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?