Annex A > Chapter 16 - Support and Counselling > Helen Stratton > After the departure of Helen Stratton
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After the departure of Helen Stratton
322 Asked what happened to Miss Stratton's post between her departure in February 1994 and when the paediatric cardiac service was united at the BRHSC in October 1995, Mrs Pratten told the Inquiry:
`The post went, and I was concerned that there was no thought of putting it back in place, and I was very concerned that all that she had achieved would be lost ... I spoke to Dr Gardner and asked her to do research on the needs of families and children, because although I was saying that I thought she had done a good job by and large ... I had no documentation to prove it, and I felt that the only way forward, really, was to get a research document looking appropriately at the needs of children and their families.' [399]
323 Dr Gardner produced a report, `Assessment of the Psychosocial Needs of Children with Heart Disease and their Families', based on questionnaires completed by 150 parents. The paper considered the effectiveness of the services then being offered and suggested areas of improvement.
`The survey revealed the parents' need for more information from medical or nursing staff. They expressed the need for additional reassurance and information, and advice on the care of their child before surgery and following discharge.
`At an emotional level, parents described periods of great distress and expressed the need for help which was in some cases met and in others not.
`Practical community-based advice was also needed such as information about financial support and help with other children at home.
`There was also evidence that children are discharged from hospital without adequate provision in advance made for psychological, emotional and in some cases practical support.' [400]
`The need for information however, requires the appointment of a Cardiac Liaison Nurse Specialist which would also bring the service in line with the Department of Health guidelines and other supra regional cardiac services throughout the United Kingdom. Many centres provide specialist nurses who provide information and explanation and provide a liaison service and co-ordinate community care. This is a service that Bristol currently lacks and the evidence for its need is compelling.' [401]
326 In the report she stated that it could be presumed that all parents would require the skills of the Cardiac Liaison Nurse Specialist at the time of diagnosis and surgery, and recommended that referrals be made at that stage. She recommended that additional emotional and practical support could be given by the Family Support Worker, and financial or social support by a social worker. She stated:
`It is important to distinguish between the roles of the Cardiac Liaison Nurse Specialist and Family Support Worker. The Cardiac Liaison Nurse Specialist is primarily involved with all medical information and counselling concerning the condition of the child. In this way the Family Support Worker is released to offer emotional and practical support to the many families who need this form of care.' [402]
327 Dr Gardner also emphasised the continued need for a play therapist. [403]
328 In distinguishing between the two posts, she recommended that the Cardiac Liaison Nurse Specialist:
`... would be responsible for providing parents with medical and nursing information throughout the period from the initial referral to the first outpatient appointment following corrective surgery. The nurse would be able to reinforce, repeat and supplement the information from the consultant involved with the care of the child, presenting it over a greater period of time and in terms that parents will clearly understand. They would also liaise between hospital and community, planning appropriately for admission and discharge.
`Some parents need additional help beyond that period and the cardiac nurse specialist would be able to assess any need and refer the family to an appropriate community professional. It is these important services, as described by the Department of Health, that are currently not provided in Bristol and diminish the quality of care ... There is clear evidence from other centres such as Birmingham, Great Ormond Street and Southampton of the success of such a post.' [404]
329 As regards the post of Family Support Worker, she recommended:
`... it is absolutely clear from our survey that the support provided by this service is of great value to some parents ...
`In releasing the post holder from the medical aspects of care (such as preoperative talks) the many services that are currently not consistently provided can be fulfilled.
`... it was evident that many families were seeking counselling in conjunction with information as distinct from social and emotional support. This was particularly true at the time of diagnosis and in intensive care. This need for information cannot be met by the Family Support Worker. Removing this expectation from the post would release considerable time for the vitally important emotional and practical support that is needed by many families.' [405]
330 Dr Gardner also recommended:
`Any professional providing psychosocial support should in turn be supported and provided with professional supervision. There is currently no provision for this.
`Support for all other members of staff should be available either formally or informally. The benefits of staff support are well documented and should be provided, particularly for nurses in intensive care.' [406]
331 Describing Dr Gardner's paper, Mrs Pratten said that it:
`... proved clearly that the post was needed ... As a result of that research we offered to fund a post in the Children's Hospital [where the service had by then moved], which we did, and after 6 months of that post, the Trust took it over, so it is now a National Health Service post.' [407]
332 Mrs Pratten explained that Kathy Selway initially took the new post, and was the conflation of the posts previously held by Mrs Vegoda and Miss Stratton. [408]
`Towards the end of 1995, Rachel Ferris ... made it clear that she wanted a part-time psychology service for the cardiac unit. I became formally clinically involved from then.' [409]
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Footnotes
[400] WIT 0269 0052; Dr Gardner's report
[401] WIT 0269 0052; Dr Gardner's report
[402] WIT 0269 0053; Dr Gardner's report
[403] WIT 0269 0054; Dr Gardner's report
[404] WIT 0269 0053 - 0054 ; Dr Gardner's report
[405] WIT 0269 0054; Dr Gardner's report
[406] WIT 0269 0055; Dr Gardner's report
[408] T47 p.44. Mrs Vegoda told the Inquiry that in September 1996 she took on a new role at the BRHSC. She said: `In 1996 I took on a new role in the Children's Hospital of Counsellor in Child and Family Support, offering counselling and support to families of children not previously receiving counselling. A cardiac liaison nurse was appointed to the cardiac team.' See WIT 0192 0005. Mrs Vegoda described her present role in which she provides child and family support throughout the hospital, although she does not cover oncology and cardiac services as they now have their own support systems, and that it was the intention of her present post to offer some support and counselling and help to families where counselling had not previously been provided. See T47 p.99. In relation to facilities currently available at the BRHSC Cardiac Unit she said: `There is a cardiac liaison nurse in place. ... Having said that, I am occasionally specifically asked by either nursing staff or somebody in the hospital to see a particular cardiac family, either because they have requested counselling, or because the nursing staff feel that they need more psychological emotional input than can then be provided.' See T47 p.172-3
[409] WIT 0534 0001 - 0002 Dr Gardner