Mr X is a 50 year old man who got out of bed on the morning of his birthday in November and promptly fell down. He was suffering with dizziness and he couldn’t stand as he felt the room was spinning. He was diagnosed with benign positional vertigo.

Mr X was treated by his GP using the Epley manoeuvre which is the sequential movement of the head in positions designed to get any floating debris to the bottom of the ear canal. It was explained to him by the registrar that this treatment worked in 80% of cases.

Unfortunately this did not resolve his condition and he was referred to hospital where the manoeuvre was carried out by a further two medical staff. Mr X noted that each time the manoeuvre was undertaken it was performed differently, and again did not resolve his benign positional vertigo.

Mr X was finally referred to Audiology when the manoeuvres previously undertaken failed to cure his benign positional vertigo.

Mr X said "I was seen by the Audiology Service on the 14 June. After waiting a few minutes I was called in by the audiologist, who asked me to lie down while she watched my eyes.” The audiologist explained to Mr X that by watching his eyes as he goes to lie down she would be able to tell which ear is causing the problem. As it turned out it was Mr X’s right ear.

“The audiologist told me that as people get older calcium deposits form in the liquid in the ear and they confuse the brain as they continue moving in the fluid in your ear when you are standing still. She wanted to perform the Epley Manoeuvre, the aim being to get the calcium deposits at the bottom of the ear canal where they will settle. I told her that it hadn’t worked before and it made my dizziness worse so I didn’t want it done again. She carefully explained and demonstrated what she would do so that I knew what to expect”. Mr X explained that the audiologist seemed to understand how he felt which was reassuring.

Mr X agreed to have the manoeuvre performed. “When I got up to my surprise I didn’t feel dizzy, I had to eat humble pie because I told her it wouldn’t work. The audiologist asked me to wait in the waiting room for 30 minutes and she would call me back in and repeat the manoeuvre again if necessary. The dizziness had gone!”

The audiologist advised me that she would call me at home a week later to make sure that the dizziness had not returned.

She called me a week later and then again a further week later. She told me “that if I had the symptoms again to call the Audiology Department and she will see me”.

Team Feedback

Mr x was suffering with dizziness and he experienced episodes on a daily basis.

He was diagnosed with benign paroxysmal positional vertigo (BPPV), which is a common balance disorder due to calcium carbonate crystals (‘otoconia’) falling out of the correct part of the inner ear (‘utricle’) into the wrong part (‘semi-circular canal).

He was treated by his GP using the Epley manoeuvre which consists of the sequential movement of the head in positions designed to move any floating otoconia back into the utricle.

As people get older, otoconia can sometimes fall into the liquid within the inner ear and they confuse the brain as they continue moving in the fluid in your ear when you are still. The Audiologist who treated him explained to him that this treatment worked in 80% of cases. It was unfortunate that it did not work on previous occasions.

The Audiologist performed the Epley Manoeuvre, the aim being to move the otoconia out of the wrong part of the inner ear, back to where they belong. The Audiologist treating this patient was able to gain his trust to perform this manoeuvre which resulted in a positive result for the patient.

Miss X is a 21 year old young woman who lives in Poole.

Miss X explained that she began to suffer with issues with her eating in November 2015. She had been attending her GP from December 2015 as she knew she had a problem with her eating but was only referred to the Eating Disorder Service in June 2016 after making an attempt on her own life. Due to her illness Miss X had to leave her job at a gym as this was adding to her body image issues. Following a year of treatment she was discharged from the service on 7 July 2017.

Miss X stated “My problems with eating started in November 2015 when I decided to enter a body building competition, which meant that I started to eat less and exercise more. I didn’t get placed in the competition and I felt that I had done all that work for nothing”.

She explained “After the competition I felt that I was now free to eat anything I wanted, that there were no boundaries. I would starve all day. Then late at night I would drive to the supermarket to get some food; eat it in the car and then go in and get some more food. I would do this up to five times and would feel so full I couldn’t move. I wouldn’t do it for a few days and then I would repeat the process again.

I knew I needed help so I went to the GP in mid-December he didn’t take it seriously and I was told to try and eat regular meals. If I had been referred at this point things would not have got so bad. I had put on weight and would hide it by wearing a large coat and wrap it around myself; I wouldn’t make eye contact with anyone and I felt so guilty.

At this time (February 2016) I started to look at website chat rooms like Instagram and chat to girls with the same problem. I learnt a lot of bad things from these sites which led to bulimia and I started experimenting with laxatives.

