1. Rampton Hospital Care Opinion and Quality Improvement Adele Fox Head of Clinical Operations

2. Why did we use Care Opinion?
Patients raising concerns in the Open Forum
Increase in complaints with specific themes
My hunch!
Lack of individual feedback

3. What did we do?
Arranged for volunteers external to Rampton who they knew to work with the Patients
Asked 5 questions:
1. Do you feel cared for?
2. Do you feel involved in your care?
3. Do you feel safe?
4. What good things happen here at Rampton?
5. What things would you change?
The volunteers met with individual patients and canvassed there views

4. Pro’s and Con’s Pro’s Con’s Individual Voice heard 1-1 support
Confidential and Anonymous
Confident to speak out
No Internet Access
Patients abilities and understanding
Feedback loop
Rampton Time!

5. Outcome You said we did! Themes were recognised and highlighted
Feedback to patients, on noticeboards in easy read
Met with them all to feedback
QIP

7. “They should set up an Anti Bullying Scheme”
My nurse sits with me, to do my care plans, and asks me questions and listens to me. I have felt bullied by patients, they try to bring me down. An anti bullying scheme should be set up. I really like activities at Southwell day centre.
Adele Bryan Wrote:- The service agrees with you regarding the anti bullying scheme, and it should be happening from September, it can be difficult living with other people. In the mean time please speak to your ward manager if you feel bullied, and they will support you.
“I like getting off the ward”
I don’t think I have a care plan—I like getting off the ward, and look forward to Monday Shopping.
Adele Bryan Wrote:- All patients should have care plans, and you can help to right them, and have a copy to keep. Ask your Named Nurse to go through your care plans with you, and talk about what you are happy with, and what you would like to change.
“ I want to move closer to home”
I have care plans, but I won’t sign them, I feel cared for by my named nurse. I want to move closer to home.
Adele Bryan Wrote:- You need to be more involved in writing your Care Plans, then you may feel able to sign them.
Being away from your family can be upsetting, and visits from your family can be to far apart. Working hard in your therapies, and with ward staff, you will be able to move to a less secure hospital, nearer to home.
“ I don’t know if I have a care plan”
I don’t know if I have a care plan.
I feel bullied by the staff, and force me to go for walks. I’m Lazy.
I don’t like hot weather, I like going to Southwell day centre and cold baths. I like talking to my Drs and Nurses.
Adele Bryan Wrote:- Staff are sometimes trying to motivate you to leave the ward, and you may feel they are bullying you when this happens. If you feel staff are bullying you please talk to your ward manager, or deputy matron. It’s good you like going to Southwell.

8. “I feel cared for by my named nurse”
I am involved in my care plans and CPA, and get a say in what goes in them. I think new staff should come to wards for coffee mornings—especially new OT’s. I feel cared for by my named nurse, he helps with home visits, and my care plans. I have been bullied in community meetings, but we can have support in these meetings, and have a 1:1.
Adele Bryan Wrote:- Good idea about the new staff coffee morning, I will try and set this up, bring it up at patient forum so it ends up on the action plan, and has to be done. Thanks for the great idea!
We are doing some Anti bullying awareness training in September, so hopefully this will help you feel better, as living together can be difficult. I’m glad you feel supported and cared for by your named nurse.
“Sometimes they talk to me really well”
Most of the time they go through my care plan with me, then I get a copy. Sometimes they talk to me really well, and are supportive, sometimes not. No one is really doing anything about staff who are abrupt or their attitude. Activities get cancelled and low staffing levels don’t help. I don’t like spending time with my named nurse.
Adele Bryan Wrote:- It’s good that you are involved in your care plan, and have a copy, but it’s a shame you don’t get on with your named nurse. Please speak to your ward manager or Deputy Matron so they can try and resolve some of your issues regarding the way some staff speak to you. Or you could speak to your advocate.
”I like groups in the day time”
My named nurse is wonderful, she is the best, and nothing can be improved as I like to see the same nurses. I like groups in the day time, I like the food, the menu is good, and there are lots of things.
Adele Bryan Wrote:- Thank you for the great feedback, I’m really pleased you have a good relationship with your named nurse and feel they are supporting you.
The menu is based on feedback, good and bad from the patients so thank you for your nice comments.
“ My nurse is kind to me”
My named nurse helps me to be clean and tidy every morning, and is very kind to me. My nurse does talk about care plans for me. Having staff around makes me happy, but Southwell day centre could open a bit more, so I can play in the LD band.
I would like more photos to help me choose food.
Adele Bryan Wrote:- Great news that your nurse helps you with your daily living tasks. It is good to come an and watch the band, and it’s good for you to play in it, and feel part of it. I will pass on the information about the food pictures.

