As I mentioned in another thread my MIL has been in hospital and was recently moved to one nearer. This evening she fell off the commode and was very disorientated. Not ideal for an 85 year old recovering from a hip op. Another poor old dear in the ward has been observed on 2 occasions asking for the loo and being totally ignored so it seems the care in that ward is less than good. My question is who do we have a "word" with about our concerns?

Ask to speak to the Ward Manager/Sister/Clinical Lead or whatever the hospital calls the person in charge of the ward.  You could ask them to run through your MILs care plan and see if you think they have everything covered and if they appear to be fulfilling it and if not why not?
It is very difficult to make a judgement on what you observe on a ward regarding patients that you are not connected with.  For instance the lady asking for the loo may possibly have a catheter in situ and yet still be confused about the sensation of needing to pass urine or even be confused about when they were last taken to the toilet.  With the best will in the world the nurses can go and reassure her every time but, at the end of the day, other priorities can impinge. 
I think you have real cause for concern, though, if they appear to have spare time and are not spending it attending to the needs of those in their care.

Having had a dreadful experience with my father and care on the ward or general lack of care to the point of neglect please keep a very close eye on what is going on with mil. Our story did not have a good ending
Try not to make yourself unpopular but dont let anything go ,sounds like stooge has good knowledge as place to start.

Having just come out of hospital myself please do feel free to have a word. I am not elderly by any means except feeling 100 but some of the care I received in a vulnerable state left a lot to be admired and has left me quite traumatised in fact and that given to one lady in particular was dreadful and reported by the family. Doctors are blind to what happens, ' we are a specialist centre, we know what we are doing' was the reply when I tried to express a concern about something I had seen. Egos can be too large for the care us patients deserve unfortunately and wont change unless we are brave enough to see if theres an issue to address. I am doing that  tomorrow, I hope you do too. Stooge has very good points but just be sure you arent fobbed off,..my family nearly were until I was able to prove what they were told wasnt true.

go the hospital receptionist and tell them you want to make a complaint to PALS (Patient Advice and Liaison Services) they will have  a pals rep with you within a few minutes and tell you all you need to know about complaining

> go the hospital receptionist and tell them you want to make a complaint to PALS (Patient Advice and Liaison Services) they will have  a pals rep with you within a few minutes and tell you all you need to know about complaining

I would say that is your last resort.  I certainly would not consider it before talking to the nurse in charge. She/he will be happy to give you a PALS leaflet if you are not satisfied following your talk.  PALS would probably direct you back to that stage anyway.

Yes it is a worry especially as the poor MIL has vascular dementia.  Thanks for the replies, will be going there tomorrow and having a word.

Hope you are able to get the care your mil should be getting as you indirectly say the lady will not beable to stand up for herself so make sure you dont give up
I have not been able to forgive myself for not getting things right for my dad

Don't forget to let us know how you get on.  I have a friend in similar situation and I will be able to pass on any advice that you may be able to give us on this thread.  Best of luck and hope your mil is ok.

Moan, complain, and moan again about everything you have concerns about.  For a year, we had concerns with my grandfathers care home but because we were raised with good manners, we didn't like to complain.  I bitterly regret this now as it turned out that home had been drugging the patients to make them easier to manage.  We took my grandfather out of that home and learned the hard way that the nurses and doctors need to know that you are ready to look out for the patient and take any complaints further.  This is the only way to get the correct care.  How awful is that?  But they are severely understaffed.
Forget your manners and complain to the staff nurse.
I feel awful for the poor old ones that have no family to look out for them.

> Moan, complain, and moan again about everything you have concerns about.
> Forget your manners and complain to the staff nurse.

