Details of visit
Service address:
Service Provider:
Date and Time:
Visiting Team:
Contact details:
Wokingham Community Hospital, Barkham Road, Wokingham,
RG41 2RE
Berkshire Healthcare Foundation Trust
26th April 2016 10:30-12:00
Nick Durman, Ullakarin Clark, Rebecca Day, Margaret
Campbell-White, Tricia Harcourt, Arunjot Mushiana
[email protected]
Tel: 07701 058645
Acknowledgements
Healthwatch Wokingham Borough would like to thank the management of Wokingham Community
Hospital and the 2 inpatient wards Manager: (Ascot Ward & Windsor Ward) Sheila Donohoe, for their cooperation, openness and willingness to work with us, We would also like to thank all the patients and staff
we spoke to on Ascot and Windsor wards.
Disclaimer
Please note that this report relates to findings observed on the specific dates set out above. Our report is
not a representative portrayal of the experiences of all service users and staff, only an account of what was
observed and contributed at the time. This report is written by Healthwatch volunteers and is meant to
convey what users of the service and staff said.
What are Healthwatch visits?
Part of the Healthwatch programme is to carry out visits to health and social care services to find out how
they are being run and make recommendations where there are areas for improvement. The Health and
Social Care Act allows Healthwatch authorised representatives, or visitors, to observe service delivery
and talk to service users, their families and carers on premises such as hospitals, residential homes, GP
practices, dental surgeries, optometrists and pharmacies. Visits can happen if people tell us there is a
problem with a service but, equally, they can occur when services have a good reputation – so we can
learn about and share examples of what they do well from the perspective of people who experience the
service first hand.
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What services does Ascot and Windsor wards at Wokingham Hospital provide?
Wokingham Community Hospital provides many services, including speech and language therapy, children
and adolescent mental health services, diabetic eye screening, physiotherapy and two in patient
rehabilitation wards. Please note this is not the complete list of services provided by the hospital.
Healthwatch Wokingham Borough’s visit focused solely on the two rehabilitation wards, namely Ascot
(Male) ward and Windsor (Female) ward. These rrehabilitation wards are for adults who need nursing,
occupational therapy and physiotherapy care. In addition our Visiting team looked at the quality of signage
outside and inside the hospital.
Executive Summary
A team of 6 Healthwatch volunteers spent time on the Ascot (male) and Windsor (Female) rehabilitation
inpatient wards at Wokingham Community Hospital talking to staff and patients. The overall consensus of
the visiting team was that the wards were clean and bright and calm. The patients we spoke to were happy
with their treatment. The staff were friendly, open to answering our questions and were caring.
Admissions to Wokingham Hospital are generally from larger hospitals. Patients generally only get admitted
to Wokingham Hospital if clinicians believe they can successfully return home after treatment and in some
cases that will require care packages to be in place.
The ward is staffed in accordance with safer staffing levels, each ward always works with a minimum of two
trained nurses per shift alongside healthcare assistants. There is a need for nursing care.
Windsor Ward (Female Ward)
26 out of 28 beds were occupied on the day of our visit. We observed that all the bays were light, airy, clean
and the atmosphere everywhere was calm. Patients with dementia are located in the bay opposite the
nursing station to assist the nurses with their care and safety.
We observed that to enable easy navigation around the ward, doors that would be used by patients are
painted to contrast with the walls and have dementia friendly picture signs, for example on the toilet doors.
Doors that are meant only for staff are painted in the same colour as the walls so they are less noticeable to
patients particularly with dementia.
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Ascot Ward (Male Ward)
The ward is funded for 18 beds but there were 20 beds in the ward. There was a side room that could be
used for private discussions. We observed that the ward was bright and clean. Patients with dementia are
located in a bay opposite the nurses’ station. Patient relevant doors, for example toilets, were painted in a
different colour to the walls so they were easily identifiable, particularly for those with dementia. Staff
relevant doors are painted in the same colour as the walls.
Signage
A Healthwatch volunteer surveyed hospital signage both inside and out and noted some areas where
signage could be improved.
Recommendations
More equipment such as blood pressure machines, observation machines and rotunda turners would make
life easier.
