The Chief Executive of BHRUT will update the Sub-Committee on progress with the Trust Improvement Plan.
Minutes:
The BHRUT Chief Operating Officer confirmed that the Trust had originally been placed in special measures following an inspection by the Care Quality Commission (CQC) in late 2013. A re-inspection by the CQC in March 2015 had been very positive but some areas of concern still remained.
In response, a new clinically led management structure had been introduced at the Trust and also present at the meeting was the Trust Head of Productivity who had been recruited to support the improvement work. The most recent CQC inspection had identified 30 new areas requiring work. Of these, 19 had now been delivered and evidenced and a further 4 had been delivered. Ten other areas were also on target for delivery.
There were two other areas were delivery was at risk. The first of these were workforce issues in the emergency department where there was a lot of reliance on locums to cover shortages of consultants and middle-grade doctors. The other issue concerned access for patients and issues with waiting times and meeting the 18 week target for elective care treatment.
Current projects being worked on at the Trust included work to keep patients records secure, document patient care plans, revisions to the induction process for locum & agency staff and training speck and language therapists on tracheostomy skills.
Recent improvement included better auditing of prescriptions and that drugs were dispensed as need, the appointment of a new chief nurse, quicker discharge times from maternity and programme of work to improve the experience and treatment of children and young people.
An assurance framework had been introduced throughout the Trust. Key performance indicators were monitored and report on at Board level. Performance was also monitored at divisional level and improvement teams regularly walked the hospital looking at cleanliness issues etc. Peer reviews were undertaken on a monthly basis and the Executive Team also undertook regular inspection walks around the hospital.
The CQC was expected to inspect again in March 2016 and it was hoped that the Trust could move out of special measures at that point. Trust officers were keen to continue stakeholder engagement and show people around the hospital. Although already rated good by the CQC under the ‘caring domain’ the Trust was keen to continue this and had recently introduced feeding buddies for patients.
The Chief Operating Officer was aware of issues around communication difficulties and the bedside of some agency staff at the Trust. The Trust had a very diverse workforce and was in the process of setting up an equalities and diversity group that would include patient representation.
It was confirmed that there was a clear process for dealing with emergency arrivals by ambulance and that this was closely monitored. Officers were happy to receive further details from Members of any specific problems in this area.
A Member felt that it was often confusing for patients as regards what medications they were having and the Chief Operating Officer confirmed that this was also monitored. There was also a new chief pharmacist at the Trust who was investigating the issue of drugs that were wasted.
It was accepted that the target of treating or admitting 95% of patients within four hours was not being met consistently. There had however been a 10% improvement in performance over the last year. The rise in number of patients treated over the Christmas had gone smoothly and no black alerts had been declared by the Trust. There remained however a reliance on agency staff in the department. The recent strike by junior doctors had not caused any major issues in A & E.
The Trust had established links with UCL as regards medical staffing and had recruited abroad. The Chief Operating Officer would provide further details of the other universities that BHRUT recruited from.
It was confirmed that the Trust had a DNR policy. This would be discussed with the patient, usually with the involvement of the patient’s family. The level of involvement a family had in these decisions would however up to the patient. It was also pointed out that many terminally ill patients were not in fact suitable for resuscitation in any case.
The Sub-Committee NOTED the update.