giving all information about Mum accurately. This meant I didn’t have to keep repeating myself and also gave me confidence in Mum’s care. I also noticed the mood of the team was very positive and motivated, with it being very clear from the start that there was strong leadership on the ward. The staff always had a smile on their face and nothing was too much trouble for them. As they knew I came from Reading, they allowed me to come in earlier than the visiting hours and they made me feel really at home; telling me I could make myself a cup of tea whenever I wanted and just generally making me feel very much part of the team caring for Mum.
Mum remained in Bridport Community Hospital for a further 3 weeks, before she moved to a Care Home. During those 3 weeks, we could not have asked for better care. The communication across the whole team was excellent and I felt all staff members were encouraging and helpful to Mum at all times. The food was wonderful and the physiotherapy staff tried their hardest to get Mum up and walking for as long as they could (in a kind, gentle manner) until it became apparent that Mum’s care had sadly become palliative and rehabilitation wasn’t going to be possible.
The doctor at Bridport was also very knowledgeable and professional, but had such a manner that you felt she was approachable and easy to discuss matters with. This made a big difference to our experience of Mum’s care.
One memorable event at Bridport was when the staff organised Christmas songs to entertain patients on the ward. The nurses took the patients in to hear the singing, but sadly Mum was unable to get herself in there as she was very unwell by this stage. So the nurses went out of their way to move Mum into the room (still in her bed) so she could hear this singing and be part of the experience. Everyone was smiling and laughing and the mood was so warm and happy – I keep thinking what a lovely thing it was of them to do for us. They went to huge amounts of effort to make sure this could happen, with four of them moving Mum’s bed and making sure she could be there. It is a really lovely memory.
Sadly, Mum passed away in the Care Home she was moved into after leaving Bridport Hospital, but the care and compassion we both received at Bridport was very positive and I wanted to say thank you to all of the team there for that. It is very clear that the strong team understood the importance of looking after the family as well as the patient.
Can I just say, in this time of crisis, that I felt that every individual in both hospitals were giving ‘their all’, and we could not ask for anymore from them. It’s just the structure that surrounds these wonderful individuals that struck me, so I wanted to point out areas that could be improved for everyone’s benefit.
Summary of care and suggested areas of improvement
The areas that came across that were different at Bridport were:
· Leadership, staff morale, teamwork and communication
· Attentiveness to the family, not just to the patient
· Attention to not only medical needs, but also social & mental needs
I also wanted to highlight our experience, as a family, of an area that could be improved, which would benefit all the NHS facilities and give massive benefits to staff, patients, family experience, and, more importantly, patient outcomes. If paper-based processes were automated using simple electronic forms, so many problems that I have highlighted could be solved, and huge benefits realised. And, with the added crisis that we find ourselves in, with fear of infection and the need for accurate information, there is a massive need to cut out paper & hand-written inaccuracies. The need for the NHS to put simple e-forms in place that streamline process & remove inaccuracies could not be more paramount.
Feedback from Bridport Hospital Matron, Ellen Holmes
This really lovely story is fantastic to hear and is testament to each of the amazing team members at Bridport, who work together so well to support not just the patients in our care but their families too.
We had received a Thankyou card from this family member soon after the patient’s discharge – but it is really special to hear their full account of the patients stay from the family member’s perspective.
We will also of course take on board the area of improvement highlighted and work together with our wider NHS colleagues to improve this.
Oonagh is 25 years old and an intelligent young lady who was diagnosed with Asperger’s. In 2010 Oonagh was experiencing high levels of anxiety with leaving the house and this stemmed from her pathological demand avoidance that she suffered from. This is a brain development disorder which is a sub-type of autism spectrum disorder. A condition that involves a greater refusal to do a task, asked by another person; even if the activity is something the individual would normally like to do. This disorder was not recognised in Oonagh’s patient notes and would often be noted as ‘lack of motivation’. This disorder hugely impacted Oonagh’s life.
Oonagh also faced difficulties with self-perception, compulsive daily behaviours and suicidal thoughts. Shelia (her mother) reached out to agencies that could potentially offer Oonagh support. Unfortunately nothing came to fruition as they did not offer what Oonagh needed. Oonagh and her mother felt let down as also a local school were unable to offer support. Oonagh needed support with developing life skills as she relied on her mother for a lot of practical support. These issues stemmed from Oonagh Asperger’s and eventually impacted her mental health. Oonagh’s mother found it difficult to identify recourses for ASD teenagers, especially for girls. Shelia spent a year fighting for support and benefits etc for her daughter but has spent 7 years fighting for what mental health support she has needed which is ongoing. Fighting for what her daughter needed also impacted on Sheila’s mental health and wellbeing. Eventually in 2010 Oonagh received funding to attend a specialist college and further education. The college offered life skills and training for people with Asperger’s.
During her time at Farleigh College she lived in the residential accommodation and when she left college in 2013 she moved back in with her parents. Oonagh was relying solely on her mother, who had given up work years ago to act as a carer for her daughter and was providing all required input on her own. Oonagh’s mother knew her daughter needed therapy mainly for her pathological demand avoidance and her high anxiety to leave the home.
It was highlighted in August 2015 that Oonagh needed some therapy for her deterioration in her mental health. She was finding social interactions difficult which led to socially isolating herself from the anxiety and fatigue from interactions. This took a toll on Oonagh and her mother as she would rely on her mother to facilitate her daily life. Oonagh was waiting for accommodation for supportive living and this would help her to become more independent with some support from carers coming in occasionally. When she turned 19 she was discharged from CAMHS and was referred to the Adult Mental Health Team. Oonagh accessed the CMHT service in 2014 for her demand avoidance and was discharged 3 months later as she was assessed and it was decided that it was in her best interest to continue with the Mental Health and Social Inclusion Team. CMHT met with Oonagh again in 2015 and she was again subsequently discharged and agreed that she would benefit from seeing Steps to Wellbeing.
A meeting was organised between Oonagh, her mother and CMHT to address some issues that they were experiencing with the lack of service provision for Oonagh. It was explained that the CMHT service provided treatment for individuals that met their service criteria. CMHT accept referrals for service users experiencing high levels of mental health issues; such as depression, anxiety, and psychosis and complex/severe personality disorder. For Oonagh to receive treatment from the CMHT she needed to meet this criteria. Oonagh's mother felt that there was a lack of national provision for service users such as Oonagh that have Asperger’s but also experience high levels of anxiety and depression.
Oonagh received input from Steps to Wellbeing. However, they were unable to provide her with the length of therapy for her degree of difficulties. They were only able to offer six sessions. Oonagh needed long term therapy for her anxiety, depression, her sleep disorder and pathological demand avoidance. Oonagh was offered CBT for her anxiety but she also needed counselling. However, this was not possible as Oonagh was receiving CBT. She was also told she was unable to come back to the service for the same issue. An aspect of the CBT meant that Oonagh needed to do homework but due to her autism she was unable to do this. Onnagh’s case was too complex for Steps to Wellbeing and she was told she needed to go back to CMHT. Onnagh and her mother were continually bounced back and forth between CMHT and Steps to Wellbeing.
Shelia has spent a considerable amount of time writing, emailing, meeting and reaching out for help and support for her daughter but to no avail. Even the National Autistic Society were unable to help. Sheila also reached out to the NHS asking for training to support her daughter but she did not get a response. Sheila decided that all she could do was make sure that Oonagh doesn’t kill herself and that is all she could do.
Shelia attended a meeting for Carers Advocate Service which is a charity that works closely with social services and they try to support carers and get their voices heard. The charity agreed that they would help Shelia. The charity wrote a letter to the Chief Executive of Dorset Health Care but no response was received. Eventually, a meeting was arranged with the manager of CMHT with Shelia and the carers advocate. Shelia felt this meeting was just to try and make her feel better and come to terms with not being able to move things forward for her daughter. There were four other meetings after this; every meeting more people were involved and still no actions. There was also lots of communication with emails and letters between these meetings and Shelia felt they were getting nowhere. Shelia made it clear she wanted something to change and she was not giving up. Finally, a big meeting was arranged with CMHT, Steps to Wellbeing and the Complaints Team.
This meeting was the final breakthrough for Shelia and her daughter. Shelia’s first thought at the beginning of the meeting was that still noting was going to change. However, the Lead Clinician of Steps to Wellbeing expressed that they did have the means to help Oonagh and could not understand why she hadn’t been helped before. The adaptions that Oonagh needed were easy and would not come to any more cost. The adaptions were clear and it was agreed that Steps to Wellbeing would give treatment to Oonagh with adaptations.
During CBT you learn strategies in the sessions and then you go home to learn these. Oonagh cannot do this because of her autism. It was agreed that she can do her homework in the sessions. There was also a need for Oonagh to have more sessions and to be able to come back for more if needed. In the past, she could have 6 sessions of CBT and could not come back unless it was for a different reason. Shelia made it clear she cannot address all her issues in 6 sessions as Oonagh issues are too complex. In this meeting, it was agreed that Oonagh would have between 10-20 sessions and that she could return like any other person. Shelia felt that the service allowed access to able-bodied people but denying access to disabled people. It was agreed that she could have more sessions and she could come back for the same issues. Oonagh was also denied counselling because she was given CBT for her anxiety. Shelia explained that anxiety was just one of her issues and she needs counselling as well to address other difficulties. It was agreed that Oonagh could have both of these and could swap between CBT and counselling.
Oonagh has had her 20 sessions and is now having a 6-month break. She will go back again in December 2019 for another set of sessions dependant on how many she needs. These adaptions were a breakthrough for her and she is making incredible progress in her life. She now lives in supportive living.
Shelia explains that this story is not the only one and there are lots of other families with the same story and these are only in Bournemouth that she knows of. Shelia is passionate that these adaptions should not just be for Oonagh but should be for anyone like Oonagh. Shelia feels that services should be more aware of the Equality Act so that services can be accessible for everybody and those guidelines are only treated as guidelines that can be adapted for people that need them adapted. Shelia feels that children with autism are being discriminated against and this needs to change. A policy needs to be in place so that individuals like Oonagh are not stuck in the same position. Shelia would like to see changes in the guidelines that were changed with Steps to Wellbeing in ‘writing’ so that these can be used across the board with other adults with Asperger’s experiencing mental health problems.