I started to feel disappointed with myself, I began to feel depressed, and I didn’t want to live. I took an overdose in March 2016. I went to see another GP in May and I was finally referred to the Eating Disorder Service, without that GP and the support I received from the Eating Disorder Service I don’t think I would be here now.

When I had my assessment they asked me what goals I would like to achieve. I told them I wanted to wear leggings or jeans and tops with no sleeves. At this point I was referred to the dietitian. The dietitian undertook some tests to see what proportion of my body was muscle and fat. It was decided that I needed to eat 2000 calories a day and a diet plan was put together for me. By following this I lost 10 kilos. I no longer feel guilty about what I eat as I eat healthily so I don’t watch what I eat”.

The service did a lot of work around body image with Miss X. Her support worker asked her to draw the body shape that she thought she was and then she had her lay down on the paper on the floor and drew around her real body shape. These drawings were compared. Miss X explained that she also learnt that lighting has an effect on what you see in the mirror and mirrors can distort your image”.

Miss X has discovered that she enjoys painting and Calligraphy and she has her own Facebook page. It is called @creatinglillie and it's on Instagram. She shows the reality that social media doesn't always show, and talks about some of the challenges she faced and how she overcame them mainly surrounding food and body image. She wants to try and give women a better example on social media that isn't perfectionism but more about loving you for you no matter what size you are.

“I have now got a job as a shift manager at Starbucks and I am going on a self-love retreat to Bali for two weeks. I am also studying counselling as I would like to help other people”.

Miss X stated “The service really helped me but because my GP did not seem to understand my illness it took a long time to be referred to the Eating Disorder Service. I would have liked to be able to talk to someone who understood my illness while I was waiting to be seen”.

Figure 1: A picture created by Miss S.

Team Feedback

The Eating Disorder Service is delighted with this feedback. Areas of activity relevant to the issue of delayed referral raised in this patient’s story are:

1. The service offers self-referral so patients do not have to wait for GPs to refer them to our service.
2. The Eating Disorder Service has undergone investment in the 2015/16 to develop a 4 week from referral to treatment for routine referrals to the service and towards which it is working to achieve a 95% compliance rate by 2020.
3. The education and training offered by the service to local GP education events about eating disorders and the local service available from the Trust to improve our colleagues in primary care awareness of Eating Disorders and the service.

Mr C is the husband of Mrs C a 76 year old woman from London. Mrs C was an inpatient in Ashmore and Shaston Ward, Westminster Memorial Hospital, between 29 March 2017 and 25 May 2017.

Mr. C explained how they both came to be in Dorset. Mrs C had been diagnosed with Parkinson’s disease and because her health was going to decline further Mr. C sold their flat in London and purchased a smaller place. This new ground floor flat was to be altered to ensure that their new home was suitable for Mrs C. This would involve significant building work.

Whilst the building work was being undertaken they moved down to Dorset for the beautiful countryside and to escape the disruption. Mr. and Mrs. C had loved France during their marriage and he planned a “last adventure” with his wife so that she could enjoy a last holiday whilst her health allowed. Unfortunately Mrs. C became very unwell and she was taken by ambulance to Yeovil hospital. After assessment and treatment she was eventually moved to Westminster hospital for rehabilitation.

“This place is a blessing” said Mr. C. “The occupational therapists got my wife moving and all the staff are extremely patient and helpful. Everyone was so encouraging to us both.” Mr. C was given a Carer’s Passport and said the ability to come and go whenever he wanted meant he was really involved in his wife’s care.

Mr. C said that every element of the care his wife received was explained to him and he felt fully aware of what was happening and why. He sat in on meetings to discuss her care and it was tough to hear the honest truth from consultants who explained her prognosis. He said “it hurt but it had to be done” and he was grateful that he was fully involved. Her medication was reduced from ten tablets a day to 5 to help her mobility issues. He was concerned about her Parkinson’s being managed with reduced medication but felt supported by the team and happily her mobility increased and she did not appear to have suffered as she remained bright and cognitive.

Mr. C explained that the preparations for discharge started fairly early with discussions with him and the rest of the family. We went through a “pros and cons” written exercise with the family and the biggest benefit for moving back to London was his wife’s closest friends could see her more often and her family could be involved. He said he was personally conflicted as he would have preferred to stay in Dorset as the county had really grown on him. However he recognised he had to put his own wishes lower down on his priorities and he realised that he would need additional help to care for his wife. So the decision was made that on discharge they would be returning to London.

