Agenda item

A representative of Barking, Havering and Redbridge University Hospitals’ NHS Trust will discuss with the Committee the Trust’s improvement plan and plans for dealing for dealing with winter pressures.

An officer from BHRUT explained that the recent CQC visit to the Trust had now been completed but no feedback had been received as yet. A report was expected from the CQC by the end of November 2016. The Trust’s improvement programme had developed into an improvement portfolio which fed into an Improvement Portfolio Board chaired by the Trust chief executive. The Board provided strategic direction and ensured the alignment of programmes as well as recommending sufficient resources were released for improvement work.

The improvement work had four components covering quality improvement, organisational development & workforce, service improvement and constitutional standards. The Portfolio Board reviewed progress monthly and reported via the Trust Executive Committee to the main Trust Board.

The Chief Operating Officer for Havering Clinical Commissioning Group (CCG) agreed that lessons needed to be learnt and that learning from incidents and mistakes needed to be clearer. Timescales varied for completion of the total of 35 improvement workstreams with some areas such as the governance and constitutional work being continuous targets. Workforce development was also ongoing.

As regards winter pressures, the Trust aimed for an 85% capacity to as this allowed extra bed capacity during bank holidays etc. Pressures were usually at their greatest towards the end of the Christmas/New Year holiday period. The Trust sought to maintain standards of care and patient dignity regardless of pressures.

The winter season usually meant a higher volume of hospital attendances as well as a longer length of stay for those patients admitted. There was a Trust-wide capacity plan which covered issues such as extreme weather and getting people to appointments in cases of transport difficulties. Staff availability during these periods was also an issue. BHRUT sought to prioritise in these instances communication with vulnerable groups and to prepare for increased levels of attendance and demand. A 24:7 urgent care centre had now been established at both Queen’s and King George Hospital. There was also a wish to try to ensure more treatment was delivered at home rather than in a hospital setting.

Internal delays to treatment were scrutinised daily and the Trust worked with partners on this. There was also a Trust workforce plan in place although it was accepted that BHRUT also still had significant numbers of vacancies. Demand was monitored daily and an agreed process was in place to deal with any service disruption. This included responses from partners such as the Council and CCG. It was accepted that on the worst days of winter pressures, the Trust may need to look at what services could still be provided.

The officer emphasised that delays in the completion of discharge prescriptions lay more with junior doctors than with the hospital pharmacy itself. Work was in progress to encourage doctors to complete prescriptions on the evening before a patient’s discharge.

BHRUT dealt with care home providers principally in conjunction with the Council via the Joint Assessment and Discharge Team. There were approximately 1,600 care homes beds for older people in Havering. In previous years there had been around 200 vacancies during the winter (although the Council’s levels of fees were not accepted by all care homes) and it was possible that some homes could close for the winter, thereby reducing the number of beds available.

Expected demand was calculated by using a percentage increase on the previous year’s demand levels and winter plans were agreed by the A & E Delivery Board comprising all relevant parties. Expected winter demand levels were required to be submitted by BHRUT to NHS England in the next two weeks and the Trust capacity plan included a tolerance of around 5%. Another option to deal with high demand could be to use additional rehabilitation beds provided by NELFT.

The Council’s Director of Adult Services added that it was not the Council’s preference to have people discharged from hospital to residential nursing homes and it would be preferable to discharge people back to their own homes. The former care beds at Royal Jubilee Court had been closed off as part of the Council’s medium term financial strategy. The operation of the reablement service was currently being reviewed as the service had difficulty recruiting and retaining staff and was not delivering sufficient hours of service.

The Sub-Committee NOTED the position.