Feedback from Steps to Wellbeing
(Response from Morad Margoum, Senior Service Lead, Steps to Wellbeing)
Oonagh’s experience is unfortunately indicative of a gap which presents itself from the transitions which occur between young people and adult services. Moreover, it is indicative of the difficulties those with Asperger’s find themselves. Unfortunately services are not commissioned in a way that meets her specific needs. Historically within the context of ASD (Asperger’s Spectrum Disorder) presentations, the argument was that this presentation was a social problem rather than a health one.
In Oonagh’s case however, I came into it after a significant numbers of misunderstandings between the wider trust (CMHT), the service, Oonagh and her mother (Sheila). The misunderstanding was that we were being asked to provide a counselling intervention for social anxiety (there is no evidence to support this in the NICE guidance and we are an evidence based commissioned service), Oonagh had previously undertaken interventions within her schooling which was focused upon this approach. The S2W service, at present works with individuals who have ASD presentations and there are adaptations available. As a result, determining that the service would take 51% of the responsibility and we trialled CBT approach with the adaptations in mind, I made the offer of seeing Oonagh within S2W and submitted an agreement between her and the service which is recorded in the notes for continuity rather than depending upon relationships.
Whilst the service is able to make these adaptations, the issue is that the service is covering a gap in provision, a review of the commissioning arrangements and remit of the service would be required for the larger scale changes that Mrs Fox is requesting, moreover, this is likely to have an impact nationally. Through the transformation of primary care mental health in the area however, I believe that it might be possible to bridge this gap with the available services.
Trevor tells his story from 6 years ago when his life was very different from today. Trevor is a 50 year old man from Wimborne who is passionate about sharing his story to help others.
Trevor shared that he has had two challenging mental breakdowns in his life. The first episode was when he was living in London in 1990. He believes this was due to overworking and taking on too many commitments. At this time he was working full-time with Queens Park Rangers football club and additionally carried out training and scouting for talented players. He was also studying at the time and doing lots of extra practical work. During the summer holidays Trevor took on more work coaching youngsters. He was then referred to mental health services in London and eventually moved to Dorset in 2001.
Trevor said work pressures caused him to be off work for 11 months due to mental health issues and he was concerned he was not stable. Trevor was under the Wimborne Community Mental Health Team (CMHT) at this time and they referred him to St Ann’s. Trevor was admitted to AAU Seaview in November 2013 and again in May 2014.
Trevor felt that the Seaview team were dedicated to helping him and others. The support that he received was not just through medication but was from implementation of interventions. These interventions were walks around Compton Acres and doing meditation exercises. He explained he would enjoy going on walks with the team and there were lots of stimulating things to do on the ward. There were board games to play and plenty of activities that made the experience interactive. Trevor was very enthusiastic about the ward and said the whole experience was positive, even down to the food. He made it very clear that he did not have any concerns about the services he received at St Ann’s and there was nothing about his experiences that was negative. Trevor considered himself very lucky and the service provided at Seaview was exactly what he needed and in his best interest. He always felt safe on the ward.
The team were always available and ready to talk to him and very approachable and always welcoming to his family who visited him on the ward. He expressed that it takes a very special person to work in the difficult environment he stayed in, with people going through some extreme cases of mental health. Trevor said it was touching how they helped him and how caring they were. He had trust and confidence in the care that he received; and felt involved in the choices about his care. Trevor felt he built some meaningful relationships with the staff on the ward as they would tell him when they were next due to be on shift. He felt he got to know the staff well and had many personal conversations with them.
Trevor explained that it was important to him to get his medication was ‘right’. This was a significant aspect of his care on the ward. Trevor felt that his GP had not given him the right medication, which he believed negatively, impacted his mental health and sent him over the edge. The staff on Seaview ensured his medication was monitored closely and ensured he was on the correct dose which amplified his trust in the staff.
Simple things really helped in his recovery. Trevor explained that going on walks to Compton Acres across the beach and visiting the Jazz Cafe with staff, was a highlight. Once the staff felt he was ready they allowed him to go with other patients unaccompanied by staff. On another occasion he went out with a patient visiting Sandbanks hotel to enjoy a hot drink and a chat. These activities helped ease him back into normality. During this time Trevor demonstrated that he was stable and confident, convincing the team at St Ann’s that he was ready to go back home. The first time he was admitted to Seaview Trevor felt he was not ready to leave St Ann`s. However, the second time he felt he was ready to be discharged and felt he was involved in the discharge process.
Trevor thought the transition from St Ann’s and coming back home the second time he was discharged was better than the first time when he was referred back to Wimborne & Purbeck CMHT.
The first time he was discharged home he did not feel he could go outside. He explained he felt agoraphobic and coming home felt a little overwhelming. However, Trevor found going outside and taking pictures of wildlife and nature as suggested by his Doctor really did help him deal with the issue. He would set a timer for five minutes on his phone and go out and take pictures and then come back after the time was up and write down what he saw and how he felt. After 2-3 weeks he was out walking on the beach and enjoying taking photos of wildlife and this was a breakthrough with Trevor’s recovery. St Ann`s stayed in contact with Trevor and touched base with him on how he was doing now and then.
Trevor explained Wimborne CMHT was very good, very consistent and reliable with appointments. There was a counsellor to speak to and would listen to how you were feeling. He was discharged from the Wimborne CMHT Team in 2015. Trevor is not taking any medication currently and has not seen anyone since then. He is now back at work and enjoying his photography and walking around Dorset.
Trevor summarised ‘St Ann’s and Wimborne & Purbeck CMHT helped me in my recovery and they both worked well together. They got me to the place where I am today, and I wouldn’t know where I would be without them.’ He explained that it felt like taking a photo ‘you’re concentrating in one moment, and in that present time just for a minute its headspace.’ Trevor’s pictures have been used by the Combat Stress charity and photography has been used as a therapy strategy for others struggling with their mental health. He is now very open about his story and experiences with mental health and shares them on social media to make others feel like they can be open to talking about their experiences too and not feel alone.
The service user was assisted in providing the story by Kirsty East, Patient Experience Facilitator.
Feedback from Seaview Ward:
The analogy of a swan springs to mind when thinking of the Seaview Team in action. To those on the outside, all appears calm as everything is taken in their stride. What often goes unseen is the intense work load and the mental stress of the job that we all go through. However, comments and appreciation like this from Trevor helps the team to stay focused on the positive impact we make in every individuals life.
We as a team will do our best to keep our standards high at all times.
We all feel that the game is on to be better every day.
Feedback from Wimborne & Purbeck CMHT
It’s really great to hear that Trevor has continued to use the skills and techniques he developed with support from the two teams he had most contact with. We endeavour to work with people to find their own strengths and resilience and it’s always very rewarding to hear from those who have been able to maintain their recovery and increase in their confidence to tackle new challenges.
Since Trevor left the service we have continued to work with other parts of the pathway and it is important in the months ahead that we maintain our relationships not only with other teams in the Trust , but also with services in our communities, so that we can offer as broad a range of opportunities as possible.
story started when she was 15 years of age, whilst studying for her
GCSE’S. She has learned that Pebble
Lodge staff never give up and now as a peer supporter she recognises it more
and more. She recognises that staff also have really difficult days seeing
children struggle. Now on the “other
side” of recovery she appreciates the fact that staff are human and try hard to
help everyone on the unit. Nikita sees staff
members come back every single day no matter what’s thrown at them and staff
continue to hope and see a future for their patients. Nikita continues to be amazed that, there is
a group of people willing to do that.
Three years ago Nikita began working with the Dorset Mental Health Forum. At the time she was still in recovery under the adult mental health team and was going through different therapies. Whilst working a as a peer she heard her line manager and different peers talk about personal recovery. This is the idea that service users hold the answers and solutions that will work for them. The approach encourages seeing the service as a tool to use, rather than the answer. Her recovery began with the concept of “I can do this” and has now developed further as she has something to offer back. Nikita feels she is an equal part of the team. I’m not Nikita, the ex-patient, I am Nikita, and she is a peer specialist.
Mr. S – An Ex-Serviceman’s Story
Mr. S is an 65 year old man who lives in Bournemouth, suffers from Post-Traumatic Stress Disorder (PTSD) and an has emotional unstable personality disorder. He explained that he routinely ended up in and out of hospital for mental health issues and between 2002 and 2018 he made 28 suicide attempts. These suicide attempts involved A&E attendance and inpatient mental health admission.
Mr S. had spent some time at Bethlem hospital in 2016 for a period of 18 weeks, where he began to see an improvement in his mental health. He was under the care of experts in PTSD and included 1.5 hours of therapy each day and medication that seemed to finally have some positive improvement in how he felt. He said that he had designed and made a coffee table during his time there. He felt these craft activities were more relevant to him than others he had undertaken when in Dorset. In addition he said that the unit allowed him and others to go out to town and to live a fairly normal life. He felt that this was a turning point in his treatment.
From his recollection, discharge planning began three or four weeks before the discharge date, preparing him and ensuring that arrangements were in place for his return to Bournemouth. He was referred to the Community Mental Health Team at Turbary Park. He was given details of the Crisis Service and discharged home.
Mr. S. said that his discharge happened at Christmas which was a particularly trying time. He was not in the habit of asking for help and always would feel that the Crisis team were there for people who “needed help more than me”. So he patiently waited for the CMHT to contact him whilst feeling that he was deteriorating. He eventually saw the CMHT on 18th January 2017.
During this time he visited his GP to get a repeat prescription of his medication prescribed by the professor at the Bethlem. Mr. S was prescribed two separate blood pressure medications to manage his PTSD. However his GP said he could not prescribe the drugs as they were not licenced for this use. Eventually he managed to get back in touch with the professor at the Bethlem and they then agreed to send prescriptions to his GP. However he had not been takin his medication for some time before the issue was resolved. Due to the lack of medication and a delay in his CMHT support his “pack of cards” collapsed and he attempted suicide again.
Mr. S was taken to Bournemouth Hospital and was admitted to Melstock House at Forston Clinic on 1 July 2017. He had become homeless and therefore remained as an inpatient on Melstock House for five months. Mr. S said it was a very difficult time as he felt he really was not in the best place for his particular needs. He said it was extremely challenging living on a ward with many older people with dementia and the activities such as jewellery making and colouring-in seemed irrelevant to him. “I was stuck there just waiting for housing to be sorted out for me” he said “and I could see it could take many more months.”
Mr. S was still under the care of the CMHT at Turbary Park. The team of psychiatrists advised him that his medication should be changed as it was not appropriate. He explained that this had been initiated by a specialist in PTSD and he did not want it to be changed. As his medication is not well known or recognised he says it is a constant battle to remain on the prescription he believes finally has managed his condition.