Unfortunately there were issues with the housing situation in London as the building work had not been passed by the local council which meant a delay in discharge. The discharge coordinator explained that they would not be “thrown out” as his wife was physically well enough for discharge. He said that he felt incredibly guilty that they were using a bed but the team reassured him that this was not his concern and that he and his wife would go to London as soon as everything was organised.

The ward manager advised that Mr. C was so supportive of his wife and he would dance backwards whilst supporting her to get her moving. The ward staff found this charming and the other patients laughed and enjoyed watching them dancing together.

Mr. C said he was now looking forward to returning to London as he loves the museums and live music. He said that one suggestion he would make, would be to suggest that the Trust looks into the Parkinson’s Classes that the English National Ballet run. His wife had always loved the ballet and they attended for five years prior to their move to Dorset. The classes include dancing to the music from the ballet that the company are performing for that season. He also said the social interaction was a key benefit from the classes, particularly for those patients who live alone.

In addition he said that patients suffering with Parkinson’s need stimulus and the staff work really hard to provide that. He felt that a Sunday Lunch where the patients sat around a table, as they would do at home, would be a great idea and something to look forward to.

Mr. C said the flexibility of the Carers Passport was really great. He knew when the OT would be seeing his wife so he could be there for the “dance class”. Mr. C said “I can’t say thank you enough. The care my wife has received has been second to none. The lovely staff care so much and their interest and involvement in my welfare has been very touching.”

Team Feedback

It was lovely that this positive patient experience was captured so well by the Patient Experience Team, who met with Mr C.

The problems with housing issues that were highlighted were dealt with in a timely manner through the coordination of our Discharge Facilitator and the team as a whole. We always strive to ensure the involvement of all those concerned; with the patient remaining always as our main focus.

The frequent ‘dancing’ between Mr & Mrs C was both enjoyable to watch and certainly beneficial to Mrs C ‘s mobility. It has long been recognised that patients with Parkinson’s Disease can benefit from music therapy, and I plan to discuss this further with our Parkinson’s Disease Nurse Specialist.

Mrs R is a 71 year old woman who lives in Blandford Mrs R was found on the floor of her flat by a senior care assistant on 18 April 2017 and taken to accident and emergency at Dorchester County Hospital. She was found to be suffering from a urinary tract infection and to have a very low insulin level. Treatment commenced and she was admitted to Tarrant Ward 24 hours later to continue her recovery.

Mrs R explained “I don’t remember being in Dorchester Hospital, my first memory is arriving at Tarrant Ward”. Mrs R explained “I had been taking my insulin but I didn’t seem to have any appetite, which I feel was how I started to become ill. I must have been hallucinating as well as I thought I was going to an orthopaedic appointment, in a taxi and then later thought I was on trial for my life!”

Eventually, I became aware of where I was and the staff really helped me. “The food was wonderful and the nurses were so special they must have had intensive training. The nurses kept on top of my drugs, I used to take my insulin 4 times a day and they altered it to two times a day, I wasn’t sure, but it did the trick, I am fine now on less insulin”.

Mrs R said “I enjoyed being on the ward and the therapy that I received. The nursing staff were always available if I needed them but they allowed me to be as independent as I wanted to be. I took part in quizzes on the ward which I really enjoyed.” Mrs. R said she had her haircut whilst an inpatient which made her feel good. She really appreciated having help to have a shower and wash her hair as it gets dirty quickly when you are unwell.

On one occasion the ward organised a visit from ‘Lofty’ a therapy horse. She said “I had been around horses when I was a child and it brought back lovely memories. I thought it was funny that the horse had shoes on and was amazed it did not slip!”

“While I was in hospital I set up a memory box with the Occupational Therapist which was lovely. I enjoyed being taken out on to the patio, it felt like a secret place to enjoy the fresh air, it made my day as I was in hospital for a month”. Mrs. R recalled. Mrs R said “The patient next to me kept trying to get out of bed, so I kept ringing the bell so staff could stop her from getting out of the bed. I felt guilty as the staff were so busy but realised I was helping the staff and helping the patient from falling again. I enjoyed helping the patients around me”.

Mrs R explained that she watched over another patient next to her who had dementia. Because of her dementia she used to swear and I would suggest she used a politician’s name when she wanted to swear “I knew it was the dementia and not her, she was a lovely lady and I did her exercises with her to help”. The staff referred to us as ‘The Naughty Girls Club’, we had a good laugh”.

