"Treatment as an inpatient in Neurology"

Review of Care – Neurology Ward, Royal Victoria Hospital Belfast

I was recently treated in the neurology ward of the Royal Victoria Hospital Belfast for a neurological condition which left me effectively paralysed from the waist down. The condition developed suddenly and was difficult to diagnose.

I would like to begin by highlighting the positives. My consultant and the supporting medical team were first class. My consultant took the time to explain the investigations and treatment plan clearly, listened carefully to my views, and made genuine efforts to take them into account. My strong impression is that everything reasonably possible was done from both an investigative and treatment perspective during the months I was on the ward.

Nursing Care (Day Staff)

The quality of nursing care during the day was mixed, though the majority of permanent ward staff were caring, professional, and attentive. They were clearly under significant pressure and appeared to be operating with insufficient staffing levels while managing patients with complex and demanding needs. As a result, there were occasions when patients did not receive sufficient attention.

For example, pad checks and skin integrity checks did not always occur as frequently or as thoroughly as they should. Medication administration is sometimes delayed, and patients were sometimes told they would be seen after another patient had been dealt with, which is understandable given workload pressures, but the delay could be prolonged and distressing for patients who may not fully understand the situation.

Night Care (Agency Staff)

Night care was a particular area of concern. This was frequently provided by agency nursing and care staff, many of whom appeared to have limited familiarity with the individual needs and clinical circumstances of the patients in their care. This lack of continuity significantly affected the quality of care provided.

While some agency staff were professional and conscientious, others appear disengaged and focused primarily on completing minimum tasks before withdrawing until morning. For example, I should have been receiving regular pad checks and changes overnight, at minimum a final check before sleep and appropriate checks thereafter. While some staff complied appropriately, others only performed these checks when repeatedly requested, and even then they did so reluctantly and hastily.

On one recent occasion, an agency nurse recorded my blood pressure at approximately 10pm and did not return for the remainder of the night until I insisted on being checked. In the morning, they again failed to provide appropriate care and left the majority of duties to a care assistant. Their attitude toward some patients could reasonably be described as dismissive and unprofessional.

There were also instances where pad checks were performed but pads were not changed, despite already having been in place for several hours and clearly requiring replacement. As a direct consequence, I developed a significant skin integrity issues that required treatment.

I feel that the reliance on agency staff—both nurses and care assistants—within the ward should be carefully reviewed by the Belfast Health and Social Care Trust. While some agency staff performed well, others appeared to lack either the training, familiarity, or motivation required to deliver appropriate patient care.

Catering

The overall quality of food was generally good. However, there were frequent shortages of items listed on the menu. Fresh fruit, which was stated to be available daily on request, was rarely available. Similarly, fruit juice starters were often unavailable. This may appear to be a minor issue but contributes to the overall patient experience and nutritional wellbeing.

Physiotherapy and Occupational Therapy

Physiotherapy and occupational therapy services were generally reasonable, though they may also have been understaffed. While I did not always agree with aspects of the treatment approach, the staff were professional. However, there seemed sometimes to be a perception that the primary focus was be on preparing patients for discharge or transfer to rehabilitation rather than fully addressing their current clinical condition.

Improved communication and scheduling could have been beneficial. Providing patients with advance notice of planned physiotherapy or occupational therapy sessions would allow them to coordinate with medical reviews, scans, and family visits.

Toilet and Shower Facilities

The toilet and shower facilities were very poor. There appeared to be only one functioning shower, and its layout was not well designed for patients with mobility impairments. The number of toilets was insufficient, and patients were often left waiting. The co-location of toilet and shower facilities further reduced availability and convenience.

Scheduling and Communication

Medical rounds, physiotherapy, and occupational therapy sessions frequently coincided with visiting times. While staff did make efforts to accommodate patients where possible, improved scheduling and communication could help reduce unnecessary stress and disruption. A daily plan shared with patients in advance could allow better coordination and improve the patient experience.

Overall Observations

Overall, my medical care was excellent, and many ward staff demonstrated professionalism, compassion, and dedication despite challenging working conditions. However, there were clear areas requiring improvement, particularly regarding night care, continuity of staffing, basic care standards, and facilities.

I was also concerned about the standard of care received by more vulnerable or less assertive patients, particularly overnight, who may not have been unable to advocate for themselves.

I hope this feedback is taken constructively and contributes to improvements in patient care and experience.