I would disagree and change that to enquire, check explaination and enquire again as long as you have concerns.  Just generally get involved and make sure you are part of the decision process. For instance, express your preference as to whether you prefer your relative to receive medication that may infact be prescribed to make them less anxious or whether you feel they are better off more alert but perhaps also face risks in being more mobile.  These decisions can be quite difficult and staff will often be very grateful for your input.
If medication is being given to sedate patients simply because of low staffing levels you will generally find the staff will support you in taking your concerns further up but treating them to bad manners or even the first port of call with all your complaints about allocation of resources is perhaps a little unfair. 
They may prefer things to be rather different too  :)

Oh yes being bought up with good manners it does seem to make it hard to complain. In my case my parents also believe men in white coats to always be right and the amount of intervention I really needed to do was not helped by may parents being scared that if they complained however politely it would be taken out on Dad
The result was the care was substantially lacking and certainly contributed to us losing him at that time. Unfortunately after the event there is little than can be done for your loved one. Court cases and money dont bring someone back which I why we didnt persue  and why I would stronly suggest you dont let things lie until you are happy.
I know  it is often not individual staff but systemic problems that cause the lack of care but when it is your relative all that pales in to insignificances

When I've had cause to complain (several times recently) about hospital care I always make a point of being polite but firm. I have also submitted my concerns via various patient feedback forms but haven't received any responses. In my experience these NHS 'customer care' type groups only pay lip service to the importance of good standards - however much you complain, nothing changes....

My parents were polite too Furriefriends but we know it doesn't always get you anywhere. When I was a teenager I had severe pains and by the end of the Sunday afternoon my parents called the GP out but they were told he was out on another call. They wouldn't call the ambulance for fear of upsetting the GP so my boyfriend (now my OH) who isn't bothered by things like that did dial 999 - lucky for me he did as my appendix burst as the surgeon opened me up.
Will keep you posted as to the MIL but really do need to be proactive before it's too late.

> so my boyfriend (now my OH) who isn't bothered by things like that did dial 999 - lucky for me he did as my appendix burst as the surgeon opened me up.
>

That's not complaining that is being decisive and good for him :)
Lois complaints can be very complex and can take time to investigate and resolve but there are national standards for this process which your Trust should be complying with.
http://www.pals.nhs.uk/CmsContentView.aspx?ItemId=1543
If they are not responding in the time expected it is time to speak to your MP.

Tagging on the end here...

My daughter was in hospital and had several complaints to make...mainly about urine samples being left on the surfaces and floor of the toilets. But other matters as well. Her bed was moved into an alcove with no lights, no electricity and because of this no emergency call button. She was in hospital for low sodium and potassium levels which affected her heart.
I told her to take photos and videos and to make sure the staff saw her doing it. She had complained and was told to stop being a trouble maker. However shortly after they saw her taking videos etc the toilets were cleaned and she was moved to a more appropriate area.
The toilet situation was particularly bad as the urine samples for a start had no names on them...so no way to tell whose records to add results to. And some of them had been left too long to be able to get accurate reading.
I observed the nurses most times sitting and chatting to each other about themselves so they certainly could have been doing the work....

Always ...record (voice) photograph or video if concerns are being flaffed off....if you intend to make a complaint it will be your word against theirs and you will need proof and there is none better than the above..

> Always ...record (voice) photograph or video if concerns are being flaffed off....

Photography is not always permitted in order to preserve the dignity of other patients so I would check that first. 

> Photography is not always permitted in order to preserve the dignity of other patients so I would check that first.

I think if Wolfie asked the staff if she could take photos for evidence of their suspected poor care of the wards poor standards or hygeine they are likely to say no!? It wouldnt necessarily have to include other patients faces.

Stooge I do think that the way some complaints procedures are flawed even after you have discussed it with the first line carers.

If a ward/department in run properly then it will not be an issue but I have had two incidences of NHS treatment where I felt the way I was treated was terrible even down to misconduct in the case of when I was pregnant.

I do however think it was down to the way the whole health service is funded and run, I know this from a professional opinion having worked in this area in a consultancy capacity.

You cannot fault the care and dedication most health care professionals give to their jobs but policies and the people trying to implement them who are often either under qualified to run organisations in a commercial way as that is the way things have to be run now. It is not their fault at all but things do have to change.

