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					                    East Cheshire NHS Trust Patient and Public Involvement Forum

Visit:         To the Paediatric Unit

               Wednesday 23rd March 2005 at 2pm

Visitors       Ray Walker Barrie Towse


Prior to the visit we were able to meet over lunch with Grace Hopps, Maternity and Children‟s Services
Manager, and discuss with her the current consultation and proposed changes within these services.
There are concerns that as a consequence of the Greater Manchester, High Peak and East Cheshire
Children‟s Review, Macclesfield will no longer provide 24 hour in patient care and that this will impact
upon the type of Maternity care provided. The East Cheshire Trust has put forward its own proposals for
change of service. We have asked whether we may be party to these proposals.

We were joined at the Paediatric Unit by Adrian Hackney, the Medical Division Manager, and shown
around the Unit by Anne Stanton the Clinical manager.

Occupancy/Length of Stay/Facilities

The Unit consists of 23 beds/cots of which 21 were occupied at the time of the visit. Average occupancy
is 50%, this information being gathered, as in all hospitals, at midnight. This however excludes quite a
large traunche of activity when children are admitted in the early hours but are well enough for discharge
before the following midnight. The average length of stay is 1.2 days. Children are cared for in two six
bedded bays or in single rooms, some of which have en suite toilets. Babies and toddlers are cared for in
single rooms to assist with sound insulation. There is the facility for parents to stay overnight using
folding beds by the side of the child. This is much appreciated by parents. There is quite a large
playroom and an outdoor play area.
It is intended that day care surgery be undertaken on the new Day Care Unit, children being cared for by
staff from the Paediatric Unit.

Hospital at Home

The Unit still operates Hospital at Home. Some children are sent home but remain under the care of the
Consultant Paediatrician and a team of 3 RSCNs from the Unit until well enough to be discharged to the
care of their GP. This means that children spend as short a time as possible in hospital. Some children
who have been in other hospitals but live within the area are cared for under this scheme.
Cleanliness/Cross Infection/Decoration

[In addition to their own powers of observation the visitors used the “Bug Watch” checklist as
appropriate.]
The Unit appeared fresh and clean. It is brightly and appropriately decorated although we observed that
the decoration tends to be aimed at the younger age group with cartoon characters. Some action has been
taken to rectify this with the very pleasant redecoration of the Playroom on a bubbles theme. Shower
rooms and toilets appeared clean and odourless. Toilets, hand basins and mirrors were of suitable height
for 8-10yr olds although perhaps not for (some) teenagers. We were told that teenagers were allowed to
use the adult facility (provided for parents). A nurse was observed washing her hands between caring for
children and a doctor wearing a colour-coded apron to undertake a procedure. One small patient with
complex needs had MRSA and was cared for in a single room. The little boy had swabbed positive for
MRSA before his admission. We were pleased to note a Care Plan was displayed on the outside of ward
doors which explicitly states how, and with what, the room should be cleaned and that gloves/protective
aprons be worn.
We noticed that the side of the nursing station counter had been damaged, presumably by a trolley. This
could be a cleanliness hazard.
The ward has a link „Control of Infection‟ nurse and staff were aware where the Control of Infection
manual was kept on the ward.

Staffing

All trained staff are Registered Sick Children‟s Nurses. The Unit also has two Play Therapists and a Play
Assistant. Children who have found hospital traumatic can return for sessions with the Play Therapists.
Children whose admissions are planned, can visit the ward prior to admission so that they know what to
expect. We were impressed by the personality of the Play Assistant and her friendly interaction with the
children. Doctors do not wear white coats and we noticed too that they were joking with the children
about who was getting Easter eggs.

Parents Room

There is a sitting room with television and telephone for the use of parents. There is an adjacent kitchen
where drinks may be made. We noticed that a teenager was using this room and felt that others in his
age group would be allowed to do so.

Provision of Toys/Hobby materials

There is a wealth of toys for the younger age group but we felt there was a lack of provision for older
children. There was no facility for patient selection of bedside radio or television sound. Unusually, the
selection of one channel had to be made for all beds at the entrance of that ward. Earphones were not
found at each bedside panel we were told that they could be provided. It seemed a poor state of affairs
that TV had to be provided with sound from the set and be audible to all in the ward when some might
wish to sleep.
We were able to talk freely with the children and parents. The children appeared relaxed and willing to
speak with us. Surprisingly, none admitted to feeling anxious about coming into hospital. “I wanted to
be made better.” “My leg hurt.” All felt that procedures etc had been explained to them. The mix of age
groups seemed acceptable even to the older children, with the exception of one mother who felt her son
did not like the food. He had been in another hospital and able to visit the restaurant to buy pizza. The rest
were appreciative of the food provided from a dedicated children‟s menu and served on the ward by
nursing staff. We were impressed by the illustrated Menu kept on the wards. There is access to the adult
menu for older children. One young man felt he could eat bigger meals and staff agreed to cater for this!
Two older children said they were kept awake by water dripping outside and staff said they would take
this up with the Estates Department.
With the exception of the one mother who felt her son did not like the food, all parents spoken with were
most appreciative of the care and facilities provided.
Both we and the Trust appreciate that there should be change in the provision of services to children we
feel it would be regrettable if there were no longer provision for overnight care for children at the District
General Hospital.

We would like to express our gratitude for the considerable time and courtesy extended to us during this
visit.




Questions

   1.       May we have sight of the Trusts proposals for the future of the service?

   2.       When is the damage to the Nursing Station to be repaired and attention to the noisy drips?

   3.       Would it not be possible to provide some jigsaws and a small “library” of hobby centred books
            for older children?

   4.       Can some attention be given to earphone provision and alteration of the radio networking of
            wards to include an option for TV sound on the main channels to which the sets may be tuned?

				
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