The CMHT put him in touch with the Armed Forces Community Health and Wellbeing Team (AFCT), based at Hahnemann House. He said that they were amazing. “They realised I was not in the right place and that Melstock House, although a lovely ward, was not right for an ex-serviceman suffering from PTSD. Firstly I met Andy Gritt however Jason Wilkinson became my regular contact and he worked night and day to find me somewhere to go. Initially he got me back to Bournemouth living at the YMCA.” He said he had little in common with anyone else at the YMCA as many were ex-prisoners or were ex-drug users however Jason was his constant contact and he managed to keep on an even keel.
Mr. S could only stay for one year at the YMCA and the deadline to leave began to loom which added to his anxiety. Jason had been working to secure Mr S a place in the War Memorials Homes in Bournemouth, a specialist housing association for ex-servicemen. Mr. S said that during this time Jason would call him or see him and tell him where he was on the waiting list which gave him hope. Through Jason’s sheer determination and a very helpful manager at the home he moved into a flat in September 2018. He now feels secure in his own home for the rest of his life.
Mr. S said that he has not had any further suicide attempts since June 2017 and puts this down to his medication being continued despite the problems he has encountered with repeat prescriptions. In addition the support he has received from the AFCT has been pivotal. “They understand my thoughts” he said. “Squaddies are different and we do better when we are dealing with other squaddies. They know what tone to take with me, when I need pushing and when I need to be given an order! They understand why I may not call the Crisis team.”
His life is definitely better, he now is a trainee at Crumbs, a catering project whose workforce is made up of vulnerable adults, and he loves it. Mr. S says he has good times and bad times and Firework night is real trial but Jennifer from the CMHT will ring him on that day and help him through.
Mr. S wanted to make the following points to the Board:
· Why was there a delay in CMHT support when a referral had come from a specialist unit in what he believes is a reasonable timeframe?
· Dorset has a huge number of ex-forces residents and many suffer from PTSD. He feels that the condition is not the same as other mental health illnesses and does need different expertise and support.
· Without the input of the AFCT he believes he would have stayed on Melstock House for a significantly longer period.
· Can access to medication be improved, despite the treatment not being recognised, when experts in the field have prescribed? He now helps other ex-servicemen friends who are going through similar issues with their medication. Mr. S believes he is not an isolated case.
· His multiple suicide attempts have ceased due to his medication, settled home life and support from the CMHT and the AFCT.
Feedback from Armed Forces Community Health & Wellbeing Team
I have known Mr S since November 2017 where I first met him at Melstock ward at Forston clinic; he had been admitted there in July 2017 due to a suicide attempt. The first contact he had from this team was from the service lead who was trying to resolve his housing issue which was having an impact on his mental health with other issues also.
At first when I met Mr S he would not engage with me at first as he just saw me as another “Civvie” who did not understand, until I explained I was a Combat Veteran. He then warmed up to me a little more as we discussed certain combat zones we had served in. We discussed many issues he had such as having no accommodation to go to, hence the reason why he had been on the Melstock ward for such a long period.
Over the next few days after meeting MR S I had managed to secure him temporary accommodation at the YMCA on Westover Road in Bournemouth with the help of the Service Lead. Mr S moved into the YMCA a few weeks after however it was a struggle at first as the majority of patrons are ex-offenders which was hard for him as he had nothing in common with them and he kept himself to himself. I knew it was important to keep regular contact with him to ensure he knew he had the help and to keep him on the straight and narrow and to significantly lower the risk of attempting suicide again.
Mr S could only stay at the YMCA for a year so I had to look at different options of accommodation once the year was up. I had secured him a place on the waiting list at the War memorial Homes in Bournemouth, accommodation for Ex-servicemen and woman. I would meet with Mr S Once a week with updates on where he was placed on the list which he appreciated. In September 2018 he moved into a one bed flat at the homes where he feels secure and a lot happier.
Before Meeting Mr S he was in the process of joining The Crumbs Catering Project for vulnerable adults as a trainee which had to be delayed due to his admission to Melstock Ward. This was something I was encouraging him to re-engage with as I believe it would help with his Mental State. I had spoken to the Training Manager to arrange a taster day for him which he excelled at and he has now been working there as a trainee for nearly a year now.
Since the time I have engaged with Mr S I have seen a vast improvement on all aspects of his life including his mental health, he now has no thoughts of suicide and this is down to all Departments within the Trust who have supported him. We now still have regular contact at least once a fortnight which helps him know he has the support when he needs it.
Feedback from Melstock House
In response to the patient story provided by Mr S, it is great to hear the positive feedback about Melstock and Mr S feeling the ward is a lovely environment. In response to the occupational activities on offer at Melstock House, we endeavour to provide activities tailored to individual needs. The feedback gained from the MDT that provided care to Mr S was he was supported with his occupational interests and this enabled him, in terms or recovery and ‘moving forward’ to obtain employment on discharge from the ward, working as a chef.
Whilst staying as inpatient, Mr S was able to practice his culinary skills, providing meals for other patients. Interest checklists are completed and OT and nursing staff encourage participation, within the limitations of what can be offered over the whole site at Forston Clinic. We have an exercise facilitator, and individuals are encouraged to remain as independent as possible from a hospital setting, such as going to town on the village bus. This is important, especially when people’s discharge is delayed due to external factors, such as housing needs, which of course we know has a strong correlation between poor mental health. Unfortunately this is a something people experience too frequently and is not something that can be greatly influenced due to the national housing crisis.
Melstock is a functional mental health unit for people over the age of 65 years old. Due to structural organisational changes within West Dorset, having had two Organic units close over the past 5 years, this has had an impact upon the service user groups who access Melstock, so sometimes there can be greater numbers of people on the ward with a primary cognitive impairment diagnosis.
Community Mental Health Team – Bournemouth West
Mr S was referred to the team on Friday 23/12/16. The duty worker spoke to him on the same day and arranged an appointment at Turbary Park Centre on 28th December which was the first day following the Christmas break. It was agreed that the duty worker would email Mr S with the Turbary Park clinic address. Unfortunately the email address used was incorrect and therefore the email did not arrive. Mr S rang the team on 29th to say he had not received the email and so had not attended his appointment on 28th.
The team should have double checked that the email had been received and or sent a letter in the post confirming the appointment details and for this we apologise.
Mrs Sanderson - A Patient’s Story
86 year old Mrs Sanderson was delighted to be able to share her experiences as a mental health patient since the age of 18. Mrs Sanderson’s story highlights how much Mental Health Services have changed, developed and improved over the 60 years. It also describes the life of someone living with a mental health illness.
Mrs Sanderson was brought up in a country town in Surrey and recalls a fairly happy childhood with her mother, father and three sisters. She did well at school and went onto study at university in London. It was during a vacation back home that she found her mind went blank; she found it impossible to study and had ‘forgotten how to learn.’ In those days no one knew about mental health and you were classed as either ‘mad or sane’. Mrs Sanderson felt that she had become mad because of the inability to learn or remember and she felt that she was useless and unworthy to the man she had fallen in love with therefore she thought that it would be best to die and took an overdose of Aspirin. Mrs Sanderson was admitted to a mental health hospital but it was more like a ‘cottage’ than the nearby asylum. University was put on hold but she continued to enjoy reading the Observer. Mrs Sanderson was admitted to various mental health hospitals over the years and recalls the old style asylums and described the various treatments that she endured. She particularly remembers that there was often a chapel, ‘a place it seemed of sanctuary and solace, whatever your religion.’
During the time that Mrs Sanderson was well she was able to return to university to finish her degree, continue onto a Masters and take up a scholarship in Italy. She went onto to study in Rome and Finland and then to teach English as a foreign language. She then ventured to Australia to become a lecturer at the University of Adelaide. Mrs Sanderson continued to take medication for her mental health illness ‘in the background’.
Whilst on vacation back in the UK, Mrs Sanderson became pregnant. Her daughter was born and she subsequently suffered from post-natal depression (as an inpatient) therefore her daughter was fostered by a lovely lady for six months. Once well enough Mrs Sanderson was able to care for her daughter and later met a man and got married. Her husband was a good father to her daughter but it was a very unhappy marriage. During her 35 years of marriage Mrs Sanderson suffered from breakdowns now and then, received various treatments including ECT and was once an inpatient at St Anne’s Hospital. It was a frightening time and place. However, during the times of being well she worked and was an English teacher to foreign students. Teaching was her salvation. Her family continued to be a support to her and she would often visit them. She has found it particularly difficult to talk to her friends about her illness as it is seen as a taboo subject but she has relied on the Samaritans and in particular two friends that have supported her through the Samaritans.
In more recent years Mrs Sanderson has remained as an outpatient and attends regular appointments at Kings Park and she also receives regular visits from her Community Mental Health Nurse. She feels that General Practitioners have a general lack of understanding of mental health illnesses but is pleased that she has been able to easily access mental health service provided by Dorset Healthcare and describes the staff and service as always making it as ‘personal as possible’.
Mrs Sanderson is delighted to feel well and said that it is a joy to feel better and be aware of the beauty of everyday life. She believes that ‘work and poetry saved me.’
Mrs Sanderson has written three poems to emphasise how the joy of recovery has impacted on her.
The Joy of Recovery
Welcome as a water in the desert –
Unvalued, ordinary – precious
To think my own thoughts quietly –
No struggle, no division
Not to hear voices;
Not to want to die;
Not to hate every day, and see ugliness;
But feels compassion, and to value –
To look once more outside myself –
Someone has cleaned my window,
And the sky outside is blue
I had forgotten.
Beautiful to have a brain – written in Spring 1984
After long years of lethargy, deadened by drugs
To note the sweet gradation of the seasons
The opening of each bud, the markings of each bird
To trawl the treasures of memory;
To send the questing beam of the mind into the future;
To weigh probabilities –
To delight in design, match colours,
To classify, identify, know names –
To a neighbour, Mr McKile
Too drugged to understand anything –
I understand flowers,
And you gave me flowers
Amelia (not her real name) is a 67 year old, retired teacher who lives in Sherborne. In 2017, Amelia experienced two sudden bereavements (her mother and her five year old dog, which leapt over a ledge on to a road) and, additionally, a 27 year relationship breakdown. These events took place over a three month period, leaving her feeling alone, empty and bereft.