I am on a project now where I have now got to overcome both cuts and a huge change to a government funded org . The people are lovely , the organisation world renowned and I have a huge task to hopefully change things for the better and take some of the people with me.

> It wouldnt necessarily have to include other patients faces.

The people who see you using a camera are not necessarily going to know that.  I think you have to ask yourself if it was worth bringing yourself that sort of trouble.

Fair enough if you are some sort of investigative journalist wishing to expose serious failings but for most complaints and concerns this would be way out of proportion.

There are much, much better ways of dealing with things and the very first would be talk to people about your concerns. If you are not happy with the outcome then take your complaint further it will then be looked in to and you can definately expect a response. 

I think, when pursuing a complaint one should remember that there may be a case to answer.  That is not to say complaints are not sometimes justified but under investigation other factors less obvious to you can be considered.  For instance, ward activity can be checked.  If it was found, for instance, that on a particular shift twice the usual number of emergency admissions were processed with one member of staff down then it may be reasonable to say getting round to clearing out the bed pans left in the toilet consistently unlabelled by the ambulant patient requested to do so may not have been a priority even if the staff take a moment for a natter as they diligently record the essential details in patients records. And desperate phone calls made around the hospital for bed capacity had turned a blank then you might consider popping a patient in a bed inadequately served with lighting until you can find the time to discharge another. 

A well run ward should look like swans at busy times.  Foot paddling like mad under the water and calmness and serenity up top so as not to spread the stress to the patients :)

However if ward activity was reasonable then they should have to state why the the toilets were not checked regularly and they are likely to fall under the gaze of the Trust Quality Group for more frequent inspection so by all means press on with concerns.

> I do however think it was down to the way the whole health service is funded and run
>

Definately and, unfortunately, not likely to get better.

.>> go the hospital receptionist and tell them you want to make a complaint to PALS (Patient Advice and Liaison Services) they will have a pals rep with you within a few minutes and tell you all you need to know about complaining
Stooge

> I would say that is your last resort. I certainly would not consider it before talking to the nurse in charge. She/he will be happy to give you a PALS leaflet if you are not satisfied following your talk. PALS would probably direct you back to that stage anyway

This taken from the Pals site  http://www.pals.nhs.uk/cmsContentView.aspx?Itemid=944
It does say they are there to act for you if you do not want to speak to someone directly yourself.

You may have unanswered questions concerning the level and quality of care you receive from the NHS, PALS can help answer these.

When using the NHS, you may have a concern about a wide range of aspects of care. For example, you may:

not be happy about the environment in a waiting room or ward,
feel that a member of staff has not treated you respectfully,
have had transport or parking problems that have inconvenienced you,
feel that treatment options have not been properly explained to you.

People using the health service usually feel they can raise such concerns with a member of staff, such as a therapist, doctor, nurse or receptionist and the NHS expects that the person you approach will do their best to help you. But if you are not satisfied by their response or prefer to talk to someone not directly involved in your healthcare, PALS is there to help.

PALS will provide a service for service users which aims to improve your satisfaction and reduce any confusion or anxiety you may have.

PALS staff will act as quickly and creatively as possible to support patients, their carers and families to deal with concerns, before they become more serious.

An important part of PALS is to help people to talk through their concerns so that they can identify the nature of the problem and work out options to resolve it. Concerns may be resolved by listening, providing relevant information, or by liaising on your behalf with relevant colleagues.

Options may include making a complaint. PALS staff will try to resolve your complaint and can tell you how to get free, independent support from outside the NHS should you wish to consider this option. Further information on making complaints is shown below

> People using the health service usually feel they can raise such concerns with a member of staff, such as a therapist, doctor, nurse or receptionist and the NHS expects that the person you approach will do their best to help you. But if you are not satisfied by their response or prefer to talk to someone not directly involved in your healthcare, PALS is there to help.

Of course you can go straight through if you wish but I think this is the best order to follow whenever you can. 
At the end of the day you will want to work together in the best interests of your relative so a good relationship is the aim.

