We undertook a simultaneous review of three hospitals managed by the Leeds Teaching Hospital NHS Trust. As part of our review we undertook an unannounced inspection on 4th and 5th August 2011 of St James's University Hospital, Leeds General Infirmary and Wharfedale Hospital.
During our inspections we spoke to a number of patients. Most people were satisfied with, and were positive about the care they received. They said they were treated with respect and that their privacy was maintained and their dignity was upheld.
At St James's University Hospital, people's comments included, 'They always pull the curtains round when dealing with you, 'Nurses approach in a very nice way and explain what they are doing. A few don't and just deal with the necessary care' and 'Treated very well'.
At Leeds General Infirmary, people said, 'Couldn't fault the care', 'Staff are cheerful and seem to listen' and 'Staff have been very good'.
At Wharfedale hospital we received comments that included, 'Have been in a few hospitals, this is one of the best. Staff are polite and friendly. Would choose this hospital in the Leeds area' and 'Hospital is first rate, come in regularly, have got to know nurses, they are all very nice.' One person stated that there are more staff than patients. During our visit, we observed staff tending to patients and did not see any issues relating to staffing levels on the ward.
Some staff at St James's University Hospital and Leeds General Infirmary told us that they did not believe there were sufficient staff at all times and as a result some people do not receive care in a timely way. For other people it was sometimes difficult to ensure their dignity was maintained while receiving care.
At St James's University Hospital, staff said that at times they could not always manage people's continence needs and they sometimes had to feed two people at once.
At Leeds General Infirmary one staff member said they felt that patient care suffers due to staffing levels and that as a result beds aren't made, patients aren't helped with food and observations are not done. Another said they had worked many shifts where there were only two qualified nurses on the ward in the day time when they have been assessed as needing three for dependency levels. They stated that this affects patient care as the nurses will not get to review pressure areas for every patient on these days and will have limited time to spend with each patient.
Some staff said there were sufficient staffing levels on the ward and that attendance is quite good.
People said they were given good information about their treatment and care and were able to ask questions. They said they felt included in decisions made about their care and were given time to consider any treatment options and procedures.
In the main, people said that hospital staff communicated well with them and that they received their test results in a timely manner.
Some people said they were not always kept informed and were not told when tests such as x-rays or scans would be carried out and sometimes did not know they were going for a test until the porter arrived to take them. One person at Leeds General Infirmary said, 'You don't know from one day to the next when you are having your scan'. Another at St James's University Hospital said that this lack of information was leading to worry and anxiety as to whether they could go home that day.
From our inspection of St James's University Hospital, we received comments such as, 'They explain everything with courtesy and understanding, from health care assistants to consultants', 'Communication has got better, they have started to communicate more', 'They make themselves available to ask you if you have any concerns or worries, they treat me like an adult' and 'They keep you well informed on treatment and such things as medication'.
At Wharfedale hospital people said they had been given enough written information to take home. They said:
'Fantastic, one of the best hospitals I've been in'
'Polite, lovely staff ' can't do enough for you'.
People at St James's University Hospital, and Wharfedale Hospital said they were satisfied with the food and choices available to them. We also saw that people were given the support they needed to eat and drink comfortably.
At the Leeds General Infirmary most people told us that the food was good and that they received plenty to eat and drink. However we did receive some negative comments about the quality of the food. These included, 'The food is so so', 'Food could be better' and 'There are only 2 decent meals on the menu in a whole week'. Others said, 'You can choose what to eat' and 'The food is exceptional and I am not easily pleased'.
People told us they felt safe at all three hospitals and security is well managed.
At the Leeds General Infirmary, all the people we spoke to told us that they felt the ward was clean and we received comments such as 'The cleaners are always about making sure its clean' and 'Staff are very good they are always washing their hands or using the hand gel'.
Similar comments were received at St James's University Hospital. These included, 'Very clean everywhere', 'Very good, very clean, my wife is very pernickety and she has also been impressed', 'Staff look clean and tidy, nice clean overalls, gives you confidence in them' and 'The staff always wash their hands, they all do it. You see them rub, rub'.
At Wharfedale Hospital people we spoke with said that they felt the hospital was 'very clean' and others said it was 'spotless'.
People who use the service were generally very complimentary about the staff at all the hospitals we visited. Most people said there were enough staff to meet their needs. People who use the service at St James's University Hospital said, 'Overall the nurses and physios have been really good. At times they are short staffed. They are stretched and sometimes we've struggled to find nurses', 'Staff are polite, they're nice and look after me well' and 'Usually enough staff, can be short on a night'.
At St James's University Hospital and the Leeds General Infirmary, most staff told us that they didn't feel they had enough staff at times which could result in people not getting the care they needed. For example, at St James's University Hospital, staff said, 'The managers try their best but there is not enough staff. I do worry. You hear they have to do budget cuts but I fear there is not enough staff and you hope it doesn't happen on your shift. They have to stop it before something happens. It is a risk. Elderly wards are generally not staffed well', 'We are so often short staffed, I have brought it up but it seems so difficult to get approval for staff cover, I feel budgets are controlling everything, shifts get cancelled, you get sent to cover at other wards' and 'Generally there is enough staff. Everyone works really well as a team'. One person said they had been having trouble sleeping. They said they did not feel they could discuss this with nursing staff as they said 'They are always too busy'.
At Leeds General Infirmary one staff member said staffing levels had been 'terrible' and that low staffing levels caused a lot of stress, that patients would not get washed and pain relief could take a long time to be administered, leading to frustration for patients. They said things were improving as more staff had been recruited recently. Another said they were often short staffed and they felt this is unsafe and means answering call bells takes a long time and nurses miss things or don't do observations.
At Wharfedale Hospital we spoke with a number of the staff. They told us that there is enough staff 'most of the time'. The staff told us that the staff group is stable and has worked together for a number of years. We were told that the staff are flexible and 'cover' for each other.