Mrs R summarised her experience “Woe betide anyone that closes Blandford Hospital as it was wonderful. It’s the very best I’ve been in, and I have been in a few. The nurses put up with me and I know I can be difficult at times, particularly when I was so unwell”.

Mrs R was taken to her home for a pre-discharge visit by a member of the Integrated Rehabilitation Team (ICRT) to assess whether her home had equipment in place to ensure her return home would be to a safe environment. Mrs R was discharged from Tarrant Ward on the 16 May 2017.

Tarrant Ward Feedback

This story will be shared with the team, it is always lovely to hear how the great care we deliver has made a difference to our patients and supported their recovery. The visit from Lofty the therapy horse was greatly appreciated by both patients and staff and we look forward to his next visit in December.

This patient story includes:

• The disorientation felt by a patient in a semi-conscious state with an infection.

• The importance of therapy in a patients recovery.

• The interpersonal relationships on the ward can help patients feel relaxed and happy.

• A positive response to her admission and her appreciation of the ward staff in her recovery.

What has the Trust learnt?

That occupational therapy plays an important role in the patients’ recovery. Personal care and

normal activities such as hairdressing and being taken outside improved her wellbeing.

The reason for the hospital stay was her physical health but her wellbeing was equally

addressed.

Actions taken:

Monica (not her real name) is a 29 year old woman who was diagnosed with psychosis and bipolar disorder in January 2016. Monica said there is a family history of mental illness, her mother suffers with alcohol misuse, her father with depression, her maternal grandfather with depression and alcohol misuse and her maternal aunt with bipolar disorder, but this was the first time that Monica herself had experienced this.

Before her illness Monica was a successful accounts manager who travelled the country and lived in a shared house. She now feels she has nothing following her illness and the ten months since her diagnosis and the time she spent in hospital.

Monica was taking antidepressant medication prescribed by her GP. But she knew that she was not feeling well. Having previously taken illegal drugs she explained she felt ‘high’. She contacted her GP who suggested that she increase her dosage of her antidepressants, however Monica stopped taking them instead. It is not known how long after stopping her medication, but this led to her feeling even more unwell and feeling very ‘high, so she called an ambulance, as she knew that she needed help.

Monica was admitted to Seaview Ward St Ann’s Hospital, following admission from Poole Hospital in January 2016, and was then transferred to Chine Ward two days later.

Monica felt that Chine ward did not manage her illness well as she felt that she was not getting better.

Monica felt that she was being given the wrong medication to help her and that they could not get her medication right. She did not sleep for many nights as she did not feel safe, this was mainly due to the way her illness made her feel, and also other patients, who she found to be noisy, aggressive and intimidating. The lack of sleep led Monica to become aggressive and violent to both staff and patients. She needed to be restrained and have rapid tranquilization on many occasions and Monica said that as a previous rape victim earlier in her life, being held down made her feel even worse. This was known to staff at the time of her admission.

Monica continued to be violent, and at the time of her hospital admission there was no provision for female intensive therapy beds at St Ann’s Hospital, so Monica was transferred to a hospital in London for further treatment. Monica stated that the move to London made her feel worse and that her medication continued to not work effectively, she thought that she was in a hotel but was being restrained by someone. She tried to escape frequently. She felt like she was in prison and was only allowed half an hour’s break each day, Monica also felt the hospital was dirty.

After a month in London Monica was discharged back to her parents’ home in New Milton. Unfortunately, Monica quickly became unwell again and was readmitted to St Ann’s Hospital in May 2016. Monica continued to be violent and had to be restrained on numerous occasions. Her care team at St Ann’s suggested that she have Electroconvulsive Therapy to try and help improve her behaviour/violent outbursts and to manage her illness. However, her parents felt that this was an archaic treatment and refused for her to have this. Monica was therefore transferred to a different London hospital in July 2016 for further treatment, as there was still no provision of female PICU beds in Dorset at that time.

Monica felt she was bullied and racially abused by other patients during her stay in the London Hospital, as she was one of the few white patients there. They took some time to get her medication under control, and during this time Monica suffered many side effects from the medication she was taking, and she also felt that this hospital was dirty as well. She felt isolated, as her friends could not visit and her family were not nearby for support.

After a month in London Monica was transferred back to St Ann’s Hospital, again initially to Seaview Ward, but she was then transferred to Chine Ward, to stabilise her medication and to support her discharge into the community Monica was discharged in October 2016 to the Early Intervention Service (EIS) .

Monica feels that this admission was much better than her previous one, as the staff in the main were caring. Monica felt she was able to be involved in her treatment and care, was given more leave and had the support of her family and friends nearby.