9. “My nurse talks with me, which I like”
“ Kempton Ward—Learning Disability Service”
My named nurse is sometimes kind to me, but if I’m not being good they take my radio and teddy bear off me at night. I love my teddy bear, and don’t understand when they take things from me. I think I have a care plan, but I’m not sure. I like to visit the shop and Southwell day centre—the staff are nice there. I would like to go more, but if I’m I don’t seem to go, why is that?
Adele Bryan Wrote:- I’m sorry you don’t seem to have things explained to you, like when you can have access to things. I would like to speak to your ward manager to ask her to go through your care plans, and see what you need to do to get off the ward to Southwell day centre more often. There will be a care plan to keep you safe, which will explain why you can’t have things in your room, but you need to see this to help you understand why. Your ward manager will help you have access to items, and visit Southwell more.
“My nurse talks with me, which I like”
I have 1:1 sessions with my named nurse 2-3 times a week, we go through my care plans, what I like , what I don’t like, this even happens when they are on nights. If I have had issues with other patients have had mediation - I have never felt intimidated. Staff treat me with respect. I think the food has Improved, and I would like to be able to ride a bike?
Adele Bryan Wrote:- It’s great to hear about your positive relationship with your Named Nurse. Mediation is a positive way to sort out your differences with peers. I will pass your comments to the catering manager, and push bikes are being looked in to.
“I like being involved in local staff Induction”
I do feel involved in my care plan here, and I’m happy to sign it. I’m in the process of swapping my named nurse, but I do get on really well with my current named nurse in my 1:1’s. I think you need more staff here. I like the art work, and really enjoy the responsibilities of local staff induction and representing my ward.
Adele Bryan Wrote:- It’s really good to hear that you have a good named nurse, and feel supported, I hope you continue to feel supported with your new named nurse. We are continuing to recruit, so you will see new people on your ward. There are currently more staff than ever but I can understand it may not seem like it when they are supporting other patients who are unwell. It’s great that you are involved in the staff induction, we wanted patients to tell new staff what they need, and what living at Rampton feels like. Staff have fed back that it was really useful to hear what's important for patients, so well done and thank you for supporting our new starters.

10. “More staff so we can do more things”
“The food could be better”
· My named nurse is very helpful, they involve me in my care plans, and to have a befriender.
· I feel bullied here sometimes, there is lots of name calling, which is upsetting.
· I think the food could be better, it hasn’t really changed, the quality could be better.
Adele Bryan Wrote:- I’m really glad you have a positive relationship with your named nurse. Lots of patients are mentioning bullying, so we have listened and we are doing training in September to help you all to live together.
“More staff so we can do more things”
I am involved in my care plans, and I do sit down with my named nurse. If I have a problem my named nurse talks it through with me. I think we need more staff here so we can do more things. When we have enough staff to get off the ward which is good.
Adele Bryan Wrote:- I’m really pleased you feel cared for and supported, that’s important in supporting your recovery. Staffing on Kempton is extremely high to support the clinical needs of patients who are unwell.
Southwell does a lot of sessions you can attend without ward staff, so try and get to them if you can. They have recently had a band to play, and a professional table tennis player. I hope you can attend them and enjoy them in the future.
“I get the help and treatment I need”
I’m involved with writing my care plans, I feel cared for by my named nurse, and she speak up for me. If I ask for things she will do them, even if later in the day. I have not seen any bullying, just name calling, I feel I’m getting the treatment I need.
Adele Bryan Wrote:- Thank you for your very positive thoughts.
With regards to the bullying, this has been bought up a few time, so training and awareness for patients will be made available, to help you all live together, despite the challenges.

11. Patient Feedback
Positive feedback about feeling cared for by Named Nurses
Felt safe with staff support
Didn’t feel safe from other Patients
Didn’t feel involved in their own care planning
Didn’t understand restrictions
Felt bullied by staff & patients

12. Staff Feedback No blame Lessons learned Interactive Felt involved
Informed future practice

13. Quality Improvement Plan
Anti Bullying training for all staff
Staff Nurses to evidence involvement with patients in their understanding of their care plans
Anti Bullying / living together discussion with patients and drama presentation
To have an explanation on restrictions and how they possibly may improve access