One evening in October 2017, Amelia drove to The New Forest, with her new puppy. She drank half a bottle of gin and waded into the river, with the intention of drowning herself that night. Thoughts of her daughter and family prevented her from further self-harm that evening and somehow 48 hours later, she managed to drive to Worthing to stay with her family.
Amelia stayed with her daughter and family for the next three weeks. She suffered from severe panic attacks and dissociation; she couldn’t talk, eat or sleep. Her daughter started to become severely concerned by Amelia’s behaviour and mental state, and contacted the West Sussex Mental Health Team and local GP Practice. Within days, Amelia saw a Psychologist from the local Community Mental Health Team; she also saw the GP Practice’s Counsellor many times over the 3 weeks.
Following her meetings with the Counsellor and the Psychologist, they made contact with the Sherborne Older Persons Community Mental Health Team (OP-CMHT), as Amelia wanted to move back home. At first, she was reluctant to meet with the team, as she didn’t want to expose herself, following her teaching roles in local schools. However, following conversations with her daughter, Amelia agreed to meet with the team, and her daughter made the initial appointments with Dr Sue McCowan, Associate Specialist, and Katie Higgs, Community Mental Health Nurse.
Dr McCowan visited Amelia at her home regularly, and would discuss various things with her and review her medication when Amelia felt it was needed.
During the first few months with the service, whilst Amelia still had suicidal thoughts, she was seen twice a week by Katie. When Katie couldn’t attend, she would be notified and someone else would visit. Amelia felt that Katie understood her creative nature; she got her to do things and would make something of their conversations, mirroring Amelia’s comments back to her. Amelia describes the visits as ‘helping me to understand that tiny improvements were very good, Katie became a sort of touchstone to help me ground myself through the darkest of days.’
Amelia felt that both Dr McCowan and Katie were absolutely incredible, supportive and diligent about her needs. They knew the ideal time to say things to Amelia and trial certain techniques and methods with her. Specifically, they found the optimum time for Amelia to begin psychological intervention with Psychologist, Dr Theo Roberts. Amelia commented how this was seamless and perfectly timed
In early 2018, Amelia started her appointments with Dr Roberts. She originally found it hard to meet with him at Stewart Lodge, but, in time, realised that the space was less important and the time she spent with him was more valuable. For her, this was an indirect form of healing. Amelia found Dr Roberts’ sessions practical and compassion-focussed. Dr Roberts was able to accommodate Amelia’s antipathy for diagrams and used a slightly different approach.
Amelia had in excess of eight sessions with Dr Roberts; some had long periods of time between appointments, owing to room demands, whilst others were regular weekly sessions. However, she found the larger gaps gave her time to reflect on what they had discussed and allowed for her to go camping and “live”. Amelia describes her sessions with Dr Roberts as him “lighting the wick, and she would let it burn.”
She had her last session with Dr Roberts on 12th November 2018 and had her last appointment with Dr McCowan on 7th November 2018. She now believes that she is in a more positive place and has a far better and clearer sense of understanding herself, and a more contented outlook on her life than before her mental health deterioration.
When reflecting on her initial journey with Sherborne OP-CMHT, Amelia described it as ‘being in a frightening and intimidating jungle, where everything was going to hurt me.’ She described the sensation that each person she worked with was carrying her above their heads, supporting her and thinking for her; whilst not disabling her in the journey, but more enabling her to take responsibility for her recovery. Amelia also felt that the team had such a cohesive way of working with her, where each member of staff involved fed into her care and ensured it was joined up – everyone knew what was happening and when.
Amelia cannot fault the care, compassion and treatment she received from everyone at Sherborne.
The OPCMHT was delighted to receive such positive feedback regarding the journey this lady experienced with our service.
The response will be shared with the wider team, across both sites and also with teams within the North Dorset Locality through the Team Leaders Meeting, in order to highlight good practice.
It is recognised that it is fundamentally important to ensure there is a good liaison and continuing discussion between all teams within the wider Older Peoples Service, in order to promote the person using the service feeling empowered, supported and enabled in their recovery, as occurred in this case.
Mr Davies was delighted to be able to tell me about his story with regards to his experience as a carer to his late wife, who passed away on 31st December 2016 in the Jean King Suite, The Willows at Yeatman Hospital.
Mr Davies’ wife was a retired midwife who was diagnosed with advanced breast cancer. After receiving treatment for six months at the MacMillan Unit at Yeovil Hospital, Mrs Davies was given the ‘all clear’. Mr Davies’ describes his experiences of the MacMillan Unit as exemplary.
Mrs Davies subsequently suffered from a convulsion, which lead to a scan and she was found to have secondary cancer in her liver and brain. Mrs Davies immediately went to Bristol Hospital to receive a course of treatment, but she was unable to go back to continue with the treatment as she became too ill.
When Mrs Davies became very poorly whilst she was at home, her and Mr Davies made a joint decision that she could no longer continue to stay at home as she unable to move. Mr Davies stated that their General Practitioner made sure that Mrs Davies was admitted to Yeatman Hospital, as it is their nearest local hospital.
Mr Davies recalls various feelings of uncertainty at this point. He recalls the doctor on the ward sharing with him that doctors ‘don’t get training on how to give bad news’. He also recalls being told, by an outside agency, that the ward wasn’t suitable for end of life care. There were discussions around care packages from Marie Curie, but the correct package was not available. A nursing home was suggested and Mr Davies visited some nursing homes, but he and Mrs Davies really did not feel comfortable or happy with the idea of a nursing home. With all of these feelings of uncertainty, Mr Davies was very well supported by the nursing staff on Rowan ward and was encouraged to speak to the Matron about his concerns. Mr Davies wrote to Anne Hiscock, Matron at Yeatman Hospital, and she immediately visited him on the ward. Anne immediately made it possible for Mrs Davies to stay on the ward, as per her wish. Mr Davies was reassured by Anne and the staff and he describes Anne and the team as kind, caring, compassionate and they could not do enough for him and his family. Mr Davies has a disabled son and another son, along with two grandchildren. He recalls the nursing staff always asking after them all. He recalls always being directly asked himself if he was alright and if he had eaten etc.
Mrs Davies was at The Willows for three months. She enjoyed being in the bed next to the nurses station, as being a retired nurse and midwife herself she could engage in what was happening around and have friendly conversations with the nurses. Towards the end of this time, she decided that she would like to be moved to the Jean King Suite (purpose built end of life suite) within the ward. Mr Davies describes the suite as a lovely personal suite with an en-suite and kitchen. Sadly, Mrs Davies passed away on 31st December 2016.
Shortly after Anne approached Mr Davies to ask him if he would be interested in joining a Bereavement Café/ Group that she had set up. Mr Davies’ first thought around this was did he really want to talk about his late wife and what had happened. However, he decided to go along and found that the group was nothing like he had envisaged. It was a group of people getting together for coffee, cake and a chat but they all had a common factor and were able support each other and be there for each other, week upon week. Mr Davies feels that the Bereavement Café has had a huge positive impact on his life and he doesn’t know what he would do without it. The group meet weekly and are joined by a voluntary nurse and voluntary Health Care Assistant. They talk about all kinds of things and are even planning a day trip out together later this summer. Mr Davies wanted to highlight the time, dedication and compassion that the voluntary nurse and Health Care Assistant give to the Bereavement Café.
It is always so rewarding to receive such positive feedback from patients and their loved ones.
We all take huge pride in all aspects of our clinical care here at the Yeatman, but end o life care is a very special and intimate element of nursing, which we view as such a privilege to deliver.
We continuously strive to improve our knowledge and skills, and regularly reflect on how we can make what we do even better; as there is always room for improvement, no matter how good we think we are...
X is a 23 year old young man who three years ago was studying mental health nursing at Bangor University. He was diagnosed six months after beginning University with bipolar disorder. For two years he was unstable with frequent medication changes and eventually had to move back home to Sturminster to live with his Mother. He was taking mood stabilisers and an antipsychotic when he returned. In line with guidelines for bipolar disorder the CMHT team stopped prescribing his antipsychotic as they felt he no longer needed it, and the mood stabliliser on its own would be enough to keep him stable.
On Thursday 25 January, after withdrawal of the antipsychotic X began to feel unwell quite quickly. The patient’s Mother quickly contacted the CMHT team on Friday 26 January. However he rapidly became more unwell over the weekend.
On Monday 29 January the CMHT arranged for an assessment and a psychiatrist assessed that X was psychotic. The psychiatrist said she would speak to the bed manager and send the Crisis Team. X agreed to go to St. Ann’s as a voluntary inpatient. The Crisis Team attended at 5pm on Monday 29 January and said that if he had not agreed to go in on a voluntary basis they would have sectioned him as he was very unwell by this stage. However X began to feel that the team were very unhelpful as they told him “if you don’t take your medication you will be taken away and injected”.
Later that evening they were advised by the Crisis Team that there were no beds available at St. Ann’s Hospital and that someone would come out again tomorrow. Due to X’s psychosis he began to think that he would be kidnapped and injected. His Mother and his girlfriend were trying to keep him calm. X’s Mother pointed out that her son is a tall, well-built, fit young man who could easily have physically moved her and his girlfriend out of the way if he wanted to get out of the house.
The following day, Tuesday 30 January, the Crisis Team arrived in the afternoon. By now X was under the impression he was on a secret mission and had to get to Wolverhampton. “Nick from the Crisis Team who attended was great with X, he really managed to calm him down” said X’s Mother. Nick said that X needed to be in hospital and he would ring later. At 6pm they were advised that there were no beds. However, in a bid to find a way to get X admitted, the team suggested that they section him, and the assessment wouldn't take place until the following day, despite the fact that X was still willing to be voluntarily admitted to St. Ann’s.
X’s Mother and girlfriend had an even more difficult night as he wanted to leave the house as he believed there were people in the woods and he began barricading the house. X’s Mother did not sleep at all that night.
In sheer frustration X’s Mother drove to Wimborne CMHT and door-stepped the psychiatrist. She was extremely shocked that X was not an inpatient. In relief that she had found someone who realised the seriousness of the situation X’s Mother burst into tears and then explained that X was going to be sectioned as a means to get a bed. The psychiatrist from Wimborne CMHT wrote a letter strongly disagreeing with the section. X and his Mother were very happy with the treatment and support received from Wimborne CMHT. The team performed as was expected and they have no concerns about their actions.