Monica explained that staff on Chine ward, helped her to find a place to live and she was discharged to the YMCA in Bournemouth following completion of her inpatient stay.

Monica is now under the care of the Early Intervention Team (EIS) and says that their support is ‘phenomenal’ and that she cannot fault the care and support that she has been given by the team. Monica has a really good rapport with her support worker and is also under the care of a psychologist, which is enabling her to talk about her care at St Ann’s and her previous sexual assault.

Monica is currently working part time but is aiming to return to work full time in the near future with the support from the Early Intervention Service.

Team Feedback

From EIS team

Monica will benefit from being able to tell her story and will feel listened to. If she feels that telling her story might help to change/inform future treatment for others then this would be a positive achievement for her.

From an objective standpoint Monica was very unwell for a sustained period of time and achieving the effective combination of medication was very difficult. However reading her personal account of her experiences and the consequences of these experiences highlights how we should all work together to improve care where possible and to also build on the positives.

Working with Monica since she was discharged from hospital she has consistently moved forward in her recovery through her own determination to rebuild her life. The team are really happy that she has managed to achieve so much in a relatively short space of time and look forward to continuing to work with her.

From Chine ward

As we did not have a female PICU Monica stayed on the ward longer than we have liked as we were aware of the consequences for sending her to an out of area PICU, which meant an unfamiliar environment, away from her friends and family, staff that did not know her and she did not know them, and we had little control over their choices of treatment.

Whilst Monica was out of area we stayed in contact with the PICU, with Monica, and Monica’s family. The hospital in London appeared to have a lot of ‘blanket’ rules and patients were not allowed mobile phones so this limited Monica’s contact with her family and friends. All visits had to take place off the ward as visitors were not allowed on the ward, meaning they needed to have staff escort, which affected the length of the visit.

For the new PICU at St Ann’s Hospital we have made a lot of effort to treat patients in the least restrictive manner and have tried to avoid blanket rules - phones are not routinely removed - and if they need to be, the rational for this is clearly documented and if necessary a care plan put in place. Family can also visit on the ward, unless there are significant concerns.

We agree with Monica with regards the out of area placements, and on her first admission there we made the decision to get her back to St Ann’s as soon as possible as the environment was in our view, not conducive to her recovery.

As we did not have PICU provision locally to support Monica, her family were supported financially by the Trust with reimbursing travel cost and expenses thus ensuring that they were able to visit their daughter regularly when she was in London.

Sam is a 27 year old young man who was diagnosed with Schizophrenia, diabetes and other disorders related to excessive alcohol intake. Sam has been sectioned three times under the Mental Health Act over a five year period between 2007 and 2012. He was first sectioned after a Ketamine overdose at the age of 16. Sam currently lives with his father in Lyme Regis after moving from Sherborne. Sam is a very reserved young man and his father assisted him in sharing his story.

Sam’s mother and father had been through a difficult split and his Dad felt this was the start of Sam’s problems. Initially Sam was still living with his mother when they were in Sherborne. Sam’s Dad explained that he knew he had to get more involved when Sam had been sectioned for the third time. He was scared that he could lose his son forever. He hoped to move Sam away from the influences he felt were having a negative effect on his son’s life. Eventually Sam and his Dad managed to move to Lyme Regis and they now share a flat.

Sam was originally under the Community Mental Health Team and was referred to Sarah, the Support Transition and Recovery Service (START) Worker in July 2016 for help with his recovery. After completing the “recovery star” where Sam’s areas of interest were identified, it became clear that Sam was very keen on improving his fitness. He also understood that his alcohol intake was detrimental to his diabetes and mental health. Sam had a huge barrier as he was worried about using public transport to get to Bridport to exercise.

Sam’s main identified interest was his love for animals. Sarah suggested volunteering at an animal sanctuary called “Ferne” in Chard however the location, again, was an issue, as there was no regular public transport. However Sam was happy to apply and deal with the travel issue should he be given an opportunity. Whilst waiting for an opening to arise at Ferne, Sarah encouraged Sam to take up other volunteering opportunities but he remained focussed on working with animals. There was a long period of waiting for a suitable opportunity to arise and his engagement faltered for a while. One day whilst Sarah was walking back to her car from meeting with Sam, she stopped to talk to a local trader who had a dog sitting outside her shop. They chatted about the fact that the dog enjoyed sitting outside but, when she was busy, she could not take the dog for a walk. Sarah asked whether she would consider talking to Sam about him helping her with the dog. When Sarah had spoken to Sam he visited the shop by the end of that day. Sam now walks the dog 4-5 times a week and has been referred by the local trader to other friends to walk their dogs.

