Review of Patient Experience of Elective Orthopaedic Services at Manchester Elective Orthopaedics Centre.

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1 Review of Patient Experience of Elective Orthopaedic Services at Manchester Elective Orthopaedics Centre. Report Summary The purpose of the report was to gather views from people using the elective orthopaedic surgery service at Trafford General. Salford Royal Foundation Trust had previously delivered this service on their Salford Royal site. The service has been relocated to Trafford General as part of the Manchester Elective Orthopaedics Centre (MEOC). The information for the report was gathered by Healthwatch Salford staff and volunteers from 15 day patients and in patients having elective orthopaedic surgery at Trafford General Hospital. Additional comments were sourced through online and social media requests for experiences through the Healthwatch Salford membership. The information was gathered using a qualitative approach, with trained volunteers supporting patients to tell their stories. Volunteers were all members of the Salford community and had been trained to gather information in a supportive way by Healthwatch Salford staff. The information was gathered during a one- day visit to the Manchester Elective Orthopaedic Centre. A Healthwatch Salford member of staff supported volunteers on the day. The response from participants visiting Salford Royal Hospital prior to attending their surgery at the MEOC was very good, with 12 comments being overall positive and 5 of them specifically relating to the excellent conduct of the staff teams. 13 of the 15 participants were happy they had received clear understandable information about the treatment they were undergoing and 11 of those taking part said they had received clear information of how to access their treatment at the MEOC. When attending for their treatment and returning home after treatment, the patients we spoke with were arriving by private hire taxi, private ambulance or in a car with a family member. It was particularly highlighted in our discussions that taxi costs were a struggle for people who did not have family support. The overall experience of participants during their time as day patients and inpatients at the MEOC was positive, with 5 of participants saying no improvements are required. The main highlights identified in this review were: The support and information provided pre and post operation. Excellent care patients had received from all members of the staff teams, with 9 highlighting this as the best part of the service. The main challenges identified in this review were: The time waited for surgery on the day was highlighted as being quite long and this is reflected in the feedback received, with 4 participants suggesting that this part of the service would benefit from improvements. Difficulties in travelling to the MEOC, particularly for people with specific needs or limited income. 1

2 Background Information The Orthopaedics service for Elective Surgery was moved from Salford Royal Hospital to Trafford General Hospital to become part of the Manchester Elective Orthopaedic Centre (MEOC). The move was made for clinical reasons such as having all of the consultants in one place, supporting a specialist team to deliver high quality care and reducing the waiting list, with the hope of creating a centre of excellence. The people on the waiting list at the time of the move were given a choice of Salford Royal Hospital or Trafford General Hospital for their care. More recently, Salford residents are now receiving their care in Trafford General as part of the MEOC. Patients are invited to go to an information session at Salford Royal Hospital (this is mandatory and explains what patients might expect for their treatment) prior to the surgery. Patients are also assessed for any supportive equipment such as walking frames, chairs, commodes etc. at this point. Patients then have their operation at the MEOC and are supported to return home. During their time in the hospital, they are expected to undertake physiotherapy exercises to support their recovery, which are continued at Salford Royal Hospital after discharge. Healthwatch Salford has conducted this review with the support of Gillian Stirrup and the staff at the MECO to independently explore the patient experiences of Salford residents accessing care at the centre, using methods of qualitative research. We would like to thank our volunteers and the patients we interviewed. This review was not intended to be comprehensive; however, it is a snapshot of the experiences of those people using the service on the day we visited. We hope that this information will be a useful addition to a more detailed review taking place by the Salford Clinical Commissioning Group (CCG) Methodology Healthwatch Salford attended the wards at Manchester Elective Orthopaedic Centre during the month of May We spoke with 15 patients who were all having elective surgery and had come through the service via Salford Royal Hospital. The patients were of mixed age, ethnicity and ability. Two of the patients questioned had learning difficulties and required support from their carer to take part. We spoke to a mixture of inpatients who were staying at the hospital overnight and day patients who would be returning home after their surgery had taken place. We asked 9 in depth questions about their patient journey, ranging from patient experiences of information and support, experiences of treatment and accessibility of information and environment. In addition, information and experiences were also gathered via electronic and social media methods through the Healthwatch Salford membership. 2

