Agenda item

Offices from Barts Health NHS Trust will present the Trust’s improvement plan (attached) with particular reference to developments at Whips Cross Hospital.

Officers explained that the overall Barts Health improvement plan had been published in September 2015. This had detailed seven workstreams with actions developed by clinicians, patients and partners. Key points of the workstreams included the following:

The Trust wished to provide safe care for patients and, following Care Quality Commission (CQC) findings that safety risk areas were not known, staff were now able to report on incidents on a daily basis via a ‘safety huddle’. This was a multi-disciplinary team that allowed identification of which wards needed additional support.

A Quality and Safety Board had also been established for Whipps Cross allowing risks to be escalated as necessary. Priority risk areas at Whipps Cross were pressure care, falls, nutrition and hydration and training for hospital staff had been arranged on these areas. A safety performance dashboard allowed notification of safety hotspots and successes and partnership work on safety was also in progress with other Trusts such as Salford Royal.

A safe staffing review had resulted in 520 more nursing posts across the Trusts of which 150 were at Barts. This had allowed ward managers to undertake more supervisory work and hence be accountable for the quality of care on their wards. Nursing documentation had been simplified and streamlined and comfort rounds had been introduced allowing more communication with patients.

There was now a revised Trust complaints process which sought to start with a conversation with patients or families and hence bring about an earlier resolution of the process.

As regards end of life care, the CQC had raised some concerns over the Margaret Centre and the need to ensure that appropriate care plans were drawn up for patients nearing the end of life. A refurbishment of the Margaret Centre at Whipps Cross would be completed in mid-November and the Trust was also working with local CCGs to allow more patients to die at home.

It was clarified that the Margaret Centre would definitely reopen after its refurbishment. The Trust felt it needed to identify patients’ end of life wishes sooner and had established a team to support more people wishing to die at home. The future of the Margaret Centre depended on the new models of care being developed. Officers added that the Margaret Centre was classified as a palliative care centre rather than a hospice.

It was accepted that workforce issues remained a concern with a lot of bank and agency staff. More than 1,000 staff had recently been appointed across the Trust. Whipps Cross had a target of 100 hires per month and there were currently 84 new employees in the recruitment process. Six recruitment days were also planned. There would also be some international recruitment for the Trust as a whole and an increased number of bank rather than agency staff was now being used.

There were also a number of consultant vacancies but these were being recruited and there had been considerable interest in a vacant A & E consultant post at Whipps Cross. The Trust was looking at incentives to get doctors to return to clinical practice in order to fill vacancies at middle grade levels. Work was also under way with consultants in order to recruit more middle-grade doctors. The hospital managing director also attended the Junior Doctors Forum which allowed doctors to become more involved in hospital projects.

The Whipps Cross site kept data on exit interviews and other Barts Health sites were in the process of compiling this. It was felt that the main reason given for staff leaving Whipps Cross was to further their career development.

Staffing levels were monitored on a daily and monthly basis and induction arrangements had been improved. The Trust had introduced schemes to improve career development and hence increase staff retention.

Forty patients per day were seen in the new ambulatory care unit at Whipps Cross and the Trust wished to recruit further to extend the operating hours of the unit. Investment had also been made in redeveloping the children’s A & E pathway.

The availability of medical records in outpatients had been improved at Whipps Cross from 75% to 96% and this had reached 100% on two days in the last week. All case notes were now bar coded and could hence be tracked with bar code readers. Staff forums had also been set up to consult with relevant staff.

A new leadership operating model had been established with a managing director, medical director and director of nursing for each site, plus appropriate support. A new Trust Chairman had been appointed and further executive recruitment was also in progress. Other initiatives had seen a clinical director appointed for each of the Trust divisions and 40 BME staff start career progression programmes.

Governance changes had included the setting up of review groups for each of the workstreams and there were also quality improvement groups for each site, chaired by the CQC. An Executive Quality Improvement Board and oversight by a Quality Improvement Committee indicated that governance structures were in place at all levels. Monthly progress reports would be published from October 2015 and a communications plan was also in place to update patients, relatives and staff.

Other investment included £2 million on the IT infrastructure at Whipps Cross and £17.8 million on backlog maintenance at Whipps Cross as well two new theatres and a new nine-bed High Dependency Unit. Some £15 million had also been invested across the Trust on medical equipment.

Discussions had taken place with agencies used by the Trust to ensure a good quality of agency nurses and safer induction of bank and agency staff had also been introduced. The nurse in charge of a ward now wore a red badge indicating this and this had been well received by staff and patients.

Further details could be provided of the Trust’s new server which would allow the use of more electronic patient records. Officers would also confirm which specialities, other than cancer and frail elderly, held multi-disciplinary team meetings.

It was accepted that there were many patients in acute beds who did not need to be there and that work was therefore needed to reduce delayed transfers of care. The target was to keep delayed transfers of care to a maximum of 2.5% of the overall bed base but this was currently exceeded at Whipps Cross. The hospital had good engagement with the West Essex CCG on this issue. Officers would provide statistics on the numbers of delayed transfers of care at Whipps Cross.

Officers supported the introduction of boards at each ward entrance with photographs of staff and an explanation of what the various uniforms represented. A similar board identifying senior staff was also on display at the entrance to the hospital. It was also agreed that it was important to have visible leadership with senior management regularly visiting wards and speaking to patients, staff and relatives.

A Guardian Service had been introduced whereby an independent person was available for staff to raise concerns with. Senior hospital management also interacted with staff side representatives in order to build trust and confidence with staff.

Officers confirmed that any discussions on the future of the Whipps Cross site were in the very early stages and no decisions on any potential sale of any of the land on the site had been taken at this stage.

The Committee NOTED the update.