On speaking with Sam he makes it clear that his is in a much better place now. In the last four years he has not been sectioned. He said there are a number of issues which have been important to gain that stability in his life.

Initially his father moving in was a key change. He began to eat regularly and had someone who he could trust. Sam said that Simon, his Care Co-ordinator visiting him at home to organise his medication has been a huge improvement. He says the walk to the GP practice was over a mile away up a steep hill and with his fitness levels was difficult. Sam attributes a significant impact to the change in his life to achieving his aim of working with animals. He says that he loves to walk the dogs, which he does individually for about an hour at a time. Also having made a commitment to walk the dogs makes him get out of the house and not sit around and drink alcohol. He has lost weight due to the walking and his mood has improved considerably. The fact that the community are supporting him has also increased his self-worth and is beginning to embed both

Sam and his Dad into the local community. Sam’s Dad has also been signposted to carer’s services by Sarah who is keen to ensure he is not feeling isolated and unsupported. Sam and his Dad both feel the journey is not yet ended and there is still a lot of work to do. However they feel positive about the changes they have made together. They continue to feel supported by Sarah and know if they do need additional help she is there.

Sam’s story includes:

• The importance of family support;

• An holistic approach to the patient;

• Thinking outside of the norm to support patients;

• Healthcare workers knowing and working with the local community to support patients;

• Understanding barriers and working to minimise those for patients

• The positive impact of having commitments to an individual

Mrs. X and Mrs. Y both stated that they were extremely happy with the approach of the hospital in general to the patient and the family, and the care that Mr. X received was second to none. Mrs. X and Mrs. Y said “the attention we received as family of a patient at the end of his life was absolutely amazing”. They wanted to let the Trust know that overall they would not have wanted Mr. X in any other hospital. There were a few incidents which they did want to raise; however, they were very clear that these were a small percentage of the experiences on Tarrant Ward.

On admission Mr. X was being asked questions as part of the admission procedure and it became clear that Mr. X and Mrs. X (she was single at the time) were not married. Mr. X explained to the nursing staff that it was a great regret that he had not married the love of his life. He felt it was now too late to make this happen. The nursing staff were touched by Mr. X’s statement and immediately got to work to see if the hospital could support the couple to realise Mr. X’s wish. Within seven days a wedding had been arranged by the staff and no detail was overlooked, from the invitation list to the food, drink and decoration of the wedding room. “It was so amazing” said Mrs. X, “I even had music to walk into the ceremony thanks to the Matron, Darren”. The decorations were throughout the public areas of the ground floor and Mrs. X was so touched to see other staff watch her walk down the corridor on the big day. “Nothing more could have been done for us on our special day and we were both so happy.” she said.

The staff approach and attitude during Mr. X’s care was one where Mr. & Mrs. X and Mrs. Y felt they became part of the Blandford Hospital family. Staff would pop in for a chat and to see how Mr. X was doing and he enjoyed their visits. Mr. X gave some staff nicknames as he had such a personal relationship with them.

Mr. X was a man who had worked outside for most of his life and he found the first side room he was settled into a little claustrophobic. The windows were very high and there was no view apart from a small area of sky. He was moved to a nicer room eventually where the windows were large and he could look out onto the fields which he greatly appreciated.

Although the ward was being used for End of Life care some aspects of the ward Mrs. X and Mrs. Y felt were inappropriate. The fact that the ward was very warm and there was no way of turning down the temperature within Mr. X’s room meant that they opened the door to his room which mean sometimes privacy was difficult.

Overall the family felt that if End of Life care is going to be provided on a more regular basis on Tarrant ward they wanted to highlight:

• A nurse discussing the last wishes of Mr. X with the family when he was sleeping in the same room. The family were concerned Mr. X could overhear as he sometimes dozed. Despite asking that the conversation be carried out elsewhere, the nurse said that it was fine and continued.
• In one incident an HCA appeared to lose her patience and threw Mr. X’s glasses to the bottom of the bed. A report was made by other members of staff who witnessed the incident.
• In another incident, the same HCA did not give the patient the opportunity to go back into his chair after using a bedpan. The patient had been unable to use the bedpan earlier and it appeared the HCA was unhappy that she had moved him twice. Mr. X went back to the bed against his wishes, as he felt the HCA did not want him to go back into the chair.
• A senior member of staff made the family feel that Mr. X had outstayed his welcome with her references to bed availability and her budget.
• The doctor from Weldmar Care prescribed medication to help Mr. X sleep. Medication was advised for 6pm to help with his anxiety, however the nurse practitioner said this was not possible as the medication round was at 8pm.This had a knock on effect, as Mr. X was then given a sleeping tablet as late as 1am, which resulted in him sleeping late and frequently missing meals.
• The family brought food into the ward as ward food was thrown away rather than being kept for Mr. X when he awoke.
• At one point Mr. X asked his sister Mrs. Y to move him as it was hurting him when some of the HCAs were moving him. In addition on one occasion his scrotum was torn through inadequate manual handling.

The family are keen to ensure that although there are a number of incidents raised they also wanted to highlight the superb care Mr. X received above and beyond the call of duty.

• The Wedding!
• One sister bringing in her toenail clippers to ensure that Mr. X’s feet were comfortable.
• The matron popping in on New Year’s Eve, bearing a glass of wine and food for Mrs. X, then spending time talking with her.
• Staff members spending hours sitting and holding Mrs. X’s hand even when not on duty.
• One member of staff brought in one of her husband’s jackets so that Mr. X could go outside.
• Another member of staff encouraged Mr. X to drink some more by going to squeeze him a glass of grapefruit juice.
• A member of staff bought a radio in for Mr. X
• Another member of staff brought in a tabard to use when Mr. X was being fed to keep him clean and tidy.

Team Feedback

The team are pleased and also saddened by some of the content of Mr X’s story. As Mr. X was a patient for a significant length of time on the ward it was usual for senior members of the team to see Mrs X on an almost daily basis. Issues raised by Mrs. X were responded to quickly and in person and, as far as was known, to the satisfaction of Mrs. X. It is unfortunate that not all of the issues included within the story were raised with the senior team at the time or indeed subsequently to Mr. X’s passing. Mrs. X has been a fairly regular visitor to the hospital since her husband’s passing and the Matron will offer to meet Mrs. X and Mrs. Y to discuss the issues raised within the story.

Ms HR is a lady who lives in Fordingbridge. Ms HR fell down about 4 years ago falling very heavily on her hip. A short while later she fell down the stairs on two occasions and went to Salisbury hospital in an ambulance. No break was discovered. She was given Tramadol for pain relief and discharged. After a few days she stopped taking the Tramadol as she felt they were making her feel very ill. Ms HR had private Physiotherapy and felt that her injury had begun to resolve.

However over the next 2 or 3 years she began to notice she had pain which was a “pulling” sensation in her thigh after walking. She ignored it but it became worse and more frequent and the pain made her sedentary. At her worst she could not walk for stiffness and pain and shuffled along rather than walking. Eventually she attended her GP practice to ask for help. The GP examined her and made a diagnosis of spinal stenosis. As the doctor described the symptoms Ms HR did not agree with the diagnosis. All the focus was on her lumbar spine and, despite her understanding referred pain, she did not believe that the real diagnosis had been found. Ms HR asked for an MRI scan from another GP at the practice and it was ordered for her lower back. At her request, she was referred to the physiotherapists at St Leonards hospital whilst awaiting the scan. The scan did show some issues, mainly wear and tear and some narrow discs, spurs and Tarlov cysts but it did not show any nerve compression. The movements that were expected to cause pain from such degeneration did not in fact do so, at any time.

Ms HR was unhappy with the first physiotherapist she saw. An assessment form was completed on the initial visit which Ms HR duly filled out. However she noticed that the form was entitled “About your Back Pain”. When she returned it to the physiotherapist she mentioned that her pain was not in her back. The physiotherapist said "That's what you've been referred for". Ms HR said that she did not have any back pain. The Physiotherapist said “Well that's what's written here” which Ms HR felt was a negative response, suggesting the patient did not know where her chronic pain was sited. Ms HR is interested in understanding everything that is happening with her body, was keen to understand the treatment being offered and to put her opinions forward. Ms HR understood that the member of staff was trying to do her job. However she feels the physiotherapist took, as a challenge to her professional opinion, some information that Ms HR had found out for herself by personal research, rather than realising it was just interest and a desire to understand why she was in such pain. The exercises she was given did not seem to help at all.

Ms HR felt completely crippled by the pain. Pain medication did not help however Naproxen had some effect but she then suffered from fairly extreme tinnitus which is a recognised side effect of long term Naproxen use. Ms. HR continued to look for other solutions and saw a private physiotherapist.