X’s Mother then rang the Crisis Team to ensure that it was on record that she did not agree with the section. She was told the section was going to happen anyway and the team would be round at some point. Another phone call was received later on that day explaining that the psychiatrist from the Crisis Team was going to carry out an assessment. After assessment, the psychiatrist agreed that a section was not necessary but X did need a bed at St. Ann’s.
That evening a bed was found on AAU – Seaview in St. Ann’s. The following day X’s Mother received a phone call from a bed manager who explained that they had not been made aware of the case and apologised for what had happened. X’s Mother explained that this phone call from the bed manager is the only reason she had not made a formal complaint.
In total X waited 4 days for a bed whilst suffering a psychotic episode. In addition, X’s Mother is concerned what could have happened if X had been alone and not had her there to fight his corner. He was willing to go to hospital but would have been sectioned against his wishes.
X and his Mother would like the following points to be noted and/or actioned by the Board:
- X and his Mother feel that everything seemed to go wrong when the Crisis
Team came into the picture and noticed that:
- They appeared to put more obstacles in the way of the required admission.
- It appeared there was reticence to attend and assess the patient.
- There were different staff at each Crisis Team visit which added to X’s paranoia.
- The Crisis Team appeared to have no compassion.
- Why when there appeared to be no beds at St. Ann’s was no further action taken to find X a bed?
- A significant risk had been taken leaving X with his Mum alone over the weekend.
- X is now very angry that his Mum and girlfriend were left to deal with him. His girlfriend had never seen him in this state before which was a shock for her.
- Finally, why was the word of X’s psychiatrist not good enough to be sent directly to St. Ann’s for a bed?
The Community Mental Health Services Manager, Crisis Team and Bed Manager have reviewed the story of this gentleman and his mother, and are really grateful they spent the time providing their feedback. All services involved absolutely agree that to wait four days for an inpatient bed whilst experiencing a psychotic episode is a highly distressing situation to be in for the person and their family.
The Community Mental Health Services Manager and Inpatient Services Manager contacted Mr X and arranged to meet with him and his mother to discuss what happened.
From this feedback the team are able to improve the experience of people needing to access crisis care and to help avoid the situation that Mr X and his mother found themselves in earlier this year.
The actions that were taken from the feedback and meeting are as follows:
- We are currently planning the detailed implementation of the Acute Care Pathway Review, which was a public review of mental health services led by Dorset Clinical Commissioning Group. The review will see some significant changes to the current structure of the Crisis and Home Treatment Team. The current East and West teams will be devolved into locality teams that ‘wrap around’ local community mental health teams (CMHT’s). We feel this will positively impact joint working between the Crisis Team and CMHT’s, as decisions about who needs to access crisis support and inpatient care will be made jointly by the CMHT and local arm of the crisis team. The crisis workers will be able to be co-located in many cases with local CMHT’s and attend their team meetings to discuss people jointly. This will improve joint working and enable CMHT’s to be more involved in gatekeeping decisions. In addition, as staff will be allocated to a locality, the Crisis staff will get to know local people using services better and there will be more consistency in the Crisis staff seeing a person at home. From our discussions it sounds like this change would have been of real benefit to the situation you experienced. The intention is for this change to be effected from April 2019.
- An improved technology solution to the bed management system. Currently, we use some manual methods in bed management which leads to the risk of human error. We are implementing an electronic system which will ensure the Crisis Team and bed managers have up to the minute, consistent information about bed states and potential admissions, so as to manage this as smoothly as possible.
- We are undertaking a staff development programme with the Crisis Team over the next year with our Organisational Development Team. The purpose of this is to look at how to support the team with upcoming changes, and how to manage working in an acute setting and the impact this can have on staff behaviours and therefore patient care. The aim is for this to be a restorative process that supports staff and improves care as a result.
We have undertaken a reflective feedback session during a Crisis Team meeting about your experience, which we do for all feedback received. Some particular staff were referenced in the concerns and we have therefore also addressed in one to one supervision the feedback about tone and style, both positive and negative, and the impact this had on the experience.
DS is an 38 year old man, who lives in Bournemouth. In 2015 DS had an operation on his Achilles tendon. Unfortunately this was not successful and he was left in a cast and then a boot. He had a second operation, where bone was removed from his hip and used to help the bone to form in his foot. His foot was also pinned. The wounds healed but unfortunately there were further complications which meant a third operation. Prior to his operations DS played football and was not overweight.
After his operations DS weighed 122kgs, over 19 stones. Unfortunately due to his long period of illness his position at work became under threat as he was not able to carry out his role. Luckily he was offered voluntary redundancy from his well-paid job in retail. DS visited the doctor for thrush and had a diabetes test. His BMI was 34.96 and he had a very high HBA1c level. The doctor prescribed three separate medications and statins. He was also referred to the Diabetes Education Programme.
He was also seeing the physiotherapists at Royal Bournemouth Hospital for his foot and began to visit their gym regularly. He said their help and support was magnificent. He explained that going to the gym for physio really was a springboard for him. He explained that he had never been in a gym before. He explained that the physiotherapists at Royal Bournemouth now refer to him as their pinup!
DS visited the Diabetes Education Programme and undertook the 3 sessions. He found the information useful despite having a fairly good knowledge of the disease because his mother is diabetic. He says that he realised he was going to have to make a significant change in his lifestyle. He knew his mother and her friends did not seem to try and manage the disease as well as he thought they could. He decided he would be different and decided to really engage with the advice he was receiving.
One of his motivations to change was to be there for his children’s children. So he began an exercise and healthy eating programme. With his food, he used the information he had learnt from his courses at the Diabetes Education Programme and made better choices. He then reduced the amount of food he was eating by only using tea plates. In regards to his exercise he initially tried to find something he really enjoyed and began with table tennis, playing in Boscombe Gardens. He then had to walk back up the hill to get home. He explained that without his experience under the care of the physiotherapists at Royal Bournemouth, he really would never have considered going to Littledown to use the gym. He feels that safe introduction to a gym environment took away the anxiety and fear of walking in to a public gym.
He has now lost 44 kgs (nearly 7 stone) and is now pre-diabetic. He takes no medication for his diabetes which is now completely controlled through his lifestyle. He looks back at his diet when he was going through the issues with his foot and admits his diet was bad, he ate comfort food and ice cream and was constantly thirsty. He now enjoys healthy food but still enjoys a Chinese meal once a week. To control his alcohol calories, when meeting up with his male friends he now arrives a couple of hours after everyone else and leaves a little early. This way he does not get caught in the cycle of buying rounds and feeling he cannot leave.
DS says he feels younger. He incorporates walking into his day whenever possible and goes to the gym almost daily. He now helps other friends who are diagnosed with diabetes and a friend recently has lost 6 stone.
He was very happy with the information on the courses from the Diabetes Education Programme but is concerned that some attendees really did not grasp how serious diabetes could be. He felt some were of the opinion that the tablets would do it all and they did not need to change. He wonders if a little more information with a shock factor i.e. how many diabetics lose a limb or their eyesight, could help people who do not have a strong will. He now does voluntary work for Victim Support and is currently looking for a new role, perhaps within the NHS.
We are delighted that DS was able to use the information provided on the Diabetes Education Programme to make lifestyle changes that resulted in him controlling his diabetes with lifestyle alone. The Diabetes Education Programme aims to empower and motivate people newly diagnosed with type 2 diabetes
Individuals approach a diagnosis of diabetes in different ways. Whilst people like DS use the diagnosis as a motivator for change, for others it takes a while for the seriousness of the condition to register. The programme is structured to include information about diabetes complications, what they are and actions to reduce the likelihood of complications.People attending the programme don’t remain under the care of the service but rather go on to be looked after by GP surgeries. Whilst the programme educators have long term outcome data and patient feedback to evaluate the programme, it is good to hear about the impact on an individual.
I am Mrs X, a new mother of a 5 month old baby. I’m a Speech and Language Therapist, specialising in feeding, and this role encompasses regularly working with Health Visitors (HV). I’ve experienced the Health Visiting service in a new light, after the birth of my child.
When the HV completed her initial home visit, she was more sympathetic and supportive; they were present for a longer period of time and saw how upset and distressed my child was, following his feeds. The HV was the first person to say I wasn’t losing the plot and advised me to take him to the GP. I went to the GP, and the outcome was that he had a cow’s milk intolerance. From this, it was recommended to place him onto a special formula and I immediately noticed a vast improvement after feeding, and in general.
Prior to this, we had previously attended Poole General Hospital (PGH), due to his poor weight gain, and a heart murmur was identified. A scan was arranged and this will be reviewed at 1 years of age. At this time, there was a very strong focus upon his weight. However, following this I still remained concerned regarding his feeding and presentation.
In addition, she took time with my husband ensuring that he was involved and understood what was happening. I really appreciated her approach, as it kept him part of the journey with our son. I also found it very helpful that the Health Visiting service provide set times and are always on time, which other services don’t always offer. As my baby was born in November, knowing when services are coming made it easier for us to go out and do things before it got dark and cold.
She had completed additional visits whilst his weight was being monitored and we were trialling the new formula. When she did this, she provided us with a phone number to contact her, and we now use drop-in clinics monthly to have him weighed and to seek further advice; I make sure that I attend these, as they are very useful. Others may be unable to attend these if they do not access to a transport.
Even though I have extensive knowledge of child development and the service in general, I would have liked to have a longer period of support from the HV to just to check everything is okay; maybe even a telephone call, just asking the question ‘how’s everything going?’ because I would always have had something to ask!
Overall, the service we have received, from all the services, has been fabulous and all staff are very supportive and caring; every person we’ve seen has been great and knowledgeable – from PGH, to the GP who we have always been able to see on the same day.
The main point about my experience with the HV is that she listened to my concerns and did not dismiss these, which in turn had a huge impact on my son's wellbeing. I felt more listened to with her, than I did with other services.
The Health Visiting Service was delighted to receive this positive response regarding the support a family received from one of our teams in Poole.
This response has been shared at a recent Poole HV Locality Meeting to support good practice and learning and will also be shared at the forthcoming Pan Dorset HV Leads Meeting for wider dissemination.
The comments regarding access to Well Baby Clinics have been noted and will be fed into our current review on this aspect of service provision by the Health Visitor Advisory Forum. It is acknowledged that the mother would have valued active input or telephone support from the service for a longer period, whilst it is noted that she had contact details for her Health Visitor. Therefore, it is important that practitioners continue to work to empower families to take a proactive approach - encouraging parents to contact the service to discuss any concerns or queries they may have, rather than feeling they have to wait for the service to contact them. Our aim is to provide a personalised service that can respond to identified needs and supplementary advice or additional visits can always be arranged as required.
