Information about communication and visiting

27 July 2020



Guidance for all visitors

Advice for visitors of in-patients

Visitors are not allowed in our hospitals, except in exceptional circumstances where one visitor will be permitted to visit.
 
Please check with ward staff about visiting arrangements. They will explain if visiting is possible and the specific arrangements in place.
 
Exceptional circumstances may include:

  • a patient receiving end of life care.
  • if you are supporting someone with a mental health issue, such as dementia, a learning disability or autism, where not being present would cause the patient to be distressed.
  • one parent or guardian for a child.
  • one birth partner accompanying a woman in labour .

If you are permitted to visit, you will need to wear a face mask during your visit. Some visitors may need to wear further personal protective equipment and this will be discussed on an individual basis. 

If you or someone you live with has COVID-19 (coronavirus) or any symptoms of it, you cannot visit the ward. If you are not sure, please speak to a member of staff. 

Advice for out-patients

If you are visiting one of our hospitals or clinics for an appointment, please come alone.  Only bring someone to accompany you if absolutely necessary.  You will need to wear a face mask when visiting the hospital.

Advice for people using our emergency and urgent care services

Adults using our emergency departments or urgent care centre services are advised to come alone.  One adult only is permitted to accompany a child visiting our emergency or urgent care services. You will need to wear a face mask when visiting the hospital.

Attending our premises

We are also asking members of the public not to attend our premises unless they are attending an appointment or visiting the emergency departments or urgent care centre.

General advice for patients and visitors

Please remember that if you, or someone you live in the same house as, experiences coronavirus symptoms – a new, continuous cough, a high temperature and/or loss of smell or taste – please do not visit the hospital.  Self-isolate and visit NHS 111 online for further advice.

All patients and visitors to our hospitals will need to wear a face mask and are asked to wash their hands for 20 seconds with soap and water as soon as they enter the hospital and when they leave. Frequent handwashing is effective at reducing the spread of infection.

Thank you for your co-operation and help in respecting these changes.



What to expect if you are allowed to visit a patient on a ward

Anyone who is showing symptoms of coronavirus (a new continuous cough, a high temperature or a loss of taste or smell) should not visit, even if these symptoms are mild or intermittent, due to the risk they pose to others.

Before you arrive

The visit will need to be arranged in advance and you will be given instructions on where to go and who to ask for on your arrival. 

You must wear a facemask.

It is a good idea to write down any questions you have before arriving at the hospital as you may forget. You can also bring in cards / letters from loved ones.

You should drive, or be driven, to the hospital in order to minimise the risk of exposure to others, particularly if the household is self-isolating following contact with your loved one.

You will be allowed to bring a mobile phone with you but please bring as few belongings as possible to minimise the risk of infection.

You should remove outer clothing eg. coat or jacket and leave these with the person who has brought you in, if you can. Please then roll up your sleeves.

You should wash your hands with soap and water for at least 20 seconds on arrival at the hospital. Frequent handwashing is effective at reducing the spread of infection. There are also hand sanitising points around the hospital, please feel free to use them.

We practice social distancing where possible in the hospital and you will be asked to adhere to this during your visit although on the ward you will witness that this is not always possible when caring for patients.

You should consider going to the toilet and having a small drink before putting on personal protective equipment (PPE), as this helps to avoid the need to put on and take off PPE more than once during the visit.  PPE will usually consist of gloves, gown, mask and a visor.

Arriving on the ward

You will be informed about what to expect when you see your loved one.

You will be provided with appropriate PPE by staff and guided on where to clean your hands, how to put on the PPE and how to maintain social distancing between visitors, staff and other patients.

If you are not clear about the PPE please ask the staff supporting you.

Please ensure that you tell staff if you have any allergies to latex.

During your visit

Our staff will do what they can to protect you and support you during your visit and will advise you of any risks.

Please follow all instructions given by our staff, they will guide you to remove all PPE appropriately.

All visitors to our hospitals are asked to wash their hands for 20 seconds with soap and water when they leave. Frequent handwashing is effective at reducing the spread of infection.

When you leave

As long as PPE is worn, you will not need to self-isolate after the visit, unless you have been to the intensive care unit, where the mask cannot be specifically fitted.  You will be advised of this by ward staff when arranging your visit.

