Patient and Public Involvement (PPI) Forum for

Luton and Dunstable Hospital

PPI FORUM - MONITORING VISIT REPORT

Facility Visited: Accident and Emergency Department (A&E)

Name of Visitors: Trevor Gash, Satwant Gill, Jean Grainger,
Carol Mead and Sheila Webb
Date: On morning of 26 July and evening of 30 July 2004 with follow up 23 August
2004

DESCRIPTION OF SERVICE AND STAFFING

Details supplied by Mrs Jane Angel, A&E Manager & Emergency Care Lead,
Luton & Dunstable Hospital NHS Trust
Actual in
Establishment Nos. of staff on duty during the day
post
No. Grade No. Grade Morning Afternoon Evening Night
Medica 19wte 5+2 cons 5+2 cons
*See below 4 3
l
wte
Nursin *See below
g
HCA
Other* 9 11 11 7
Tech 1.00 Plaster
Other* Technician
Clerical 8.22 Anc 3
Other* 1-00 Anc 6
*Consultants 2.00 wte
Specialist Registrars 3.00 wte
Staff Grade Doctors 4.00 wte
Nurses Grades
1.00 wte Matron (1 August) Grade of this position at present is H
4.00 wte G Grades
10.30 wte F Grades
17.09 wte E Grades
17.12 wte D Grades
8.21 wte A Grades
5.55 G Grade Nurse Practitioners
1.00 F Grade Nurse Practitioners

Do you use bank staff? Yes/No Regularly/Occasionally/Rarely How many? …….

Do you use agency staff? Yes/No Regularly/Occasionally/Rarely
How many? Varies, but never more than one at a time.
Please state any other services provided to patients – e.g. therapies, counselling, etc.
Full Support therapies
1
Support for PPI Forum for Luton and Dunstable is provided by
Voluntary Action Luton,15 New Bedford Road, Luton, Beds, LU1 1SA
Tel: 01582 733418
E-mail iris.beazley@valuton.org.uk
 Patient and Public Involvement (PPI) Forum for
Luton and Dunstable Hospital

Do you have students in the ward, dept, clinic etc. Yes/No

If yes, what
profession? …Nursing & Medical
Whilst there was no major pressure on Reception, we noted the thinness of cover when
just one was at the desk as short queues rapidly developed and phone calls etc. also have
to be handled.

We understand that there is a bid to increase Reception staff from 1 to 2 at night.

The staff generally gave an impression of friendly professionalism, readily communicating

with staff in other Departments.

The ‘Dot Matrix’ sign was indicating a waiting time 1-2 hours on both visits, which did not
seem to reflect the more rapid progress seen through the waiting areas.

Unquestionably the introduction of the Acute Assessment Unit (AAU) has had a major
impact on the running of A&E, enabling staff to concentrate on the primary tasks of
diagnosis and treatment rather than ongoing care.

PREMISES

The general impression is of light, bright waiting and treatment areas, with a ‘Children’s
Room’ and a valuable ‘Relatives’ Room’ for emotionally difficult episodes. However, it has
to be recognised the waiting areas appearance is institutional and soulless.

Seating remains standard throughout the waiting areas with no special provision to
accommodate the elderly or disabled. [Highlighted previously by Patients’ Representative
Group (PRG).] Whilst practical, the chairs are not comfortable for long-term waiting.
(Please see note under Recommendations.)

Accessibility appears good, but signage ranges from inadequate to confusing. From any
direction but Lewsey Road there is little or no signage until the latter stages. Approaching
the Main Entrance one is directed to the Fracture Clinic, but allowed to advance into
Reception before temporary notices send you back into A&E.

A wandering patient strolling into “Resus” evidenced the inadequacy of “No Entry” marking
and the absence of security door systems. We understand that card-swipe doors are
intended to be introduced shortly and we are concerned that this should proceed with
some expediency.

The general cleanliness of the unit in respect of floors, ledges, shelves etc appeared very
good. There appear to be reservations regarding standards at times of Bank Holidays
when patient volumes are high, but fewer cleaning staff are available.

2
Support for PPI Forum for Luton and Dunstable is provided by
Voluntary Action Luton,15 New Bedford Road, Luton, Beds, LU1 1SA
Tel: 01582 733418
E-mail iris.beazley@valuton.org.uk
 Patient and Public Involvement (PPI) Forum for
Luton and Dunstable Hospital

We noted some high level areas (tracks etc.) and doors which did
not reflect the same state of cleanliness noted above.

Some damage, particularly that visible in the corridor adjacent to the Garden caused
concerns as to access issues and cleanliness – Are beds/trolleys difficult to manoeuvre?
Were patients being transported at the time? How often does this happen? How often are
these areas specially cleaned/repaired?

We had noted that PRG had raised some issues and though not wishing to interfere with
their follow up, we remarked no sight of clocks, posters/paintings or TV/video.

Our shared concerns over the inadequacy of the ‘Dot Matrix’ and our wish for better
information provision may be addressed by the installation of a plasma screen capable of
delivering a number of messages and expressing them in different languages.

EQUIPMENT

We are not qualified to assess the actual effectiveness, but no deficiencies were
highlighted by staff and the physical state of the equipment suggested that it is in good
order.

It is presumed that tape repairs to mattresses satisfy hygiene standards.

STAFF VIEWS

We were given the firm impression of staff having pride in the Unit and its performance and
believing that AAU has enabled A&E to have a clearer focus enabling it to deliver care
more effectively.

There was generally a good understanding of issues that are important to patients, with
systems/policies to address them, but a recognition that peak periods can seriously affect
delivery.

Staff do not perceive that the Walk-In Centre has had any measurable affect on A&E.

