Table 2 Discussion extracts related to five priority service improvement areas

Collaboration along an integrated care continuum for frail older patients

“Often there is a reluctance of people to be discharged unless there is a safety net. People want to leave hospital but often there isn’t a support structure and it can all break down again.”

“We have talked about other hospitals not communicating and sharing databases but even with the A&E from reception to the [assessment area] to be assessed again you have to provide all your details again.”

Continence care

“Do they need to be on a trolley? Because the trolley means the sides are up and the person is immediately dis-empowered.”

“Can you get yourself to the bathroom? You are on a trolley and a nurse can’t come to you every time and all of a sudden it’s a serious thing.”

“I’m still horrified by the idea that I’m but up on a trolley as a default. I’ve come in with something and all of a sudden … the critical thing for me is if I can get to the loo or not.... And if I can’t I’m put in this situation that I’m in a … cot with bars that I haven’t been in since I was 18 months. I can’t go to the bathroom and I turn into an infant in the space of a couple of hours. I think we need to take a chance on people because the outcome can be catastrophic on the person.”

Improved mobility

“It’s a huge amount to do with self-esteem. The difference between seeing a visitor when you’re in your pyjamas and seeing a visitor when you’re in your choice of clothes […] we all want to appear well.”

“If I’m well enough [to be out of bed then] lying on my bed in my pyjamas is not conducive in getting home quickly.”

Access to food and hydration

“I’d think catering staff would have found it really hard [before bringing them on board], to be taking in [patients’ meals] and not actually be allowed to assist somebody.”

“Access to water is important as dehydration amongst frail patients can lead to critical conditions like delirium.”

“Important that these changes do not fade with new staff. Learning units and inductions are mandatory for new staff, so having these changes integrated.”

Improved patient information and signage

“You are so vulnerable when you come into hospital … and a lot of it can be improved with just communication.”

“Communication is key. A whole lot of anxiety can build up. They had a test on Monday and its now Wednesday and someone says “oh we will get back to you” but people are anxious by virtue of being in hospital even with its not very serious. They need to know all the time of what the stage of investigation is.”