You should stay at least 2 metres away from others as you leave the ward/hospital and avoid touching any surfaces.

Leave the ward/hospital as quickly as possible, using the most direct route, and go straight home.

Avoid touching your eyes, nose and mouth with unwashed hands.

Cover any coughs or sneezes with a tissue, then throw the tissue in a bin.

Wash your hands again with soap and water for at least 20 seconds as soon as you get home.

Put your clothes on a hot wash as soon as you get home, and have a shower.

Follow stay at home guidance if you become unwell.



Communication between patients and family and friends

We recognise that the visiting restrictions imposed due to the Covid-19 pandemic has affected the ability for some patients to communicate with  their family and friends.  We are asking patients who they would like as their ‘Key Ѽ’ so that staff can provide regular updates on their progress. We would ask that the person nominated as the Key Ѽ liaise with the rest of the patient’s family and friends.

If the patient cannot communicate, we will review the information recorded in the patient’s notes and ask the family/friends/carers to nominate the Key Ѽ.

Best wishes service - postcards delivered to patients on wards

The Royal Free Charity is kindly hosting a ‘best wishes' card service which allows you to send a card to patients who are being treated at Barnet Ѽ, Chase Farm Ѽ or the Royal Free Ѽ.

Hosted on the charity’s website, the cards can be personalised and will be delivered to the named patient.  The cards available have been selected as the winners from a local school’s art competition, and are available here: 

You are able to send letters and postcards to patients yourself.  As long as the patient’s name, ward and bed number are included on the envelope, ward staff will collect and deliver them.

Virtual consultation with patient and family/friends/carers

The visit will be instigated by the medical, nursing or therapy teams, in response to the patient’s clinical situation / discharge plan, or because the Key Ѽ has specific questions to be discussed with the hospital teams in the presence of the patient.  This consultation will need to be arranged in advance and you will be given instructions on date, time and mode e.g. via Zoom, FaceTime or via the hospital remote consultation app ‘Attend Anywhere’.

It is a good idea to write down any questions or concerns that you have before the virtual consultation so you don’t forget any important issues.

Please also note that you are within your rights to record the video call, with staff and patient consent, and with the understanding that the images will not be made public. If the patient is unconscious and cannot give consent, then recording permission is at the discretion of staff.

Interpreting during a virtual consultation is available

We recognise that patients, relatives and carers with a day-to-day understanding and use of English may have difficulty with complex medical language and giving informed consent for procedures.

The trust offers an interpreting service, provided by an external company, who use carefully screened and qualified interpreters, offering a strictly confidential service in a wide range of languages. 

We have access to a telephone interpreting service 24/7.  We can facilitate 1-way interpreting telephone calls, where you are on-site with the patient and staff.  We can also facilitate 3-way interpreting telephone and video calls, where you are at home and need to be connected to staff and the patient with an interpreter on the line. 

Tips for a successful interpreting session

Think of the interpreter as a human language link, helping communication between languages and cultures.  Make sure you direct your questions to the staff, as opposed to the interpreter.

Let the interpreter know the information that you want to find out.

Go through your questions as methodically as possible.

Understand that there may be some delay before the interpreter can get the information you need from the staff.

Be aware that different languages often require a different number of words.

 



End of life care

End of life care is the treatment, care and support for people who are probably in their last year of life, although this timeframe can be difficult to predict. Depending on the illness, some people might only receive end of life care in their last weeks or days, but many people are living for a long time now with many illnesses.

Advance Care Planning

Advance Care Planning involves talking to you and your family and friends about what to expect towards the end of your life. The healthcare professionals looking after you will talk to you about your specific needs and wishes, and will ensure they consider your wishes in relation to the treatment they provide to you. They will always want to provide treatments where the benefits outweigh the risks.

The care of the dying relates specifically to care in the last days and hours of life.

When do I need to think about Advance Care Planning?

You can start Advance Care Planning (ACP) at any time, starting earlier is always better as it gives you more time to think through all the possible options.