When Ms. HR mentioned her attempts to try other solutions the physiotherapist advised her that she could no longer be seen if she was seeing other private physiotherapists. Ms. HR was very unhappy with this response and she said that she was not happy to be discharged due to this policy. Another physiotherapist discussed with the patient what she wanted to achieve and Ms HR was offered a physiotherapy class. Ms HR readily agreed.

Ms. HR said that the class she attended was much better. She found the new male physio she saw Mr. B, “he was a completely different kettle of fish. He was laid back, showed he cared and was not uncomfortable in being asked why things were being done. I felt taken care of. I knew he wouldn’t feel threatened by my questions.” Ms HR said that she knows she may present a challenge to professionals; she is assertive and is not afraid to challenge them. However the gentleman she saw in the class was not fazed by her approach and appeared to listen and try to understand her. When asking if the exercises he was advising, on a balance board for example, would be OK for her, he took time to reassure her and explain the rationale behind the exercise.

After some time she began to realise that her new physiotherapist had not treated her injury in isolation but had treated her holistically. He got her to recognise that her constant search for alternatives may be muddying the water a little. He explained her cocktail of remedies and approaches made it difficult to assess their impact and suggested that she might want to take a step by step approach to see what really did make a difference to her pain. She trusted him and he gave her the time she needed and listened to her anxieties. By her sixth appointment she was stronger and more flexible, still in pain and not moving has she once had, but definitely there was progression.

Mr. B had suggested acupuncture which was arranged and this did make a small difference. Mr B. further suggested that she may be suffering from Chronic Pain Condition. He carefully suggested that there could be a psychosomatic element and suggested a referral to the pain clinic could help. However on discussion with her GP she was advised that she could not be referred unless it was shown that five drugs had been tried previously. She was unhappy with this suggestion as she found that the first line drugs had made her feel very unwell. She wonders why there is no non-drug pain management offered? Mr. B said he would try and refer her but she has heard nothing, so believes he is not allowed to refer to the clinic.

Ms HR can now move freely and has no pain in her thigh. She believes that the physiotherapy had helped by building some strength and more flexibility but relief from stiffness and pain was still erratic and random from day to day. After this point she said her chiropractor said her coccyx was out of alignment and after realignment she has never had the thigh pain again. Once the thigh pain was resolved it allowed for proper movement and much more relief followed.

Team Feedback

We are grateful to hear Ms HR’s story. From the service point of view, the first physio is an excellent clinician however was relatively inexperienced in comparison to the second physiotherapist Ms HR saw. Communication skills are built and honed with time and experience and unfortunately there did appear to have been a clash between her and the patient. The physio called in a more senior physio who suggested the transfer of care to another physio, who was felt to be a more appropriate clinician to help this lady. We recognise that this is a learning point for us to transfer to another physio if appropriate if the patient-physio relationship is not working. Patients are discussed with a senior or another colleague if the patient is not improving within the first 3 sessions.

On 23rd March she began to really panic that her baby was very ill; she believed her breast milk was not nourishing and that the baby was unable to breathe. After two calls for an ambulance Natalie was admitted to the John Radcliffe Hospital in Oxford and after a preliminary diagnosis of Postnatal Psychosis and a lack of local beds she was sent home from hospital, 13 hours later, under the care of her mother with antipsychotic medication. Eventually after a difficult time at home with her anxiety and paranoia growing and her becoming verbally and physically aggressive with her mother she was eventually sectioned under section 2 of the Mental Health Act. An inpatient place was found for Natalie at Florence House in Bournemouth.

• Having a small unit makes it feel more homely;
• Cooking together makes life feel more normal;
• Being able to decide what you can do, when and planning out your week is like normal life:
• Making friends with the other women on the unit;
• The staff: positivity; cups of tea and a chat; sharing their own personal lives – more like a normal conversation not nurse and patient;
• The weekly meeting where issues could be raised;
• Feeling the staff genuinely cared about the patients.
• Being helped to integrate back in to society with support from staff to attend Doctor’s appointments, baby groups, shopping, or even just go for a coffee.
• Nursery nurses really helped create a good routine with her baby which she still benefits from now.

Natalie was shown by the Occupational Therapist how to make a memory blanket from her daughter’s outgrown baby grows which she continues to do and now has a sewing machine to make the process easier. Natalie now makes memory blankets for other women and children in hospital and has her own memory blanket Facebook page.

@mudgettmemoryblankets