Patients would benefit from increased access to recreational pursuits such as music via CD player, talking
books, TVs that are easily seen and work reliably, volunteers visiting and access from Ascot Ward day room
to the adjacent garden.
Improvements could be made by adding signage explaining overflow car park at back of hospital, how to
enter hospital from the back, reception needs clearer signage.
Why we visited
We choose to visit the inpatient Wards at Wokingham Community Hospital as we had not been to a
Hospital Service previously. Through our outreach work we had spoken to members of the public who had
been patients at the hospital, who had received rehabilitation services there and who had been discharged
from the Royal Berkshire Hospital and transferred to Wokingham Hospital.
In addition we have had comments from the community in general about signage at NHS premises not
always being clear, sometimes confusing and in some cases particularly difficult for those with sight
impairment.
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What we were looking for
We looked at a few key topics affecting the quality of patient experience in the hospital:
 Were the patients fully involved and consulted about the discharge process and their date of discharge?
 Did the patients feel listened to and well cared for by the staff?
In addition we also looked at a few key topics relating to Staff :
 Difficulties, if any, with recruitment and retention of Staff
 Training of staff particularly relating to dementia and those patients that have communication
problems.
In addition to the above we listened to and noted any other comments that patients and staff raised during
our visit including what things they would improve.
What we did
The visit to Wokingham Community Hospital on 26th April 2016 was arranged in conjunction with Helen
Mackenzie, Director Of Nursing, prior to the visit, the visiting team met with the ward manager for an
overview and general discussion about Ascot and Windsor wards.
The visiting team split into two groups, one to visit Ascot ward and the other to visit Windsor ward. One
group concentrated on the signage inside and outside the hospital.
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What we found out
The overall consensus of the visiting team was that the wards were clean and bright and calm. The patients
we spoke to were happy with their treatment. The staff were friendly, open to answering our questions and
were caring.
The Hospital & Patient Pathway
We were told that Wokingham Community Hospital was originally for the local community, however
depending on the bed situation, Wokingham patients could now be admitted to Oakwood rehabilitation ward
at Prospect Park hospital or to West Berkshire Community Hospital in Newbury. Patients from outside
Wokingham could be admitted to the Wokingham Hospital. However, we were told that staff try to locate
and/or relocate patients to their local hospital whenever possible.
We heard from the ward manager that admissions to Ascot and Windsor wards are generally from larger
hospitals, e.g. Royal Berkshire Hospital and sometimes from Frimley Park Hospital. GPs will try and refer
patients directly, in these cases the patient would be transferred to Royal Berks Hospital for relevant tests.
The patient may continue treatment at Royal Berkshire Hospital or might be transferred to Wokingham
Hospital. Patients generally only get admitted to Wokingham Hospital if clinicians believe they can
successfully return home after treatment and in some cases that will require care packages to be in place.
However, in some cases, patients do not recover sufficiently to return home and will have to move to
residential care homes.
Patients are usually admitted for 2-4 weeks depending on their needs and progress. Sometimes a longer stay
may be necessary. Patients undergo daily physiotherapy in order to try and regain mobility.
There is a discharge co-ordinator in place who liaises with patients, families and social services and a
provisional discharge target is put in place from the outset. The ward manager told us that that the hospital
gets “fantastic support” from Social Services at Optalis. Two patients we spoke to confirmed that they, their
families and the social work teams were all involved in their discharge planning and the patients were aware
of their proposed discharge date.
Staffing
The team asked the ward manager if there was any problems recruiting and retaining staff as we are aware of
workforce recruitment challenges within health and care due to the high cost of housing and cost of living.
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The ward manager told us there had been some issues in the past; When she arrived at the hospital 2 years
ago there were 21 vacancies out of 80 posts. At the time of our visit the Hospital Wards were fully staffed.
There had also been a reliance on agency staff to fill vacancies which was expensive. We were told that more
recently there had been a lot of effort and investment in recruitment and retention of staff. The cap on
agency staff spending has also had a benefit due to the £100 outer London weighting allowance. We were
told that generally the hospital now gets several applicants per vacancy.