Caring for someone with dementia entails a lot of ‘firsts’ – the first time you realise they are never going to get better. The first time he went out and forgot where he was. The first time he no longer knew how to make a cup of tea, and the worst ‘first’ of all – the first time he didn’t know who I was.
All was well with dad living in his annex, pottering around with support from me and my husband – we both work full time, and took it in turns to help dad get up each day. Suddenly he took a down turn and we realised we needed more help. This was especially difficult for dad, being from a Dorset gypsy background there is a cultural fear of ‘authority’. I gently persuaded him it was for the best and so a social worker arrived…sadly he didn’t gel with us and offered very little support. I felt the assessment was a form filling exercise - I hadn’t slept properly for 18 months due to dad calling out every night, so being offered a trip to the cinema was not what I needed. We were offered a week respite, but with no notice and the home being well below standard I wasn’t letting dad go there. I felt awkward, we don’t like to ‘make a fuss’, but I asked for a different social worker, who was much better for us.
She organised care workers to help dad get up and eat etc. It was difficult as they never arrived at the same time and with staff were continually changing there was no consistency.
Eventually this situation began to have an impact on my working life. It was agreed I could compress my hours to four days, which helped me balance work and dad.
Christmas 2016 dad fell over, he could barely stand unaided - he was taken to A&E but sent home as no broken ones. He fell again the next day, I tried to lift him and in the confusion he punched me … hard. He was taken back to A&E while an emergency care home was sought. Against the wishes of his GP and Social Worker he was sent home again, this time he couldn’t stand at all so we stayed up all night with him to keep him safe. I felt we had been treated very poorly, with no understanding or compassion shown to me or my dad.
A care home in Hampshire was found (nothing in Dorset available) - I asked for a nursing home but my views were not listened to. After two weeks dad was asked to leave as he ‘needed nursing home care’. I was offered a place the other side of Weymouth but turned it down, as dad needed to see us and would decline if not.
A specialist dementia nursing home in Bournemouth was found. Dad was sadly mistreated there and I lodged my concerns to social care and the CQC, who inspected and found them ‘Inadequate’ in all areas. It was very distressing as staff at the home didn’t speak or listen to me or dad and spoke to him in a gruff way. He stopped eating and drinking as they were not making any effort to support him. Dad lost 3 stones in 9 weeks and was covered in bruises.
A lovely district nurse assessed dad for Continuing Healthcare – she even came to my home to explain why and how it worked, she listened to me and I felt at last someone was showing us care and compassion.
managed to get dad moved to a new and vastly better nursing home, where he
started to eat and drink again. Sadly after only a short while he died. They
were wonderfully supportive of us all and dad had a ‘good death’.
Looking back it’s
like a nightmare. I don’t know how I worked and cared for dad while hardly
sleeping. I would have gladly cared for dad full time but finances prevented me
and I remain very sad about that, but very appreciative of my employer for all
their support and understanding of my situation.
summary, I feel that my story demonstrates:
- A supportive employer has a huge impact on the ability of the carer to cope.
- The importance of recognising yourself as a carer.
- The need for staff in social and healthcare to remember that carers when initially beginning to use services do not know how the system works.
- Recognise that carers when accessing services are not trying to walk away from their responsibilities.
- If an NHS staff member found it so difficult to navigate and cope with the system how are other members of the public managing.
- The carer knows their cared for person really well – listening to them
will improve the quality of care you can provide.
This story covers a wide range of issues and is focused on the patient and carer’s journey rather than a specific service. In this case, it is felt that feedback from the Dorset HealthCare service included in the story would not add any value.
Mr X is a 50 year old man who got out of bed on the morning of his birthday in November and promptly fell down. He was suffering with dizziness and he couldn’t stand as he felt the room was spinning. He was diagnosed with benign positional vertigo.
Mr X was treated by his GP using the Epley manoeuvre which is the sequential movement of the head in positions designed to get any floating debris to the bottom of the ear canal. It was explained to him by the registrar that this treatment worked in 80% of cases.
Unfortunately this did not resolve his condition and he was referred to hospital where the manoeuvre was carried out by a further two medical staff. Mr X noted that each time the manoeuvre was undertaken it was performed differently, and again did not resolve his benign positional vertigo.
Mr X was finally referred to Audiology when the manoeuvres previously undertaken failed to cure his benign positional vertigo.
Mr X said "I was seen by the Audiology Service on the 14 June. After waiting a few minutes I was called in by the audiologist, who asked me to lie down while she watched my eyes.” The audiologist explained to Mr X that by watching his eyes as he goes to lie down she would be able to tell which ear is causing the problem. As it turned out it was Mr X’s right ear.
“The audiologist told me that as people get older calcium deposits form in the liquid in the ear and they confuse the brain as they continue moving in the fluid in your ear when you are standing still. She wanted to perform the Epley Manoeuvre, the aim being to get the calcium deposits at the bottom of the ear canal where they will settle. I told her that it hadn’t worked before and it made my dizziness worse so I didn’t want it done again. She carefully explained and demonstrated what she would do so that I knew what to expect”. Mr X explained that the audiologist seemed to understand how he felt which was reassuring.
Mr X agreed to have the manoeuvre performed. “When I got up to my surprise I didn’t feel dizzy, I had to eat humble pie because I told her it wouldn’t work. The audiologist asked me to wait in the waiting room for 30 minutes and she would call me back in and repeat the manoeuvre again if necessary. The dizziness had gone!”
The audiologist advised me that she would call me at home a week later to make sure that the dizziness had not returned.
She called me a week later and then again a further week later. She told me “that if I had the symptoms again to call the Audiology Department and she will see me”.
Mr x was suffering with dizziness and he experienced episodes on a daily basis.
He was diagnosed with benign paroxysmal positional vertigo (BPPV), which is a common balance disorder due to calcium carbonate crystals (‘otoconia’) falling out of the correct part of the inner ear (‘utricle’) into the wrong part (‘semi-circular canal).
He was treated by his GP using the Epley manoeuvre which consists of the sequential movement of the head in positions designed to move any floating otoconia back into the utricle.
As people get older, otoconia can sometimes fall into the liquid within the inner ear and they confuse the brain as they continue moving in the fluid in your ear when you are still. The Audiologist who treated him explained to him that this treatment worked in 80% of cases. It was unfortunate that it did not work on previous occasions.
The Audiologist performed the Epley Manoeuvre, the aim being to move the otoconia out of the wrong part of the inner ear, back to where they belong. The Audiologist treating this patient was able to gain his trust to perform this manoeuvre which resulted in a positive result for the patient.The leaflet Mr x refers to has been reviewed and is currently with communications being made ready for printing.
Miss X is a 21 year old young woman who lives in Poole.
Miss X explained that she began to suffer with issues with her eating in November 2015. She had been attending her GP from December 2015 as she knew she had a problem with her eating but was only referred to the Eating Disorder Service in June 2016 after making an attempt on her own life. Due to her illness Miss X had to leave her job at a gym as this was adding to her body image issues. Following a year of treatment she was discharged from the service on 7 July 2017.
Miss X stated “My problems with eating started in November 2015 when I decided to enter a body building competition, which meant that I started to eat less and exercise more. I didn’t get placed in the competition and I felt that I had done all that work for nothing”.
She explained “After the competition I felt that I was now free to eat anything I wanted, that there were no boundaries. I would starve all day. Then late at night I would drive to the supermarket to get some food; eat it in the car and then go in and get some more food. I would do this up to five times and would feel so full I couldn’t move. I wouldn’t do it for a few days and then I would repeat the process again.
I knew I needed help so I went to the GP in mid-December he didn’t take it seriously and I was told to try and eat regular meals. If I had been referred at this point things would not have got so bad. I had put on weight and would hide it by wearing a large coat and wrap it around myself; I wouldn’t make eye contact with anyone and I felt so guilty.
At this time (February 2016) I started to look at website chat rooms like Instagram and chat to girls with the same problem. I learnt a lot of bad things from these sites which led to bulimia and I started experimenting with laxatives.
I started to feel disappointed with myself, I began to feel depressed, and I didn’t want to live. I took an overdose in March 2016. I went to see another GP in May and I was finally referred to the Eating Disorder Service, without that GP and the support I received from the Eating Disorder Service I don’t think I would be here now.
When I had my assessment they asked me what goals I would like to achieve. I told them I wanted to wear leggings or jeans and tops with no sleeves. At this point I was referred to the dietitian. The dietitian undertook some tests to see what proportion of my body was muscle and fat. It was decided that I needed to eat 2000 calories a day and a diet plan was put together for me. By following this I lost 10 kilos. I no longer feel guilty about what I eat as I eat healthily so I don’t watch what I eat”.
service did a lot of work around body image with Miss X. Her support worker asked her to draw the body
shape that she thought she was and then she had her lay down on the paper on
the floor and drew around her real body shape.
These drawings were compared. Miss
X explained that she also learnt that lighting has an effect on what you see in
the mirror and mirrors can distort your image”.
Miss X has discovered that she enjoys painting and Calligraphy and she has her own Facebook page. It is called @creatinglillie and it's on Instagram. She shows the reality that social media doesn't always show, and talks about some of the challenges she faced and how she overcame them mainly surrounding food and body image. She wants to try and give women a better example on social media that isn't perfectionism but more about loving you for you no matter what size you are.
“I have now got a job as a shift manager at Starbucks and I am going on a self-love retreat to Bali for two weeks. I am also studying counselling as I would like to help other people”.
Miss X stated “The service really helped me but because my GP did not seem to understand my illness it took a long time to be referred to the Eating Disorder Service. I would have liked to be able to talk to someone who understood my illness while I was waiting to be seen”.
Figure 1: A picture created by Miss S.
The Eating Disorder Service is delighted with this feedback. Areas of activity relevant to the issue of delayed referral raised in this patient’s story are:
- The service offers self-referral so patients do not have to wait for GPs to refer them to our service.
- The Eating Disorder Service has undergone investment in the 2015/16 to develop a 4 week from referral to treatment for routine referrals to the service and towards which it is working to achieve a 95% compliance rate by 2020.
- The education and training offered by the service to local GP education events about eating disorders and the local service available from the Trust to improve our colleagues in primary care awareness of Eating Disorders and the service.
