NHS Care of Older People

Lilian Greenwood Excerpts

Thursday 27th October 2011 Westminster Hall

[Lilian Greenwood (Nottingham South) (Lab)]

It is a pleasure to serve under your chairmanship this afternoon, Mr Betts. Like the hon. Member for Mid Norfolk (George Freeman), I must apologise that I have to leave at 4.30 pm, so I may not hear all the contributions that are made.

I congratulate the hon. Member for Stourbridge (Margot James) on securing this vital debate and on asking many important questions about quality of care and patients’ experiences of hospital. In addition, I welcome the contributions that have been made by other Members, which have been very important in fleshing out those issues.

I will make quite a brief contribution to the debate. Hon. Members have rightly recognised that, although there are some serious concerns about the care of older people within the NHS, there is also good practice that we can build on. So I will limit my remarks to giving one example of good practice that I hope will be of interest to hon. Members.

Earlier this year, I visited Queen’s medical centre, which is one campus of Nottingham University Hospitals NHS Trust. For those who are not familiar with it, it is a major acute and teaching hospital in Nottingham. While I was there, I visited ward B47, which is an acute medical ward for patients with dementia and delirium. Ward B47 has received a national health and social care award for mental health and well-being, and it was highly commended for putting patients and the public first.

While visiting ward B47, I met Professor Rowan Harwood, who is a consultant in health care of the elderly, Caron Swinscoe, who is the clinical lead for dementia, the ward’s matron, Ali Cargill, and Louise Howe, who is an advanced practitioner in occupational therapy, specialising in mental health services, and who spent 10 years working in mental health before she came to work on the ward.

Queen’s medical centre set up the medical mental health unit as part of a collaborative research project between Nottingham University Hospitals NHS Trust and the university of Nottingham, which was funded by the National Institute of Health Research and the Department of Health. The unit at Queen’s built on earlier work in 2005 by the Royal College of Psychiatry, which had shown that patients with dementia and delirium formed a large proportion of in-patients in acute general hospitals and that they had much worse outcomes than those in-patients with less complex problems. The unit was specifically designed to start to address that situation.

Ward B47 is a 28-bed ward, with three registered mental health nurses, a specialist mental health occupational therapist and an activities co-ordinator. Those staff members are working together with an existing multidisciplinary team, which includes an occupational therapist with experience in discharge planning. That new team was set up in January 2010. In addition, the environment of the ward was changed and all staff were given additional training in person-centred care.

In this debate, hon. Members have quite rightly spoken about the Care Quality Commission’s findings in relation to quality of care and about what are, in some cases, the extremely distressing experiences of their own constituents and families. Even where care is good—I am pleased to say that, in most cases, it is good—hospital admission can be a distressing and frightening experience. For older people with dementia, hospitalisation can be even more difficult and confusing. Families often report concerns and anxiety about the effect that a stay in hospital has on their loved ones, even where care is good.

My first impression on entering ward B47 was that it was different from other wards that I have seen. It was a calm but stimulating environment, and I will say a little more about the physical aspects of the ward. The most obvious difference was that there was a central activities room where a number of patients were taking part in activities supported by the co-ordinator and other staff. Even in the short period that I was there, I could see that the activity that was under way—patients were playing a game that involved throwing beanbags on the floor—encouraged physical activity. Obviously, people’s abilities were different, but the staff encouraged those who could participate to do so. The activity prompted conversation, interaction and engagement, preventing people from becoming isolated and allowing other staff to spend time with the more unwell patients who required more attention—a subject that other Members have touched on.

The ward’s staff explained how and why they were doing things differently. In making my remarks, I draw specifically on an article by Louise Howe, the occupational therapist, published in OTnews in May 2011. In it she states that the staff had observed that many patients lost their ability to function independently during a stay in hospital, and she gives a typical example. An elderly woman who had been living independently was admitted to hospital and, although forgetful, was able to carry out daily tasks such as preparing a meal. After a month, the occupational therapy team carried out an assessment and found that she was having difficulties recognising and using everyday items. The team was concerned that when she was discharged she would struggle to live safely in her own home—to cook and be around hot objects—and that prompted Louise and the OT service to come up with an approach to maintain patients’ abilities while in hospital. Essentially, they would assess patients’ level of function on admission—how able they were to wash, dress and self-care—and develop an individual care plan that all staff would work to, to help patients to maintain activities and skills. Patients would then be reviewed on discharge to see whether the actions had been successful.

The team also started to change the environment to make it more enabling for patients with dementia, with clearer signage on the ward, large clear clocks—people like to be able to assess how long things take—redecoration to make the individual bays look unique so that patients could distinguish their own beds, and memory boxes above beds to display personal items and make the environment more welcoming. The ward also commissioned photographs, showing staff and patients talking, completing self-care tasks and participating in group activities, and they were displayed around the ward to provide comfort and reassurance. Although that might sound like a small thing, staff and patients and their families reported that it was a welcome and positive move.

The occupational therapy team has strengthened links with community mental health services to ensure continuity of care after discharge, and has built links with bodies such as the Alzheimer’s Society, which provides a weekly advice and support service on the ward. The unit’s work is being researched by the university, which is looking at a number of measures—with a properly assessed control group—to compare mental state, delirium, pre and post-admission function, quality of life and carer feedback. The response from staff and visitors has so far been positive, the findings look good, and the team is looking to develop the ward further, for example by providing a more comprehensive programme of activities, including in the evenings when patients can become particularly distressed. It is also considering breakfast and afternoon tea groups to encourage patients to maintain their domestic skills, and the provision of sensory stimulation for patients who find interaction difficult and relaxation for those who find the environment over-stimulating.

I appreciate that my contribution has focused on one ward in one hospital and that there are many issues to address, but I hope that where there is good practice in the care of older people in an NHS hospital it can be used effectively to improve quality of care and patient outcomes across the wider health service and that we have the resources to enable that to happen.