The ward is staffed in accordance with safer staffing levels, each ward always works with a minimum of two
trained nurses per shift alongside healthcare assistants. There is a need for nursing care.
The visiting team were interested in staff training, particularly training related to patients who have a hearing
impairment or who have dementia. The ward manager told us that staff are given specific training regarding
hearing impaired patients, all staff undergo mental health and dementia awareness training. We were told
that if patients have communication problems then leaflets are available in various languages and flip charts
or handwritten notes are used for those who are deaf or hard of hearing. We asked the ward manager if she
was aware of the new ‘Accessible Information Standard’ which organisations must comply with fully from 31st
July 2016, the ward manager said she was not yet aware of those standards.
There is an older person’s mental health team is on site to assist where necessary with patients who have
dementia or delirium. There is a doctor on site between 08:00-17:00 and a dietician visits the wards three
times a week.
The team spoke to a health care assistant on Ascot ward who said they had been working at the hospital for a
few months. We asked specifically if they had received dementia training, the healthcare assistant told us
they hadn’t received the training yet but expected to receive it soon.
There are patient/staff forums and feedback sought via family and friends questionnaires and a patients
feedback board in the wards corridors. A part time activities co-ordinator for the wards, most recently had a
patients group talking about the Queens birthday.
The team were also interested in medicines management and whether discharges were delayed whilst
waiting for medication to be dispensed. The ward manager told us that patients usual medicines were stored
in the patients lockers and where appropriate patients are allowed to self-medicate. The wards have
acquired new more secure drug trolleys, purchased with funds donated recently by RVS.
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Windsor Ward (Female Ward)
The Windsor ward is split into several bays with a total of 28 beds. 26 beds were occupied on the day of our
visit. We observed that all the bays were light, airy, clean and the atmosphere everywhere was calm. Patients
with dementia are located in the bay opposite the nursing station to assist the nurses with their care and
safety.
We observed that to enable easy navigation around the ward, doors that would be used by patients are
painted to contrast with the walls and have dementia friendly picture signs, for example on the toilet doors.
Doors that are meant only for staff are painted in the same colour as the walls so they are less noticeable to
patients particularly with dementia.
We observed in the corridor that there were noticeboards which had information about staff including their
photos. There was transparent information about the incidence of bed sores and patient experience
comments were clearly displayed.
We saw that Windsor Ward had a separate day room and dining room. These were clean and bright. It was
pleasing to see there was access to the garden through a door in the day room.
We observed a number of conversations taking place between patients and staff. The staff we met or
observed in Windsor ward came across as caring, interested in their patients and dedicated to their work. It
was nice to see social interaction taking place including a group chatting around a table prior to lunch.
We spoke to three patients in Windsor Ward all who were dressed in their own cloths and sitting in chairs.
The first was a lady with MS who had a knee replaced. She needed daily physiotherapy to get her mobile
again. She
was full of praise for the staff, the food and the hospital,
describing it as
“Brilliant”
The patient was sitting in a side room where there was a small flat screen TV on the wall which was working
sporadically. The ward manager told us there was a signal problem in the hospital. The TV was also located
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behind the patients chair and facing the side of a bed that was on the opposite wall. As the TV could not be
angled it was really of no use. We were told that the TVs were supplied by the Rotary Club.
The second patient we spoke to was an elderly lady who was in the bay opposite the nurses’ station. She had
been admitted following falls. She told us that she liked it at the hospital. She described her two sons and
then had some cheerful banter with a member of staff about having two daughters also that she didn’t talk
about. She appeared relaxed and content but conversation between us was limited.
The third patient we spoke to was an older lady who appeared very bright and had been admitted following a
shoulder operation. She was very aware and was full of praise about everything at the hospital. She knew her
discharge plans and was hoping to get home earlier than the planned discharge date. We observed that
patients had some discharge information, for example discharge date, on small white boards above their
beds. We observed that the patient appeared to have a bruised face. The patient told us she had a really bad
allergic reaction to one of the creams used in the ward. The member of staff who was with us asked the
patient about it and noted that the patient had a bright red allergy warning on her wrist.
