Nightingale Hospital

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

At the time of the inspection patients spoke very positively about the care and support from the staff team. They described staff as kind, empathetic and flexible, going the extra mile to support them as individuals. Some went so far as to describe the support they had received as ‘life saving.’ We did receive some concerns from previous and current patients describing a small number of bank/agency staff members who did not work with them in a supportive way, especially during meal supervision. They were aware of steps taken by management to improve staff induction training. Patients said that if they had any concerns, they could speak with the ward manager who was very helpful in solving any problems. As recommended at the previous inspection, patients reported that there was an improvement in staff respecting their privacy. There were posters making patients and visitors aware of the use of CCTV in communal areas. Carers were invited to ward rounds and other relevant meetings about their relatives’ care if patients gave permission. A family and friend support group was held approximately weekly, including eating disorder specific topics. One carer was grateful that they had been able to continue attending the sessions for carers after their relative had decided to leave the programme. Warm and positive relationships were demonstrated between patients and staff members. Patients told us that there was a full programme of activities available to them during the week, but there were fewer activities at weekends. Others advised that there were enough weekend activities. Management reported that they were introducing more opportunities for activities outside of the unit at weekends. Weekly community meetings were held on the ward, during which patients could raise any concerns, or suggestions they had about the service. We saw evidence that actions were addressed following these meetings including addressing some staff interventions perceived to be unhelpful.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Prior to the inspection, we received concerns from some people using the service about the way some staff members had supported them. However, at the time of the inspection patients spoke very positively about the care and support from the staff team. They described staff as kind, empathetic and flexible, going the extra mile to support them as individuals. Some went so far as to describe the support they had received as ‘life saving.’ Patients did describe a small number of bank/agency staff members who did not work with them in a supportive way, especially during meal supervision. They were aware of steps taken by management to improve staff induction training. Patients also raised specific concerns about the support they received from one identified staff member, and we relayed this to senior management, who advised that they were taking steps to address the issues raised. Meal supervision training was scheduled in September 2024, to cover regular bank and locum agency staff as this was a particularly stressful time for patients. Patients and carers were very positive about most of the staff at the service and said they were treated with kindness, compassion, and dignity. People felt that staff listened to them and communicated with them appropriately, in a way they could understand. Patients said that if they had any concerns, they could speak with the ward manager who was very helpful in solving any problems they had. As recommended at the previous inspection, patients reported that there had been an improvement in staff respecting their privacy, including knocking and waiting for a response before entering their bedrooms. Carers were invited to ward rounds and meetings about their relatives’ care if patients gave permission. There was a family and friend support group including eating disorder specific topics. One carer was grateful that they had been able to continue attending the sessions for carers after their relative had left the service.

Our interviews with staff, and managers confirmed that they had a positive and supportive attitude towards patients. Staff we spoke with understood the needs and preferences of patients and spoke of how they supported them sensitively and with compassion. They said that they felt able to speak up if they observed patients not being supported appropriately and had access to reflective practice sessions to ensure that they learned how to support particular patients more effectively as a team. As required at the previous inspection in June 2022, managers had provided training, supervision and reflective practice to staff to improve the culture on the ward and reduce variability in staff compassion and empathy towards patients. They had improved the induction for bank and agency staff members working on the ward.

An advocate attended the ward twice weekly. They fed back that staff and management were open and approachable, responding to any concerns promptly. They noted that some patients had raised issues around some bank and agency staff, and they were aware of steps being taken by management to address these concerns.

Our observations of staff and patient interactions and time spent in the service confirmed a positive and supportive environment. There was a pleasant atmosphere in the service during our inspection visits. Warm and positive relationships were demonstrated between patients and staff members. We observed that patients’ privacy and dignity were respected and upheld at all times, with confidential information stored appropriately out of public areas.