It is felt that far too many patients attend A&E inappropriately. Some because their
condition does not require the service. Some because they do not have a GP. Some
because they have difficulty making an appointment with their GP. Some who are unaware
of NHS Direct.

Staff look forward to improving security (see note regarding card-swipe doors above), but
there seems to be some concern that Reception staff are in an exposed position in the
event of some fracas although there is an escape route.
3
Support for PPI Forum for Luton and Dunstable is provided by
Voluntary Action Luton,15 New Bedford Road, Luton, Beds, LU1 1SA
Tel: 01582 733418
E-mail iris.beazley@valuton.org.uk
 Patient and Public Involvement (PPI) Forum for
Luton and Dunstable Hospital

Whilst we did not see any security guards patrolling, we were told that, when called, they
respond quickly and that there is one policeman based at the Hospital during the day.

Some concern that good information techniques are not robust e.g. small ‘signposting’
cards are not regularly available for issue and that the ‘green pots in the fridge’ scheme for
single elderly people seems to have ceased.

We were told that formal instruction is given and, on an occasional basis, on a number of
topics associated with the operation of the Department, but this does not include
appropriate handling/management of the elderly.

Students from Hertford and Luton Universities undertake placements and many apply for
positions when qualified. Staff regard this as a good scheme.

PATIENT VIEWS

Although we have undertaken discussions with patients in the waiting areas, we have
made specific efforts to speak to those with more serious conditions that have merited
admission to wards.

It has therefore been gratifying to find a very high level of satisfaction. All said that
procedures undertaken were explained in advance, but there were indications that there
were uncertainties about general process and doubts while waiting as to what was to
happen next. Whilst our sampling was too small to be definitive, we noted the total
satisfaction for ‘Major’ cases, including those relatives accompanying patients who felt that
they were properly involved. However, we wonder whether staff are less considerate of
anxiety in more ‘Minor’ cases, which their professional judgement enables them to dismiss
as unfounded, but which nonetheless are a ‘major’ event to the patient at the time.

OUR CONSIDERATIONS

Communication remains as ever a primary issue. We note the use of translation books for
routine questions and Languageline support for more complex involvement; however we
are still concerned that whatever the language patients do not always understand the
process. We also believe that it is not only a matter of manner of communication, but also
of timing.

We feel that some elderly patients or those with mental health issues could benefit from the
support of someone we style “patient’s friend”, who could be from outside or a member of
the Hospital team, who would lookout for the interests of the patient, which might not
otherwise be addressed by virtue of their timidity or confusion.
4
Support for PPI Forum for Luton and Dunstable is provided by
Voluntary Action Luton,15 New Bedford Road, Luton, Beds, LU1 1SA
Tel: 01582 733418
E-mail iris.beazley@valuton.org.uk
 Patient and Public Involvement (PPI) Forum for
Luton and Dunstable Hospital

Some unnecessary work in the Department seems to flow directly from public ignorance
and we would wish to see the Hospital, with partners, taking a more positive approach.

There would appear to be value in some statistical analysis to determine issues such as
over-referral from particular GPs, which could facilitate working with partners to optimise
value.

The Action Plan for A&E demonstrates the positive efforts being made to improve the
Department’s service delivery.

We welcome the approval by the Trust Board to the appointment of an

additional Consultant.

THANKS TO STAFF AND PATIENTS

Whilst concerned that our role and visit on 30 July seemed to come as a surprise to some
staff, we were grateful for the friendly and helpful approach of those who assisted us during
our review.

5
Support for PPI Forum for Luton and Dunstable is provided by
Voluntary Action Luton,15 New Bedford Road, Luton, Beds, LU1 1SA
Tel: 01582 733418
E-mail iris.beazley@valuton.org.uk
 Patient and Public Involvement (PPI) Forum for
Luton and Dunstable Hospital

RECOMMENDATIONS
• Though recognising there are considerations of priority for finance, we support the
extension of 2 staff cover at Reception.

• Upgrade of the dot matrix sign arrangement to a more informative plasma or other
screen system is strongly supported.

• We consider terms like ‘triage’ to be unhelpful to good communication and believe they
should not be used in any contact with the public.

• Decoration of the waiting areas should be reviewed not only with regard to the
introduction of more comforting colour, but also as to the possibility of installing pictures
and/or television. (We wonder if the possibility of a newspaper/books franchise has
been considered.)

• Seating should be reviewed in terms of functionality for disabled or elderly and for
comfort. (Subsequent to the visit we were informed that new chairs are on order which
hopefully will be appropriate to the needs outlined above.)

• Clear, coherent signage from all parking areas should be installed.

• We support the early installation of improved security.

• Cleaning arrangements should be reviewed in respect of Bank Holidays, high level

areas and ‘stubborn’ staining.

• In view of the concerns over inappropriate attendance we would encourage

commitment to an innovative approach to public education.

• We understand that from data held it may be possible to construct an analysis of

inappropriate attendance associated with GP practices and from areas more adjacent
to the Walk In Centre and of areas where there are significant numbers without GPs.
We suggest this is undertaken with a view to developing action programmes in
association with the relevant PCTs.

• We gathered that instruction is given to staff, but not on a ‘protected learning’ basis,
which we would encourage. We would welcome particularly attention to the skills of
appropriate communication and treatment of the elderly.

• We do not believe that, within reasonable timescale, Reception can adequately explain
the patients’ “pathway” through the Department and that therefore simple, language
appropriate leaflets should be made available.

September 2004

6
Support for PPI Forum for Luton and Dunstable is provided by
Voluntary Action Luton,15 New Bedford Road, Luton, Beds, LU1 1SA
Tel: 01582 733418
E-mail iris.beazley@valuton.org.uk