Ascot Ward (Male Ward)
The Ascot Word is similar in layout to Windsor ward as it is split into several bays. The ward is funded for 18
beds but there were 20 beds in the ward. There was a side room that could be used for private discussions.
We observed that the ward was bright and clean. Patients with dementia are located in a bay opposite the
nurses’ station. Patient relevant doors, for example toilets, were painted in a different colour to the walls so
they were easily identifiable, particularly for those with dementia. Staff relevant doors are painted in the
same colour as the walls. We saw that there was one patient shower room.
We observed in the corridor that there were noticeboards, these had information about staff including their
photos. There was transparent information about the incidence of bed sores and patient experience
comments were clearly displayed.
We were shown the dedicated physiotherapy/occupational therapy room which was at the entrance to Ascot
ward but away from the hospital bed bays. This room is used by both Male and Female patients.
Social interaction is encouraged by having welcoming day rooms in both wards and patients being
encouraged to have their meals in the dining rooms on the wards. We saw the combined day/dining room.
This was different to Windsor ward where there was a separate dining room and separate day room. The
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room was clearly defined into two areas with dining tables and chairs in one half of the room and
comfortable lounge chairs in the other half of the room. The room had been recently refurbished and had a
bright and airy feel. Unlike the Windsor ward there was no access from the room to the adjacent outside
garden area which was being developed to provide an outdoor facility for patients. It was noticed that the
dining areas had pictures of the meal choices. We think this is really important. This model could be used a lot
more in communicating ideas and locations.
Healthwatch Wokingham Borough had been invited and did attend a meeting at the Ascot ward some months
previously, along with patients, staff and other groups, to discuss the refurbishment of the ward. The majority
of improvement points raised at that meeting had been implemented as part of the refurbishment. However,
unfortunately one of the key points raised at the meeting, namely adding a door from the day room to the
garden, had not been implemented due to lack of funding.
We spoke to two patients in Ascot ward. The first patient had been admitted from the Royal Berkshire
Hospital. He was sitting on the chair next to his bed and wearing his own clothes. The patient told us about
the delay in his discharge from the Royal Berkshire Hospital and that he hadn’t been kept informed by them
about his discharge and transfer. He also told us that he didn’t like the loud noise and business of the Royal
Berkshire Hospital and that it was difficult to sleep. He told us the atmosphere at the Wokingham Hospital
was so much better, quitter, calmer. He told us that at the Wokingham Hospital he was aware of his discharge
plans from the outset and that he and his daughters had been involved with the plans. We noted leaflets on
his bedside table about Adult Social Care. He
told us he was glad he was at
Wokingham Hospital and told us he had physiotherapy daily since
he had been admitted.
“Very good care”
And
“Being dealt with
as a person”
The second patient we spoke to had come from the private Dunedin Hospital. He was very jovial and happy
and greeted us warmly. He was sitting on a chair next to his bed and wearing his own clothes. He had been
involved in the discussion with his daughter to be transferred to Wokingham Hospital which had been
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recommended to him as a professional and caring service. He
told us that he had been
involved in discussions about his discharge plan from the moment
he was admitted.
“Treated with
great care”
And
“Aware of what’s
happening with his care”
He also told us that if he wasn’t sure about what was happening during his stay at Wokingham
Hospital he was confident enough to ask for information. He told us he has physiotherapy
twice a day and that arrangements are in place for him to have physiotherapy at his home
once discharged. He was aware that Occupational Therapists had been to his home to make an
assessment for his needs. The patient also told us
“The food is good,
but there is no
Guinness”
There was information outside of the wards about the protected meal-times. I think there should be greater
explanation about what this is and why it’s in place so visitors and relatives understand. Perhaps this
information is given elsewhere.
We spoke to Nurses and Health Care Assistants, asking what single thing would make things better for
staff/patients.? We were told the following:

More blood pressure machines. Those they have at present have to be moved from one bay
to another therefore Nurses cannot work in different bays at the same time

More observation machines
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
Another rotunda turner (These are used for moving patients who cannot balance or walk
from one place to another) There appears to be only one.

Talking books and radio are both popular but there is only one CD player.

