Royal Edinburgh Hospital Patients Council
Annual General Meeting
The Hive, Monday 24 November 2014
NOTES
36 people attended the AGM.
Apologies
Apologies were received from Shirley Gowers, Dick Fitzpatrick, Kathleen
Stewart, Gwenne Mackintosh, Charlotte Mitchell, Linda Irvine and Susan
Hood.
Guest Speaker
Tim Montgomery, Director of Operations, Royal Edinburgh Hospital and
Associated Services (REAS) spoke about “the things that keep him awake at
night, both good and bad”.
a) The complex arrangements of REAS which has a £50 million budget,
mostly for 1200 staff. There are around 400 beds on the site, including
adult, children and older people’s mental health services, learning
disabilities service, forensic unit, brain injury unit, eating disorders and
trauma – varied and interesting but difficult to know everything
thoroughly. Tim gets five or six pieces of good news every day, and
five or six pieces of bad news. A letter or a card from a patient can
make everyone’s day.
b) The new hospital will have ground floor single ensuite rooms, gender
separation where appropriate, lots of public spaces, and has been
planned with Patients Council involvement from the start. It aims to
provide safety, security, and a quiet place to sleep at night. There are
some offices on the first floor but staff will spend most of their time out
on the wards. There will be 16 beds on each acute ward instead of 20,
but no reduction in staffing numbers. There will be 17 fewer beds
overall (5 adult, 2 IPCU, 10 older people) – this is considered to be
enough beds because more people can be cared for in their own
homes by the Intensive Home Treatment Teams. The bowling club
was allowed to finish its 2013 season before closing to make the site
available for the new brain injury unit. Patients will be involved in
deciding names of wards. Evidence suggests that providing a better
environment will reduce or eliminate incidents of aggression.
Rehabilitation services will be reprovided in the next phase. A
Learning Disabilities hospital will be built on the site of the ADC.
c) It can be harrowing or disappointing to hear bad things e.g. complaints
about staff attitudes. Most complaints are upheld so we should
encourage people to raise concerns, with the Patients Council, with
staff, or write to Tim. It can be harrowing to listen to families if people
are hurt here. But most people are happy with their care – please tell
staff, it is so rewarding!
d) The Mental Welfare Commission and the Scottish Government provide
invaluable feedback. They can identify standards the hospital has not
met, as well as the good stuff, and this leads to improvements.
e) Smoking on wards and in the hospital is a major problem because
other people are exposed to the effects of smoking, and smokers can’t
get a cigarette when they want. Most people use the smoking shelters
but there is still some smoking on wards. Drugs on the ward and
patients returning drunk to wards are also problems which affect other
patients and staff. Illness can be traumatic and cause concern to many
people. We need to be tolerant but also respectful. Following a
consultation, smoking in the hospital grounds will be banned from
March 2015. Tim will consult locally to see how to take this forward in
the REH, which is a very different environment from a general hospital:
residential area, long-term patients. It will be more challenging to make
the smoking ban work here and change the culture over time. So we
need a good working system that doesn’t bring staff into conflict with
patients. Each service has different issues. Legally, no-one has a right
to smoke. It is also a health issue. So people need to seek cessation
help. NHS Lothian will be employing two new workers, one of whom
will be based at REH. REH will begin to implement the no smoking
strategy in April but compliance will take a long time. We are
concerned about people who are on a locked ward and can’t get out,
and about people congregating at the front gates to smoke. We
wondered if e-cigarettes will be allowed in the courtyards. There is still
a lot of smoking on the wards so it will be hard to stop people smoking
in the grounds. More activities need to be provided to alleviate
boredom and combat smoking. Patients Council could campaign for
this.
f) Tight finances make it hard to prioritise everything you want to do such
as providing a great activities programme. REH is overspent, not safe
enough, not providing enough activities, and has not delivered the
savings it was meant to. There is concern that patients and staff get a
bad deal. However, REH have shown in the last few weeks that they
can do things differently: no patient has had to be accommodated out
of area and no ward has reached 100% occupancy, leading to a better
experience on the wards. The new hospital will probably be more
expensive to run, offering better activities, environment etc.
g) NHS Lothian has some supported accommodation and is planning
more, some on the REH site. One person suggested building a new
rehab hospital out at Hartwoodhill but we thought it would be better to
spend the money in Lothian. People get stuck in hospital with nowhere
to go which is detrimental to health. We need more emphasis on aftercare. We wondered if summer tourists ever need REH care but Tim
said this doesn’t really happen. There are a lot of homeless people in
Edinburgh who have perhaps lost their home through ill-health.
Relapses can be high in the adult population but it’s okay for people to
go home and come back when they get ill again. Does the hospital
help people to get better though? We need consistency – people have
to tell their story too often to different members of staff. There are
administrative problems passing information between the hospital and
the community - we need better links and better support in the
community. People spend less time in hospital now: for most people 810 days, with an average of three weeks. Too many people are here
much longer though. It seems to take longer to get accommodation if
you’re in hospital rather than in the community or homeless. The
Council doesn’t seem to take mental health issues into account when
assessing housing need. There is a big gap between hospital facilities
and community – perhaps step-down accommodation, such as flats on
the hospital site, would help.
We wondered about the potential dangers of patients carrying lighters.
We asked when people with alcohol problems would be allowed to access
psychiatric services. Tim acknowledged that people who use drugs and
alcohol can also have mental health issues. We’ve created separate services
and should be trying to integrate them more.
We wondered why there are restrictions on the library computers. Tim said
that they are provided by NHS Lothian who impose restrictions on all their
computers.
Notes of the Annual General Meeting 2013
These were approved.
Annual Report and Financial Report
Simon Porter, our new Project Co-ordinator, thanked management committee
members, volunteers and staff.
Alison Robertson, Chair of the Patients Council, described the Patient Quality
Indicator surveys which test how the wards are performing. We focus on the
patient experience. Our lived experience enables patients to trust and be
honest with us. The overall aim is service improvement. There is lots of
positive feedback but also concerns over staff ratios, lack of activities, patient
safety, smoking and consultant availability. Our volunteers provide group
advocacy on wards and work on hospital reprovisioning; Wayfinder PSP;
Stories of Changing Lives II; Safety, Privacy & Dignity; smoking, legal highs,
self-directed support, psychological therapies, nutrition etc.
Younger and older people are mostly happy with the care they receive
although boredom is a common concern. There seems to be a shortage of
occupational therapists throughout the hospital. Consultant availability can be
a problem for older people. Bed shortages, often caused by the unavailability
of appropriate accommodation in the community, cause real difficulties and
can result in patients with a diagnosis of dementia having to be
accommodated on Eden ward which is designed to cater for patients with
functional mental health issues.
Most of the Patients Council financial activity (i.e. staff and management
costs) is handled by AdvoCard. Our Trustees deal with volunteer,
membership and office expenses which can be seen in both the full annual
report and the summarised easy read version.
Election of Members of the Management Committee
Shirley Gowers, Ronnie Jack, Albert Nicolson, Alison Robertson and Patricia
Whalley were re-elected to the management committee.
Date of first meeting of new Management Committee
This will take place on 1st December 2014.
AOCB
We expressed concern about the number of older people who are ready for
discharge from the hospital but for whom no suitable accommodation is
available.