Patients told us that staff knew and understood their needs, preferences, and wishes. They said that their personal, cultural, social, and religious needs were understood and met. Although they noted that they sometimes had less responsive care from agency staff who did not know their needs so well. They noted that the ward had many restrictions which were part of the eating disorder treatment programme, but most staff treated them as individuals aiming to be as flexible as possible based on each person’s needs. Patients were aware that they could have a copy of their care plan. Records could be provided in other languages if needed. Patients said that staff went out of their way to treat them as individuals, and be flexible in meeting their needs, considering any relevant protected equality characteristics. Some patients we spoke with said there were not enough activities at weekends, but others were satisfied with the weekend programme. We relayed patients' concerns in this area this to management who reported that they were introducing more opportunities for activities outside of the unit at weekends. Following discussion at community meetings, it was agreed that trips out of the service would be held fortnightly at weekends. Whilst not all patients saw their named nurses regularly, they said that they were able to speak to a member of staff individually whenever they wanted to, and that this worked well. Patients noted that sometimes they received contradictory information and advice from therapists and nursing staff.

Staff we spoke with were knowledgeable about individual patients’ needs and gave examples of how they supported different patients according to their needs and preferences. For example, patients were given support after stressful activities, and were encouraged to keep meaningful connections with family members. Staff were aware of different patients’ dietary needs, and preferences for engagement, with some patients wanting more regular check ins, and others preferring more time alone. Some staff acknowledged that there could be an improvement in communication between therapy and nursing staff, to ensure more consistent care for patients. Following the inspection, the service provided examples of records indicating improved communication between nursing and therapy staff and weekly catch-up meetings between the ward manager and the lead therapist.

We observed staff supporting patients with their individual needs and preferences as reflected in their care plans. At staff handovers and other multidisciplinary meetings, staff discussed patients’ individual needs in sufficient detail to ensure that they provided holistic support.

Patients’ care plans reflected their holistic needs and preferences. There were systems in place to provide care plans translated into different languages or easy read format. Patients could have visitors in the evenings on weekdays, and more flexible hours during weekends. Provision for visitors had improved since our previous inspection when there were more restrictions due to the Covid-19 pandemic. A male advocate visited the ward regularly. Managers had discussed with the advocacy service, and arranged that a female advocate could be contacted on request, and this was made clear on the advocacy poster on the ward.

Patients told us that they were supported to have choice and control over their care and to make decisions about their care and treatment. Patients confirmed that staff made sure they understood their rights and if appropriate arranged times to review them regularly throughout their care and treatment. They were also encouraged to identify goals they wished to work on each week. They had the opportunity to discuss their treatment including restrictions, therapies, and medicines with staff members as needed. Patients confirmed that they were supported to maintain relationships and networks outside of the hospital and they had regular contact with their friends and family. There were some opportunities to be involved in activities in the local community, and following the inspection staff undertook to make more opportunities available for patients at weekends including visiting cafes, parks and the cinema to promote and support their social and wellbeing needs. There were specific restrictions on patients as part of the specialist eating disorder treatment provided, however, staff reviewed these with patients regularly, and patients contributed their own views to daily risk assessments, so that restrictions were relaxed or removed when this was appropriate. Patients still described some inconsistencies between information given by therapy staff, and information from nursing staff. They also noted that they sometimes had to wait a long time to be assessed by a therapist as fit to attend groups. This meant that on their first day, they sometimes missed a day of groups whilst waiting to be assessed. Some patients also noted that they would have liked to have more information about the service including restrictions in advance prior to their admission, to be better prepared.

Staff gave examples of how they supported people to understand and manage their eating disorders, as well as offering support with other mental or physical health or social situations. They described formulating care plans in partnership with patients, and a stepped approach towards supporting people towards discharge or to move on to the day service provided on the ward. They supported people to maintain relationships and networks outside of the hospital as far as possible. Managers noted that a brochure with a large amount of information about the ward was sent out to patients prior to admission (which included items not permitted on the ward). However, they noted that it might be helpful to look at making this information more accessible, by prioritising certain information that patients needed to know. There was a timetabled programme of groups and activities for patients provided by therapists, with other staff available to provide support outside of these groups.