Most of the TV remotes have gone missing which means patients cannot switch TVs on/off or
change programs without asking staff to do it for them. This impacts both staff and patients.
Getting some new universal TV remotes would be useful and popular and stop Nurses being
drawn away from their work to change channels for patients.

Ascot ward has been improved and redecorated but it does not have as good facilities as
Windsor ward and no access to the garden
Use of volunteers within the hospital
With regard to fund raising and volunteers. It was not clear how actively fundraising is pursued. The RVS do
fund raise through the café, some money had been raised for painting and money and equipment had been
received from the Lions charity. The team thinks there are opportunities to do more fund raising.
With regard to volunteers, there didn’t seem to be any volunteers visiting patients and we would be
interested to know the process for ward volunteer recruitment.
Signage inside and outside the hospital
One member of our team looked at signage and also looked at the visitor facilities. The following points were
noted:
The front of the car park was full and it wasn’t immediately obvious one had to drive to the back to find
additional parking. Of course all this becomes clear once you’ve been to the hospital once.
If I hadn’t been shown, I would have walked from the rear car-park to the front of the hospital, as one doesn’t
immediately think to enter from the back. There is a nice large ramp at the back and immediately on entering
there is a map/layout of the hospital on the wall and the two wards are immediately accessible. As long as
you can see and you can read, there wasn’t much of a problem finding the main reception, although I think
that the hospital could benefit from additional signage with pictorial images above the doors along the
corridors.
The reception could do with a sign above where the receptionists sit.
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There is written information about the different departments at reception, but this is not immediately visible
given the way the chairs and seating are arranged. However, it’s made very clear in my opinion that all
visitors must first go to reception and that they will then be directed to where they need to be.
I found that there was adequate signage to all the departments in the hospital and it seemed clear that
reception would advise on anything else.
I observed that the visitor’s toilets had very full and overflowing bins. Other visitor waiting areas all had
water available and there was a machine to get tea and coffee in the reception area.
The RVS café was pleasant, clean and comfortable and there is a nice outside area to sit.
Service Provider response
Thank you for visiting Wokingham Hospital, providing us with positive and constructive feedback, and giving
us the opportunity to respond to your report.
Since the visit and receipt of the feedback we have reviewed the areas which were raised for our
consideration.
The signage in and around the hospital has been improved with the introduction of external signage around
the hospital grounds to direct patients and visitors to the different entrances, in particular the main hospital
entrance, at the rear of the hospital and a sign for the Memory Clinic.
Internally, the hospital layout is now on display throughout the corridors and a “You are Here” indicator on
each poster will hopefully enable people to get their bearings.
Visiting times are available at the ward entrances but there was a lack of information on protected
mealtimes. A notice will now be put up on the ward to correct this.
With regards to fundraising for equipment the wards are well supported. Wokingham Lions Club support with
significant activity to raise funds when required. We have regular contact and a good relationship with them
so that, when equipment is needed, we liaise with them and they are very supportive in undertaking
successful fundraising. Commonly their plaque is added to the equipment upon delivery.
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The RVS support the ward with the social events for the patients, for example preparing catering and
organisation events such as the ward Christmas party or the Queens 90th birthday celebrations.
We do also have charitable funds where donations from relatives etc. are used to benefit our patients.
For volunteers and volunteer recruitment, we currently have a lady come into the ward with the “pat the
dog” scheme. The RVS volunteers support some of our activity groups and the exercise classes. Until recently
we had a lady come onto the ward in the evening for social chats with patients but unfortunately she had to
leave and we are currently looking for a new volunteer to replace her. In addition, taking your feedback on
board, the ward team are now actively looking into enticing further volunteers, supported by the trust’s
volunteer development team, to increase activity on the wards.
Regarding the overflowing bins in the public toilets, a cleaning regime is in place that should be adhered to.
Your feedback has been raised with the domestic staff to ensure the regime is followed. This has also been
escalated to the Service Manager of Facilities Services and adherence will be monitored to ensure the issue
does not arise again.
Many thanks again for the helpful feedback and we look forward to welcoming Healthwatch again in the
future.
Helen Mackenzie
Director Of Nursing
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