Mr C is the husband of Mrs C a 76 year old woman from London. Mrs C was an inpatient in Ashmore and Shaston Ward, Westminster Memorial Hospital, between 29 March 2017 and 25 May 2017.
Mr. C explained how they both came to be in Dorset. Mrs C had been diagnosed with Parkinson’s disease and because her health was going to decline further Mr. C sold their flat in London and purchased a smaller place. This new ground floor flat was to be altered to ensure that their new home was suitable for Mrs C. This would involve significant building work.
Whilst the building work was being undertaken they moved down to Dorset for the beautiful countryside and to escape the disruption. Mr. and Mrs. C had loved France during their marriage and he planned a “last adventure” with his wife so that she could enjoy a last holiday whilst her health allowed. Unfortunately Mrs. C became very unwell and she was taken by ambulance to Yeovil hospital. After assessment and treatment she was eventually moved to Westminster hospital for rehabilitation.
“This place is a blessing” said Mr. C. “The occupational therapists got my wife moving and all the staff are extremely patient and helpful. Everyone was so encouraging to us both.” Mr. C was given a Carer’s Passport and said the ability to come and go whenever he wanted meant he was really involved in his wife’s care.
Mr. C said that every element of the care his wife received was explained to him and he felt fully aware of what was happening and why. He sat in on meetings to discuss her care and it was tough to hear the honest truth from consultants who explained her prognosis. He said “it hurt but it had to be done” and he was grateful that he was fully involved. Her medication was reduced from ten tablets a day to 5 to help her mobility issues. He was concerned about her Parkinson’s being managed with reduced medication but felt supported by the team and happily her mobility increased and she did not appear to have suffered as she remained bright and cognitive.
Mr. C explained that the preparations for discharge started fairly early with discussions with him and the rest of the family. We went through a “pros and cons” written exercise with the family and the biggest benefit for moving back to London was his wife’s closest friends could see her more often and her family could be involved. He said he was personally conflicted as he would have preferred to stay in Dorset as the county had really grown on him. However he recognised he had to put his own wishes lower down on his priorities and he realised that he would need additional help to care for his wife. So the decision was made that on discharge they would be returning to London.
Unfortunately there were issues with the housing situation in London as the building work had not been passed by the local council which meant a delay in discharge. The discharge coordinator explained that they would not be “thrown out” as his wife was physically well enough for discharge. He said that he felt incredibly guilty that they were using a bed but the team reassured him that this was not his concern and that he and his wife would go to London as soon as everything was organised.
The ward manager advised that Mr. C was so supportive of his wife and he would dance backwards whilst supporting her to get her moving. The ward staff found this charming and the other patients laughed and enjoyed watching them dancing together.
Mr. C said he was now looking forward to returning to London as he loves the museums and live music. He said that one suggestion he would make, would be to suggest that the Trust looks into the Parkinson’s Classes that the English National Ballet run. His wife had always loved the ballet and they attended for five years prior to their move to Dorset. The classes include dancing to the music from the ballet that the company are performing for that season. He also said the social interaction was a key benefit from the classes, particularly for those patients who live alone.
In addition he said that patients suffering with Parkinson’s need stimulus and the staff work really hard to provide that. He felt that a Sunday Lunch where the patients sat around a table, as they would do at home, would be a great idea and something to look forward to.
Mr. C said the flexibility of the Carers Passport was really great. He knew when the OT would be seeing his wife so he could be there for the “dance class”. Mr. C said “I can’t say thank you enough. The care my wife has received has been second to none. The lovely staff care so much and their interest and involvement in my welfare has been very touching.”
It was lovely that this positive patient experience was captured so well by the Patient Experience Team, who met with Mr C.
The problems with housing issues that were highlighted were dealt with in a timely manner through the coordination of our Discharge Facilitator and the team as a whole. We always strive to ensure the involvement of all those concerned; with the patient remaining always as our main focus.
The frequent ‘dancing’ between Mr & Mrs C was both enjoyable to watch and certainly beneficial to Mrs C ‘s mobility. It has long been recognised that patients with Parkinson’s Disease can benefit from music therapy, and I plan to discuss this further with our Parkinson’s Disease Nurse Specialist.And finally, I totally agree that our patients benefit from our activities which on occasion includes ‘lunch club’ in which patients sit together; I have encouraged our staff to increase the frequency of this activity wherever possible.
Mrs R is a 71 year old woman who lives in Blandford Mrs R was found on the floor of her flat by a senior care assistant on 18 April 2017 and taken to accident and emergency at Dorchester County Hospital. She was found to be suffering from a urinary tract infection and to have a very low insulin level. Treatment commenced and she was admitted to Tarrant Ward 24 hours later to continue her recovery.
Mrs R explained “I don’t remember being in Dorchester Hospital, my first memory is arriving at Tarrant Ward”. Mrs R explained “I had been taking my insulin but I didn’t seem to have any appetite, which I feel was how I started to become ill. I must have been hallucinating as well as I thought I was going to an orthopaedic appointment, in a taxi and then later thought I was on trial for my life!”
Eventually, I became aware of where I was and the staff really helped me. “The food was wonderful and the nurses were so special they must have had intensive training. The nurses kept on top of my drugs, I used to take my insulin 4 times a day and they altered it to two times a day, I wasn’t sure, but it did the trick, I am fine now on less insulin”.
Mrs R said “I enjoyed being on the ward and the therapy that I received. The nursing staff were always available if I needed them but they allowed me to be as independent as I wanted to be. I took part in quizzes on the ward which I really enjoyed.” Mrs. R said she had her haircut whilst an inpatient which made her feel good. She really appreciated having help to have a shower and wash her hair as it gets dirty quickly when you are unwell.
On one occasion the ward organised a visit from ‘Lofty’ a therapy horse. She said “I had been around horses when I was a child and it brought back lovely memories. I thought it was funny that the horse had shoes on and was amazed it did not slip!”
“While I was in hospital I set up a memory box with the Occupational Therapist which was lovely. I enjoyed being taken out on to the patio, it felt like a secret place to enjoy the fresh air, it made my day as I was in hospital for a month”. Mrs. R recalled. Mrs R said “The patient next to me kept trying to get out of bed, so I kept ringing the bell so staff could stop her from getting out of the bed. I felt guilty as the staff were so busy but realised I was helping the staff and helping the patient from falling again. I enjoyed helping the patients around me”.
Mrs R explained that she watched over another patient next to her who had dementia. Because of her dementia she used to swear and I would suggest she used a politician’s name when she wanted to swear “I knew it was the dementia and not her, she was a lovely lady and I did her exercises with her to help”. The staff referred to us as ‘The Naughty Girls Club’, we had a good laugh”.
Mrs R summarised her experience “Woe betide anyone that closes Blandford Hospital as it was wonderful. It’s the very best I’ve been in, and I have been in a few. The nurses put up with me and I know I can be difficult at times, particularly when I was so unwell”.
Mrs R was taken to her home for a pre-discharge visit by a member of the Integrated Rehabilitation Team (ICRT) to assess whether her home had equipment in place to ensure her return home would be to a safe environment. Mrs R was discharged from Tarrant Ward on the 16 May 2017.
Tarrant Ward Feedback
This story will be shared with the team, it is always lovely to hear how the great care we deliver has made a difference to our patients and supported their recovery. The visit from Lofty the therapy horse was greatly appreciated by both patients and staff and we look forward to his next visit in December.
This patient story includes:
• The disorientation felt by a patient in a semi-conscious state with an infection.
• The importance of therapy in a patients recovery.
• The interpersonal relationships on the ward can help patients feel relaxed and happy.
• A positive response to her admission and her appreciation of the ward staff in her recovery.
What has the Trust learnt?
That occupational therapy plays an important role in the patients’ recovery. Personal care and
normal activities such as hairdressing and being taken outside improved her wellbeing.
The reason for the hospital stay was her physical health but her wellbeing was equally
Actions taken:Mrs R did not have any suggestions for improvement.
Monica (not her real name) is a 29 year old woman who was diagnosed with psychosis and bipolar disorder in January 2016. Monica said there is a family history of mental illness, her mother suffers with alcohol misuse, her father with depression, her maternal grandfather with depression and alcohol misuse and her maternal aunt with bipolar disorder, but this was the first time that Monica herself had experienced this.
Before her illness Monica was a successful accounts manager who travelled the country and lived in a shared house. She now feels she has nothing following her illness and the ten months since her diagnosis and the time she spent in hospital.
Monica was taking antidepressant medication prescribed by her GP. But she knew that she was not feeling well. Having previously taken illegal drugs she explained she felt ‘high’. She contacted her GP who suggested that she increase her dosage of her antidepressants, however Monica stopped taking them instead. It is not known how long after stopping her medication, but this led to her feeling even more unwell and feeling very ‘high, so she called an ambulance, as she knew that she needed help.
Monica was admitted to Seaview Ward St Ann’s Hospital, following admission from Poole Hospital in January 2016, and was then transferred to Chine Ward two days later.
Monica felt that Chine ward did not manage her illness well as she felt that she was not getting better.
Monica felt that she was being given the wrong medication to help her and that they could not get her medication right. She did not sleep for many nights as she did not feel safe, this was mainly due to the way her illness made her feel, and also other patients, who she found to be noisy, aggressive and intimidating. The lack of sleep led Monica to become aggressive and violent to both staff and patients. She needed to be restrained and have rapid tranquilization on many occasions and Monica said that as a previous rape victim earlier in her life, being held down made her feel even worse. This was known to staff at the time of her admission.
Monica continued to be violent, and at the time of her hospital admission there was no provision for female intensive therapy beds at St Ann’s Hospital, so Monica was transferred to a hospital in London for further treatment. Monica stated that the move to London made her feel worse and that her medication continued to not work effectively, she thought that she was in a hotel but was being restrained by someone. She tried to escape frequently. She felt like she was in prison and was only allowed half an hour’s break each day, Monica also felt the hospital was dirty.
After a month in London Monica was discharged back to her parents’ home in New Milton. Unfortunately, Monica quickly became unwell again and was readmitted to St Ann’s Hospital in May 2016. Monica continued to be violent and had to be restrained on numerous occasions. Her care team at St Ann’s suggested that she have Electroconvulsive Therapy to try and help improve her behaviour/violent outbursts and to manage her illness. However, her parents felt that this was an archaic treatment and refused for her to have this. Monica was therefore transferred to a different London hospital in July 2016 for further treatment, as there was still no provision of female PICU beds in Dorset at that time.