3 Findings Pre Operation Support Participants overall experience of using the Orthopaedics Services at Salford Royal Hospital prior to attending their surgery at the MEOC was very good. 13 of the 15 comments were positive, with patients saying they were happy and had experienced no problems with the service. 6 of the positive comments were specifically about the excellent conduct of the staff teams and the pre op support provided. Excellent pre op support, Surgeon Mr Muir has been helpful and explained the procedure I am having Brilliant I have heard good things about Trafford Hospital and the Physiotherapists. I am not worried at all 13 of the 15 participants expressed they were happy they had received clear and understandable information about the treatment they were undergoing, but only 1 participant said they had received an information booklet to read at home. I have attended a pre op consultation and received the information I needed when I asked for it Pre admission, they do an excellent introductory session to the ward staff, physios and OT's. This helped to answer all the questions I had and I came in on my admission date feeling calm and prepared My pre op and post op information and support has been excellent. The consultant reassured me about the process so there were no surprises There was only one participant who said they did not receive clear information. stating they had not been made aware their surgery would be taking place in Trafford. I wasn t aware treatment would be at Trafford General, Salford Royal didn t say that at my outpatient appointment There were some comments in relation to challenges identified as part of the pre-op process. In particular, one patient experienced difficulties when asked to take part in a pre op consultation over the telephone. I m annoyed at being given short notice for telephone questionnaire (consultation) as I was teaching in class Due to the patients occupation they were unable to take calls during usual working hours and the consultant was unable to call back at a more convenient time for the patient. They could not find enough time to call me back 3

4 Treatment One participant made particular reference to the respect that staff have for patient preferences and their efforts to ensure they are met. I requested to have local anaesthetics and my wish was respected by the anaesthetist and after some discussion by the doctor, which I greatly appreciated. As I live alone I was allowed to stay overnight, which I also truly appreciated knowing how badly my body reacts to anaesthetics The overall experience during time spent as day patients and inpatients at MEOC was positive with 4 participants saying no improvements are required. Really good experience food and staff are good and the physio team are brilliant Honestly nothing (needs improving), top levels of care and attention at all times On the morning of my surgery, all the pre-op staff did a great job at keeping me settled and informed. Post-op care on the ward was excellent, with the staff being lovely in nature and very friendly Brilliant! Attentiveness of staff I ve been offered drinks, been cared for, allowed flexible visiting hours and I ve been allowed to stay and provide the extra support my daughter needs. I couldn t wish for better treatment. Even the cleaners have a friendly attitude, treated us like family. Very good staff at MEOC and Salford Royal, excellent treatment and I will be sad to leave. They are always there when you want them Staff are down to earth and Janet the physio was very good Brilliant. You are listened to and treated like a person One person commented on the differences between Salford and other orthopaedics teams in the Centre. They felt that this caused some challenges in clinical care. The only comment I would make is that there seemed to be a degree of unwillingness to make clinical decisions by the ward doctor because of what the "Salford team" might think. I'd suggest more work needs to be done on this as, given it's a shared facility and different hospitals have differing care pathways, some empowerment needs to be given to make decisions so they are minimising the negative impact on the patient. Otherwise I wouldn't hesitate to recommend the facility 4

5 Waiting Times One patient had experienced difficulties in receiving his treatment as the appointments had been cancelled on several occasions. This resulted in his surgery taking place a year later than expected. The patient expressed that they were not aware of why there had been a delay and thought that it may be due to poor management of appointments. My surgery was delayed for a year because of appointments being cancelled Participants suggested that waiting for surgery on the day was quite lengthy and this is reflected in the comments of 4 of those surveyed. Despite some challenges, patients understood that the teams were working hard and that waiting is a part of the process. Waiting times are a bit long but I expected to wait It s always good to wait less but I don t want to complain about it 3 of the 13 people surveyed said their wait was made more frustrating because they were not aware when they would be having their procedure and staff were unable to tell them when they would be seen. It has been quite boring I arrived at 6am and have been waiting in the hospital since 7am. Its 1pm and no one knows what time I will be treated. I was aware of the waiting before attending today but it is still frustrating. One participant had significant learning difficulties and was being supported by their elderly mother who also had mental health issues. This particular participant had attended for surgery previously but had to have it rescheduled due to them being too anxious. The patient was distressed and was quite distressed on the ward. The mother was concerned and anxious that their child was getting too agitated and would end up being rescheduled again. Having the appointments rescheduled was causing the patient and her mother stress as it required the patient to attend numerous pre op appointments. Mixed feelings I feel unsure what is going on my daughter (the patient) should have been put at ease over the local anaesthetic, she has learning disabilities and is getting very anxious and vocal Post Op Care and Support There was a good understanding of what the follow up procedures would be in place, with 7 of the people surveyed giving clear explanations of plans for their physiotherapy and dressing changes which were to be carried out by a district nurse, at home or at Salford Royal. I will receive an appointment at Salford Royal to change my dressings and then 11 days later my stitches will come out. Daily home visits to change dressings and then regular physio. 4 participants were slightly unsure what would happen next and had some idea of what the follow up care would be. Probably receive some standard care 5