> The people who see you using a camera are not necessarily going to know that.  I think you have to ask yourself if it was worth bringing yourself that sort of trouble.
>
>

I'm not talking about someone walking about with a large lense camera...lol..I would imagine they would have the sense to discretely take photos on a mobile or small digital camera and keep these to use if and when needed. Not everyone goes in all gun ho but not everyone gets satisfactory answers either and then going ahead with an empty handed complaint based on their say so and against defensive staff....you can wish you had the photos or tape recordings at that point but its too late. As for vulnerable patients with dementia specifically...dont even let me begin to get started on that subject.....!  Oooer..I better depart! :(

> ..I would imagine they would have the sense to discretely take photos on a mobile or small digital camera

That is what I imagined you were talking about.  Not something I would wish to have to explain if someone did notice.

How is your MIL today? Missed you at r/c tonight x

In My experience PALS is a good place to start...but they  can only help with an INTERNAL investigation...as they are also part of the NHS "trust"....there is also LAMP.....both of which I have gone through....

It is a long drawn out process..but in My own particular case..and after a further meeting where I was handed someone elses prescription sheet (!?).....it has now allowed Me to take My complaint to The Next Level...which is The Ombudsman.... At this stage I am considering whether to press on alone....or get Legal Representation....

If they are genuinely trying to make believe that the prescription sheet was mine...then one can only wonder why "I" had been prescribed 3 drugs (2 via intramuscular injection...and 1 oral (never mind that the Staff in Question tried to force Me to take 2...!)...one of which was for Parkinsons Dis-Ease Type Symptoms....! (I refused all medication....bar the "dragged off to the "seclusion room" and forcibly injected with a dirty needle...dropped on the floor...just prior to Him pulling My Jeans down...jab....")

What I witnessed in there will haunt Me for a long time...and with hindsight I wish I HAD taken photos of The Vulnerable Elderly Lady..who was sedated to the hilt...and left lieing in Her own urine for over 24 hours...Her private parts on display....and without a drink.....(Can't have done Her kidneys much good...???) if I hadn't gone and fetched a nurse...and complained on Her behalf then I dread to contemplate the outcome....

When She came in...I was looking after Her....making Her drinks and keeping Her company.... as no-one seemed to be taking any notice of Her at all....She wanted to contact Her Son...and I offered Her My Blackberry to call Him...after they drugged Her I never had another conversation with Her...

I have remained in contact with several of the patients...and would dearly love to make contact with The Elderly Lady or Her Son...to find out if She is okay.....

If you have concerns...you MUST complain....I feel that if I hadn't have had My Daughter Cathy...demanding IMMEDIATE explanations from the Staff Nurse in Question...and a Doctor....then they wouldn't have had Me Moved Out of The General...and into Glenfield with such haste....

I too pity all those...and there are many..... vulnerable people...with NO-ONE...on The Outside....

When my daughter was taking photos and videos it was of her area and the toilets. No one else was in them. I wouldn't tell her to take photos of anything not related to her complaints which includes other patients. I do however think when making a complaint to the nurse or whomever ....it should be recorded because I have found people often "forget" what they say when confronted by someone higher than themselves.
I worked in hospitals and know how hard it can be....but there is never an excuse for the attitude some nurses or carers have towards patients. I often felt stressed having to deal with patients or the staff levels but that was my problem not theirs. If the care or conditions are poor document it and complain you don't have to have anyone else in the photos...and if you are asked to show what you have on the camera ...show them and tell them why you have them.

As my job is a PALS Complaints manager... I will be happy to answer any questions you have, and offer advice :-)

It is correct that if there is a problem with a ward be it with staff, care etc... we would always advise patients/relatives to speak with the ward manager or matron in the first instance. If they don't know about the problem, they can't look into it. If things don't improve, then we would contact the lead nurse or manager for that particular directorate. I would try to arrange a meeting in this case with the ward manager/matron, family and PALS to discuss the concerns raised and provide the patient and family with an action plan.