Monica felt she was bullied and racially abused by other patients during her stay in the London Hospital, as she was one of the few white patients there. They took some time to get her medication under control, and during this time Monica suffered many side effects from the medication she was taking, and she also felt that this hospital was dirty as well. She felt isolated, as her friends could not visit and her family were not nearby for support.
After a month in London Monica was transferred back to St Ann’s Hospital, again initially to Seaview Ward, but she was then transferred to Chine Ward, to stabilise her medication and to support her discharge into the community Monica was discharged in October 2016 to the Early Intervention Service (EIS) .
Monica feels that this admission was much better than her previous one, as the staff in the main were caring. Monica felt she was able to be involved in her treatment and care, was given more leave and had the support of her family and friends nearby.
Monica explained that staff on Chine ward, helped her to find a place to live and she was discharged to the YMCA in Bournemouth following completion of her inpatient stay.
Monica is now under the care of the Early Intervention Team (EIS) and says that their support is ‘phenomenal’ and that she cannot fault the care and support that she has been given by the team. Monica has a really good rapport with her support worker and is also under the care of a psychologist, which is enabling her to talk about her care at St Ann’s and her previous sexual assault.
Monica is currently working part time but is aiming to return to work full time in the near future with the support from the Early Intervention Service.
From EIS team
Monica will benefit from being able to tell her story and will feel listened to. If she feels that telling her story might help to change/inform future treatment for others then this would be a positive achievement for her.
From an objective standpoint Monica was very unwell for a sustained period of time and achieving the effective combination of medication was very difficult. However reading her personal account of her experiences and the consequences of these experiences highlights how we should all work together to improve care where possible and to also build on the positives.
Working with Monica since she was discharged from hospital she has consistently moved forward in her recovery through her own determination to rebuild her life. The team are really happy that she has managed to achieve so much in a relatively short space of time and look forward to continuing to work with her.
From Chine ward
As we did not have a female PICU Monica stayed on the ward longer than we have liked as we were aware of the consequences for sending her to an out of area PICU, which meant an unfamiliar environment, away from her friends and family, staff that did not know her and she did not know them, and we had little control over their choices of treatment.
Whilst Monica was out of area we stayed in contact with the PICU, with Monica, and Monica’s family. The hospital in London appeared to have a lot of ‘blanket’ rules and patients were not allowed mobile phones so this limited Monica’s contact with her family and friends. All visits had to take place off the ward as visitors were not allowed on the ward, meaning they needed to have staff escort, which affected the length of the visit.
For the new PICU at St Ann’s Hospital we have made a lot of effort to treat patients in the least restrictive manner and have tried to avoid blanket rules - phones are not routinely removed - and if they need to be, the rational for this is clearly documented and if necessary a care plan put in place. Family can also visit on the ward, unless there are significant concerns.
We agree with Monica with regards the out of area placements, and on her first admission there we made the decision to get her back to St Ann’s as soon as possible as the environment was in our view, not conducive to her recovery.
As we did not have PICU provision locally to support Monica, her family were supported financially by the Trust with reimbursing travel cost and expenses thus ensuring that they were able to visit their daughter regularly when she was in London.
Sam is a 27 year old young man who was diagnosed with Schizophrenia, diabetes and other disorders related to excessive alcohol intake. Sam has been sectioned three times under the Mental Health Act over a five year period between 2007 and 2012. He was first sectioned after a Ketamine overdose at the age of 16. Sam currently lives with his father in Lyme Regis after moving from Sherborne. Sam is a very reserved young man and his father assisted him in sharing his story.
Sam’s mother and father had been through a difficult split and his Dad felt this was the start of Sam’s problems. Initially Sam was still living with his mother when they were in Sherborne. Sam’s Dad explained that he knew he had to get more involved when Sam had been sectioned for the third time. He was scared that he could lose his son forever. He hoped to move Sam away from the influences he felt were having a negative effect on his son’s life. Eventually Sam and his Dad managed to move to Lyme Regis and they now share a flat.
Sam was originally under the Community Mental Health Team and was referred to Sarah, the Support Transition and Recovery Service (START) Worker in July 2016 for help with his recovery. After completing the “recovery star” where Sam’s areas of interest were identified, it became clear that Sam was very keen on improving his fitness. He also understood that his alcohol intake was detrimental to his diabetes and mental health. Sam had a huge barrier as he was worried about using public transport to get to Bridport to exercise.
Sam’s main identified interest was his love for animals. Sarah suggested volunteering at an animal sanctuary called “Ferne” in Chard however the location, again, was an issue, as there was no regular public transport. However Sam was happy to apply and deal with the travel issue should he be given an opportunity. Whilst waiting for an opening to arise at Ferne, Sarah encouraged Sam to take up other volunteering opportunities but he remained focussed on working with animals. There was a long period of waiting for a suitable opportunity to arise and his engagement faltered for a while. One day whilst Sarah was walking back to her car from meeting with Sam, she stopped to talk to a local trader who had a dog sitting outside her shop. They chatted about the fact that the dog enjoyed sitting outside but, when she was busy, she could not take the dog for a walk. Sarah asked whether she would consider talking to Sam about him helping her with the dog. When Sarah had spoken to Sam he visited the shop by the end of that day. Sam now walks the dog 4-5 times a week and has been referred by the local trader to other friends to walk their dogs.
On speaking with Sam he makes it clear that his is in a much better place now. In the last four years he has not been sectioned. He said there are a number of issues which have been important to gain that stability in his life.
Initially his father moving in was a key change. He began to eat regularly and had someone who he could trust. Sam said that Simon, his Care Co-ordinator visiting him at home to organise his medication has been a huge improvement. He says the walk to the GP practice was over a mile away up a steep hill and with his fitness levels was difficult. Sam attributes a significant impact to the change in his life to achieving his aim of working with animals. He says that he loves to walk the dogs, which he does individually for about an hour at a time. Also having made a commitment to walk the dogs makes him get out of the house and not sit around and drink alcohol. He has lost weight due to the walking and his mood has improved considerably. The fact that the community are supporting him has also increased his self-worth and is beginning to embed both
Sam and his Dad into the local community. Sam’s Dad has also been signposted to carer’s services by Sarah who is keen to ensure he is not feeling isolated and unsupported. Sam and his Dad both feel the journey is not yet ended and there is still a lot of work to do. However they feel positive about the changes they have made together. They continue to feel supported by Sarah and know if they do need additional help she is there.
Sam’s story includes:
• The importance of family support;
• An holistic approach to the patient;
• Thinking outside of the norm to support patients;
• Healthcare workers knowing and working with the local community to support patients;
• Understanding barriers and working to minimise those for patients
• The positive impact of having commitments to an individual
Mrs. X and Mrs. Y both stated that they were extremely happy with the approach of the hospital in general to the patient and the family, and the care that Mr. X received was second to none. Mrs. X and Mrs. Y said “the attention we received as family of a patient at the end of his life was absolutely amazing”. They wanted to let the Trust know that overall they would not have wanted Mr. X in any other hospital. There were a few incidents which they did want to raise; however, they were very clear that these were a small percentage of the experiences on Tarrant Ward.
On admission Mr. X was being asked questions as part of the admission procedure and it became clear that Mr. X and Mrs. X (she was single at the time) were not married. Mr. X explained to the nursing staff that it was a great regret that he had not married the love of his life. He felt it was now too late to make this happen. The nursing staff were touched by Mr. X’s statement and immediately got to work to see if the hospital could support the couple to realise Mr. X’s wish. Within seven days a wedding had been arranged by the staff and no detail was overlooked, from the invitation list to the food, drink and decoration of the wedding room. “It was so amazing” said Mrs. X, “I even had music to walk into the ceremony thanks to the Matron, Darren”. The decorations were throughout the public areas of the ground floor and Mrs. X was so touched to see other staff watch her walk down the corridor on the big day. “Nothing more could have been done for us on our special day and we were both so happy.” she said.
The staff approach and attitude during Mr. X’s care was one where Mr. & Mrs. X and Mrs. Y felt they became part of the Blandford Hospital family. Staff would pop in for a chat and to see how Mr. X was doing and he enjoyed their visits. Mr. X gave some staff nicknames as he had such a personal relationship with them.
Mr. X was a man who had worked outside for most of his life and he found the first side room he was settled into a little claustrophobic. The windows were very high and there was no view apart from a small area of sky. He was moved to a nicer room eventually where the windows were large and he could look out onto the fields which he greatly appreciated.
Although the ward was being used for End of Life care some aspects of the ward Mrs. X and Mrs. Y felt were inappropriate. The fact that the ward was very warm and there was no way of turning down the temperature within Mr. X’s room meant that they opened the door to his room which mean sometimes privacy was difficult.
Overall the family felt that if End of Life care is going to be provided on a more regular basis on Tarrant ward they wanted to highlight:
- A nurse discussing the last wishes of Mr. X with the family when he was sleeping in the same room. The family were concerned Mr. X could overhear as he sometimes dozed. Despite asking that the conversation be carried out elsewhere, the nurse said that it was fine and continued.
- In one incident an HCA appeared to lose her patience and threw Mr. X’s glasses to the bottom of the bed. A report was made by other members of staff who witnessed the incident.
- In another incident, the same HCA did not give the patient the opportunity to go back into his chair after using a bedpan. The patient had been unable to use the bedpan earlier and it appeared the HCA was unhappy that she had moved him twice. Mr. X went back to the bed against his wishes, as he felt the HCA did not want him to go back into the chair.
- A senior member of staff made the family feel that Mr. X had outstayed his welcome with her references to bed availability and her budget.
- The doctor from Weldmar Care prescribed medication to help Mr. X sleep. Medication was advised for 6pm to help with his anxiety, however the nurse practitioner said this was not possible as the medication round was at 8pm.This had a knock on effect, as Mr. X was then given a sleeping tablet as late as 1am, which resulted in him sleeping late and frequently missing meals.
- The family brought food into the ward as ward food was thrown away rather than being kept for Mr. X when he awoke.
- At one point Mr. X asked his sister Mrs. Y to move him as it was hurting him when some of the HCAs were moving him. In addition on one occasion his scrotum was torn through inadequate manual handling.
The family are keen to ensure that although there are a number of incidents raised they also wanted to highlight the superb care Mr. X received above and beyond the call of duty.
- The Wedding!