6 I expect I will have a follow up appointment 2 participants said they were completely unaware what would happen next and 1 of these said they had struggled to find out what the follow up process would be. I m unsure of the processes at MEOC and I am not sure if I will be supported here or not One participant had difficulties following their treatment that they felt could have been prevented if they had been advised in advance. Due to the local anaesthetics I was not able to wee. I would have liked that this had been explained to me after the operation and that some degree of care about the agony of needing to wee and not being able to do so. I learned afterwards that this was a common feature of epidural type anaesthetics and I would have appreciated if at least the doctor or a nurse would have conveyed that the option of a catheter was available. Venue and Travel 11 of the participants interviewed said they had received full and clear information of how to access treatment at the MEOC. These participants felt that the area was well signposted and easy to find. 2 participants were not familiar with the geographical area of Trafford and had felt anxiety about driving in unfamiliar areas and worried about getting lost whilst trying to find the hospital. 2 participants made no comment. I wasn t sure how to get here so I didn t drive and had to get a taxi. When attending for treatment and returning to Salford after treatment, the majority of patients surveyed, (61.5%) were arriving by car with support of a family member. 30.8% had arrived by private hire taxi and 15.4% of those using a taxi were patients with learning difficulties who were unable to use public transport. Only one participant had arrived using a private ambulance and it was highlighted that taxi costs were expensive for those who had to use them. Healthwatch Salford researched this and the average distance from Salford (Pendleton) to Trafford General is 8.6 miles resulting in a taxi cost of 17.20p. Trafford General staff stated that they do not reimburse travel costs but they were unsure if Salford had a different policy. We got a taxi, we funded it ourselves but I m not sure if we can get the money back or not Travelling to Trafford General Hospital was a struggle for people who did not have family members and many thought it would have been much more difficult without the support of family members. I came via Salford Royal, it was all good but wouldn t have been possible without my family For those participants using private ambulance, there was some uncertainty of the time they would be collected from MEOC, or the time at which they would arrive home. It was also highlighted by an inpatient that it was very difficult for family to visit, given that it would take their family 2 hours on public transport from Salford, with family members having to travel on two buses to arrive. It was 2 hours on the bus for visitors so we ended up getting taxis 6

7 Its 2 buses from Salford to get here and my daughter cannot take a bus Areas of Good Practice and Recommendations for Improvements Healthwatch Salford would like to congratulate Salford Royal on the positive experiences people related to us about their pre-op and surgical care. There was a strong feeling from most of the participants that they were happy with their care and that they felt supported throughout their experience. Most people we spoke to had received information on their care, what to expect and the plans for their post op aftercare. There were some people we spoke to who were unclear about what to expect and their support following the surgery. Recommendation: We would like to recommend that there is a process for checking that all patients receive and understand clear information relating to their treatment and aftercare. Most people we spoke to expressed some anxiety about travelling to and from their appointment. Whilst we recognise that it is often impractical to fund people s transport needs, there may be opportunities to support people to plan how best to attend their appointment using public transport. Recommendation: We would like to recommend that patients are supported to consider the best options and routes for travelling to their appointments. This would be most useful at the pre-op stage so that anxieties relating to travel are reduced before the time of the appointment. Discussions regarding visitor travelling time might also be useful at this point to ensure that people are able to plan effectively. Many of the people we spoke to highlighted challenges around the waiting times experienced. Whilst patients were understanding of the potential waiting time, it did lead to some issues around anxiety, particularly for those patients who have additional support needs. Recommendation: We would like to recommend that patients are clearly made aware that the hospital opening time of 7am is not the appointment time allocated to them. Hopefully, this may assist in managing expectations of waiting times. Patients with additional support needs should have opportunity to discuss this prior to their appointment so that reasonable support can be arranged. We would like to comment Salford Royal on the positive feedback from patients around their clinical care. It is clear that the people we spoke to felt that there were well looked after and received the best clinical care. We recognise that the move to the MEOC has been fairly recent and therefore the clinical teams are still settling in to work together. Recommendation: We would like to see more opportunities for the clinicians and teams to work together and share best practice. Hopefully this would support the patient s experience of one seamless team, rather than feeling that there are separations in views from the clinical teams. 7