Leading change

The Carers’ Lead in the patient experience team at the Lister Hospital, East and North Hertfordshire NHS Trust has implemented service improvements to support carers, through an extension of visiting hours across the hospital and other measures. As a result, improvements have been made in communication and partnership working between staff and carers, and carers now feel increasingly empowered.

Where to look

Carers often have increased contact with hospital staff when the person they are caring for moves between health and care services. The admission of a loved one can also mean someone may be becoming a carer for the first time. Data collected by community services and local charity groups estimated that 100,000 carers in Hertfordshire were not registered formally as carers. With this information, the Carers’ Lead saw that there was an opportunity to offer more support and strengthen the role of carers within Lister Hospital as part of East and North Hertfordshire NHS Trust.

What to change

The Carers’ Lead recognised that the visiting arrangements were inconsistent and ward staff often relied on visitors identifying themselves as being carers. As a result, many carers had less access to the people they were caring for, as staff were unaware of their carer role.

How to change

An audit at the Lister Hospital revealed that on average, visiting was set for four hours a day, with significant unwarranted variation identified across the organisation. It was Trust policy to allow 24-hour access to carers, but this was not consistently being applied.

The Trust’s Carers’ Lead secured a commitment to increase visiting hours, to help make it more convenient for patients’ friends and families. A trial, extending visiting to 12 hours a day was initially piloted on three frailty wards and after successful implementation and feedback from patients, carers and staff, it was then rolled out in stages across the hospital. Notably changes in culture were needed as the extension of visiting hours made carers feel more a part of the care pathway.

This change is now ‘business as usual’, and has increased staff confidence in identifying and supporting carers. Accompanying actions have included:

• A new ‘Carer Passport’ badge, so carers can be easily recognised;
• Carers being offered restaurant and coffee shop discounts, snack bags when they do not wish to leave the bedside, beds for overnight stays and access to personal facilities;
• New information on the Trust website for staff, to ensure they understand the guiding principles and are confident when talking to visitors and identifying carers;
• The recruitment of volunteers to help identify and formally register carers.

Adding value

• Better outcomes – Staff are more able to identify carers, talk to them about their role and signpost them to the appropriate community support – which has been identified as improving carer resilience and confidence. There have been 312 carer referrals since implementing the change (data for January 2017 – December 2017), an increase of 250% from 2016 figures. Additional outcomes have also been that as carers, who are aware of the preferences of the individuals they care for, have been present they are also helping to ensure optimal patient hydration and nutrition, by offering drinks and food.

• Better experience – Carers have provided positive feedback via surveys about being better informed, having their own needs met, being made to feel welcome and involved and how helpful it is to receive discounts for refreshments. Patients also benefit from having visitors for longer periods. Feedback has also been that the environment also feels less ‘crowded’ because visitors no longer all attend at the same limited time slot.

• Better use of resources – Carers can help provide additional support for patients who may be confused, agitated, and are at risk of falling. This is because a carer can ensure that staff understand the language or nuances of care that an individual might particularly require to calm them and avoid escalation. This reduces the need for 1:1 nursing or other dedicated staff support.

Challenges and lessons learnt for implementation

• It is important to listen and understand the concerns of both staff and carers. Each part of the organisation has come up with their own way of implementing the change so there is local ownership of it. Discussion, information and training has been important.
• Having more than two visitors at the bedside (Trust policy) was sometimes challenging due to ‘safety & space restrictions’. To help staff to convey this and to educate visitors, signage was improved and a leaflet was produced explaining the policy. It was also important to look at alternative options, such as a patient sitting in the day room when multiple visitors attended.
• Having evaluated the change, some specialist wards such as the acute stroke ward have increased visiting hours to a lesser extent – to allow a required clinical need to implement complex patient care, patient rest and visiting. However carers on these wards do have unlimited access.
• Staff did not always know how to signpost carers to community services. To help them, a carers’ leaflet has been produced with contact and support information. Staff can also access a new ‘carer page’ on the Trust’s intranet.

Find out more

For more information contact:

Jodie Deards

Carers Lead / Patient and Carer Experience

Jodie.deards1@nhs.net