Care plans indicated that patients were involved in making decisions about their care and support and included their perspective. Patients completed daily risk assessments of their own, which were compared with staff assessments, and also recorded their feedback prior to each ward round. Patients were able to raise concerns or suggestions for improving the service directly to staff, through regular community meetings, and with support from an advocate if preferred. The timing of the advocate’s visit to the ward had been adjusted to ensure that patients were free to meet the advocate individually if they wished. As recommended at the previous inspection of the service, there were posters making patients and visitors aware of the use of CCTV in communal areas.

Weekly community meetings were held on the ward, during which patients could raise any concerns, or suggestions they had about the service. We saw evidence that actions were taken forward and addressed following these meetings including addressing some staff interventions perceived to be unhelpful. Other improvements made as a result of feedback included providing more board games, changing the laundry detergent provided, starting a body image group, and improving the frequency of cleaning in communal areas. There was also a patient forum meeting call for the hospital, to which a representative from each ward was invited. At the time of the inspection, no representative was attending for the eating disorder unit.

Patients we spoke with were generally satisfied with staff responses to their immediate needs. They noted that this was not always the case for bank/agency staff working on the unit. They said that regular staff on the ward observed and communicated with them and prioritised their views, wishes and comfort as far as possible. Staff gave them help, emotional support and advice when they needed it. They noted that staff were often able to anticipate their needs to prevent concerns or distress. Most carers we spoke with were also satisfied with staff responses to their relatives’ immediate needs. Patients felt confident that staff would respond to their needs quickly and efficiently, especially if they were in pain, discomfort, or distress. However, some patients spoke of past experiences on the ward when they had not been supported sensitively. They had relayed concerns to the management who were working to address the issues they had raised.

Staff told us how they worked to meet patients’ needs, through engagement whilst carrying out observations, and knowledge of patients’ different needs and priorities. They said that there were currently enough staff on shift to meet patients’ immediate needs, but there had been a time period towards the end of 2023 and early 2024 when patients’ high level of needs on the ward had been difficult to meet. They noted that management had worked to support them during this time.

We observed staff engaging with patients sensitively and meeting their needs during our inspection visits. At staff handover meetings staff discussed people’s needs, and those requiring support for their physical or mental health needs or social situations.

The service’s policies and procedures ensured that people’s needs, views, wishes and comfort were a priority. Staff understood their duties to anticipate and respond to patients’ needs to prevent discomfort or distress. Patients’ care plans detailed their needs and how they preferred to be supported and were reviewed regularly. As recommended at the last inspection, there were plans in place to improve patients’ control of the temperature in their bedrooms, with the installation of air conditioning.

Staff told us that the provider recognised and met their wellbeing needs. They described appropriate resources and facilities for safe working, and regular breaks scheduled. Staff said they had opportunities to provide feedback, raise concerns and suggest ways to improve the service or staff experiences. The management team were responsive in arranging for improvements to be made. Staff said that they had support available to them if they were struggling at work and described good team working and a positive atmosphere at the service which had improved the atmosphere for patients also. They noted that there had been a stressful period on the ward at the end of 2023, and early 2024, when patient acuity was high, and they had found it difficult to work on the ward. The management team recognised this and attempted to put in place systems to support them, including providing twice-monthly reflective practice, senior management support on the unit, and limiting the number of patients admitted to the unit at this time. There was also an independent employee assistance service available for staff who were struggling. Staff said that they were encouraged to undertake professional development and did not have concerns about any discrimination impacting on their career development within the service. They felt valued by the management team.

The management team spoke about changes put in place following a difficult period on the ward. They were clear about priorities for the ward including addressing staff turnover, and further improvements needed in staff training. They also noted that there was a need for some staff to work on other wards within the hospital on rotation to prevent conditions that might enable a closed culture on the ward.