However, you may like to consider a conversation with your health care professional (your consultant or GP), regarding ACP, if you have one or more life-limiting conditions (such as: cancer, heart disease, kidney disease, dementia, respiratory disease, liver disease and neurological disease) and one of the following indicators of poor or deteriorating health:

  • Three or more unplanned admissions to the hospital in last 90 days.
  • Staying in bed or chair for more than half a day.
  • Needing at least two carers to help out with essential daily activities of life such as washing, dressing, toileting, etc.
  • Progressive unexplained weight loss.
  • Persistent symptoms, despite optimal treatment of your underlying condition or illnesses.
  • Choosing to reduce, stop or not have treatment; or wishing to focus on quality of life

Please know that we (healthcare professional) will initiate conversations, too, if you meet these criteria.

How do I start my Advance Care Plan?

The overall aim of Advance Care Planning is to both enable people (you) to live as long and as comfortably as they can and also to enable people, when they  are in their last days of life, to die in comfort, with dignity and in the surroundings of their choice. Although most people respond well to treatment, it is important to think about what you might want, if you were to become very unwell and our best treatment cannot improve your situation. Your healthcare team is responsible for assessing your health. We need to know what is acceptable to you and what you want, so that we can make the right plan together.

It is a good idea to communicate your wishes and preferences about your treatment, such as who to involve in discussions, the types of treatment you would like to have and the place where you prefer to be cared for, so that these can be considered when we are planning your care.

At Royal Free London NHS Foundation Trust, we are committed to providing compassionate care to you and your family and friends, and to team this with your expressed wishes. We encourage all our patients who are in their last year of life to consider completing an electronic document called ‘Co-ordinate my Care’.

 is an innovative NHS service that builds medical care around the wishes of each patient. Plans are created with a healthcare professional (usually a GP) and then shared electronically with all healthcare professionals who might be involved in care and treatment.

  •  if you are a patient or carer
  •  if you are a health or social care professional
  •  start your own plan, in your own time, in your own home, online

Also, we are committed to providing high quality care and ensuring choice for all patients, wherever possible. We will work with you or your representative:

  1. To enable you to be in your preferred place of care and
  2. To support you and your family.

We will discuss with you any decisions you may have already made regarding your care and will talk with you about the best way we can support you at the end of your life.

If you wish to be cared for at home, we will do our best to accommodate this, with help from community services. We will discuss with your relatives and carers about what is practical. For further information about what to expect, please see our leaflet for relatives and friends, Care in last days of life.

For those patients who are acutely ill with limited reversibility of medical conditions and thus, who may be approaching the end of life, Advance Care Planning will include discussions about cardiopulmonary resuscitation (CPR) (CPR is provided if your heart stops functioning), treatment and comfort care should be provide in the ward setting rather than intensive care.

CPR attempts to restart the heart or breathing when these have stopped. Unfortunately, this is  and does not work in patients with advanced and irreversible illness. This is because CPR will subject the patient to a vigorous physical intervention that deprives them and those important to them of a dignified death. For some people this may prolong the process of dying and, in doing so, prolong or increase suffering.

Your doctor or the healthcare professional caring for you will ensure that decisions about CPR are discussed with you, in order to establish your wishes. The healthcare professionals will make a clinical judgement about whether to attempt CPR, based on how likely it is to succeed, as we need to ensure that an ineffective treatment is avoided and patients who are dying have a dignified and peaceful end.



Other support services available

Chaplaincy and spiritual care

The Chaplaincy-Spiritual Care team is here for everyone of any faith, belief or philosophy of life.  We offer spiritual, religious and pastoral care to patients, staff, visitors and volunteers.

You do not have to think of yourself as religious to make use of our service. Some people may value the opportunity to talk to someone about how they are feeling and the changes they may be facing.

Our teams include Christian (Anglican and Roman Catholic), Jewish and Muslim Chaplains. We have a range of volunteers including Buddhist, Sikh and Humanist practitioners currently.  If a representative of your faith is not listed above, we will be happy to arrange a representative for you where possible.

Bereavement services

Our bereavement team is committed to providing an effective, compassionate and sensitive service, and the bereavement officers offer practical and emotional support to the families and friends of loved ones who died within the trust's care. 

Support hub

The Support hub offers support and information to people affected by long-term health conditions and their carers. The staff provide a friendly ear to talk to about whatever is on your mind and provide information on further support in the community if needed.  The support is free of charge.

Patient advice & liaison service (PALS)

If you need advice or have concerns about the care and treatment being provided to a loved one, our PALS team will offer you help and support and liaise with relevant staff to answer your questions and resolve your concerns quickly.