(Own Address)
FAO
Dr K-r (acting consultant/locum)
and
Dr A-i (ward consultant, responsible clinician)
H-Ward, Bradgate Unit, Glenfield Hospital, Groby Road, Leicester LE3 9EJ
cc. Ward Matrons (+named nurse)
cc. J-
8th July 2015
Dear Dr… et al.
Discharge of J- (deleted) H ward
Ward rounds and arrangements for discharge.
J has told me today of the unexpected news that the date for her discharge has been set for 21st July, 13 days (8 working days) from today, as decided by Dr K-r (locum/cover). Every time J- has been readmitted to hospital, questions have been asked regarding the speed of the previous discharge. Sometimes there has been concern at the lack of an effectively gradiated discharge plan or well spaced leave, or co-ordinated support with the community team, or even a clear plan in J’s notes for readmission for when she is in crisis. I am happy to attend the next two ward rounds, or a discharge meeting, but would prefer that there will also be present professionals who are consistently involved in her care. These must include most of the following: the consultant who has been overseeing the medications overhaul, Dr A-i (ward consultant, responsible clinician); J’s CPN, the only consistent member of staff at the Community Team, S- H- (CPN and Care Co-ordinator); perhaps the community OT, J P, the Ward OT, A, and very importantly, nursing staff who know J well enough in terms of risk and understand her personally, i.e. a named nurse (N) or nurse of J’s choosing (such as Na, if N is not available). If possible, or pertinent, a senior member of the Crisis Team, so that if there is an agreement for ongoing support, or a conditional readmission plan, that it is put in writing or communicated to other staff in that team, to avoid repeat failings. I apologise if I am stating anything obvious here, but I have been to meetings in the past where there is barely one professional present who has a working relationship with J, which is not acceptable. J’s GP has also told us that even he is sometimes not kept informed by the LPT of changes in her treatment.
As well as establishing that J is in very different state to the distress she was suffering when she was first admitted to hospital, I hope topics being discussed will include making sure J is now on the absolutely right medication, and that there is a continuity of useful or new therapies, such as rape counseling and maybe pointers for the community OTs.
Due to personal and part time work commitments I may not always be available as an escort if J is required to have sudden increase in leave-days in the next two weeks (especially at this length of notice). Since she, at this moment, is still ward based, you may need to find staff to accompany her on those extra visits. A rapid increase in leave over a short period of time right before discharge is not my preferred plan, and I’ll be happy to help with alternatives to this (given enough time to plan ahead).
Total length of stay vs. progress in treatment and setbacks
I believe that after her recent admission to the LRI for acutely painful and possibly deadly cellulitis, (a complication from her legs being swollen, in my own opinion, a side effect from her mental health medication), a clumsy and careless readmission to Heather Ward caused the second major setback in her recovery. J has detailed this in her green notes sheets, i.e. misinformation about the status of her room and possessions, manhandling and damage to possessions, the lack preparation or warning given for the room change and total disregard for her OCD upon her return, despite repeated mentions and highlighted triggers in her care-plan, which her named nurse has carefully revised with us to the letter. We are grateful that she is allowed to remain on H Ward, but I am still disappointed with utter the lack of tact and empathy, so often robotically brushed aside at the Bradgate Unit with generalised terms like “ward policy” and “acute care”. The first major setback was the depersonalizing and disempowering referral process to the out of county Cambian Service for long term residential care. J did not instigate either event, and yet there will be no recompense in time lost during this ward stay. It has taken extra time for us both to rebuild trust in the whole process of mental health treatment after one doctor allowed J to leave the ward and walked with her to the main road where J was in real danger of throwing herself into traffic (which I witnessed at first hand). Presumably that doctor didn’t believe J was suicidal (a mistake based on assumptions around her diagnosis, which we are trying to challenge). The same doctor inferred that J’s life was worth less than the seclusion gown she had been wearing, because to leave the premises wearing it constituted a theft of hospital property. After a month of not making any changes to J’s medication, as agreed at her admission, a locum doctor and a junior doctor told Jo, whilst sectioning her, that they did not believe that she heard voices (since then, Dr A-i’s increase in antipsychotics has helped with this). This would have been devastating for anyone, i.e. not to be taken seriously, realizing that you had been misled and stalled for a month, whilst your rights were being taken away and you were to being forced along a treatment path without any say. It may seem churlish, but still relevant, to mention a long period of many weeks of the bullying in plain sight of both patients and staff by an aggressive patient (on a ward for vulnerable women), when J was allowed to be targeted specifically, making even a trip to the kitchen a terrifying experience. After all these events, in this ward stay alone, I still consider Heather Ward to be one of the better wards at the Bradgate Unit, and J’s relationship with the staff to be better than most from the past.
I am hoping that these disruptive ward-caused events (and triggers) are taken into account, especially from our own perspective, when trying to take a broad view of progress from admission to discharge. Also I would like to be reassured that even when discharge dates are set that if J is not well enough to return home that she will not be sent.
Please feel free to share this letter, if required,
Yours faithfully
(My name)
Partner, carer (part time) for J
(Address, phone email etc)
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