'Front of house PALS' seek to clear things like this up very quickly (where I work anyway) and we have another PALS team who deal with more 'formal complaints' and carry out investigations. This can take up to 25 days for a written response so for things that need sorting 'now' we would always firstly approcah the department or ward involved.

Hope this helps a little, pm me if you need any further help

Gabrielle :-)

That is a very generous offer Gabrielle !

Do you know if PALS covers Wales as well as England ?  I cannot get onto the website at the moment to check.

Hi Lois_vp... no it appears there is only one PALS office in Wales according to the PALS website...

I wonder how they deal with complaints... I may have to go and have a bit of a browse later.... :-)

Gabrielle x

Thanks for the input & advice. A quick update: I didn't go in as I had a raging sore throat (MIL also has no spleen)so one SIL spoke to the sister & the other one put it in writing. On the day MIL had her fall my SIL discovered she was wearing 2 morphine patches so probably O'D, she's only supposed to have 1 every 3 days and these were overlapped by one day. Now that that's been sorted she is more with it but likely to be there for at least a fortnight. The other lady I mentioned has advanced dementia, her family have complained a lot so now 2 nurses attend to her every time....

I am very pleased you feel a little more care is being taken of mil particulary with the morphene patches

I hope things go better now for her and at the very least you can be confident that she is having good care.
Hope the sore throat gets better quickly

Thanks FF. It's difficult to know how much confusion is down to the drugs or dementia. My OH was upset to be asked "are you my brother?" & "where's my husband?" (died4 years ago), so I've put a photo album together in the hope that something might jog her memory.

Its very hard on family when this happens but often because they dont understand how dementia affects the person they love or how to respond . In the case of your OH she will likely be seeing him as a similar age as she sees herself, young, as she likely wont be seeing herself as elderly and therefore he cant be her son and maybe somewhere in his features theres something that reminds her of her brother...his Uncle...and of course that makes her most usually too young in her mind to be a widow and wants to know where her husband is, just as you and I naturally would, she may well ask about the children if she sees someone elses! The photo album may jog her memory and bring back some reality to here and nowbu it wil be short lived ubtil the next time it is looked at, thats the nature of Dementia, its about short term memory loss. If you were to go through it with her every hour every day for a fortnight in the same routine without change you may form some memory bridges if  you surround her with accesable visual prompts that dont need to be got but can just be seen without effort afterwards..interesting and rewarding when it happens...but not to argue 'No Mum thats not your Brother' but just let her be happy thinking it is whilst you stay happy and reassured knowing its the same love she feels, its just the relative label she cant quite connect. I hope thats helpful as a starter if you didnt know and happy to help with anything else but also apologies if Im teaching you to suck eggs

No, not at all, thanks for the info. This is the first case we've had close contact with, apart from ourselves when we joke about it having got upstairs and not remembering what we went up for! I've written names alongside the photos that can be covered up or revealed incase she can't remember. It'll be interesting to see if she can recognise her old poodle and schnauzer.

Thats lovely..just another pointer too came to mind when thinking about using the photos...please please try to avoid asking 'do you remember?' 'Do you know who this is?' etc. She most likely cant so its like asking a blind person 'can you see this' or a deaf person 'can you hear this'? You will be setting her up to fail before shes even tried and this in turn knocks the persons confidence and self esteem very quickly. Just sharing the book and looking through the photos together maybe with little statements like 'that looks a little like you Mum' to see her reaction is enough and she may come back with 'thats because it is me!' and treat you as stupid! If she doesnt comment on the dogs you can ask her if she ever had any dogs and see what she says but if you tell her she had some you are telling her shes forgotten and in turn telling her shes got problems and that can leave her anxious and worrying. Sharing photos can be a lovely time but can cause anxiety if youre not careful but you are putting a lot of care in..it just has to be managed well...your idea of covering names is nice if it wont upset her if she realises she had forgotten them when she uncovers them,..just play it carefully with the first couple of pages until you gauge her reaction :) Shes lucky she has a lovely D I L !