Update from Neill Moloney, Director of Planning and Performance, Barking, Havering and Redbridge University Hospitals NHS Trust (BHRUT).
Minutes:
The Director of Planning and Performance at Barking, Havering and Redbridge University Hospitals’ NHS Trust (BHRUT) updated the Committee on a number of issues that had been raised by Members. Clinicians had firstly confirmed that it was necessary to transport patients by ambulance the short distance from the hospital helipad to A&E.
The total number of beds available did vary slightly but there were a total of 746 beds at Queen’s and 389 beds at King George. In addition, there were 75 observation beds and 25 well baby cots at Queen’s and 41 further beds at King George. The reported problem with seating in bays 2 and 3 of the cardiovascular unit at Queen’s would be attended to by the Trust Estates department.
The four hour rule was still a performance indicator for A&E but other local measures were available on the Trust website. These included numbers of unplanned reattendances with seven days, patients leaving the department without being seen and the time until treatment was administered. The Trust was meeting its target of delivering three of five indicators at King George but had only met one indicator (numbers who left the department without being seen) at Queen’s.
Officers accepted that there was a major challenge to speed up the process of patient discharge. The JONAH computer system was used to identify the main constraints to discharge. Efforts were ongoing to improve issues such as access to diagnostic tests and results, clinical decision making and arranging medication to be available on discharge. A discharge partnership board of all relevant stakeholders had been established, chaired by Alison Brown. The final Care Quality Commission report on the Trust had also focussed on relationships with partners.
BHRUT shared concerns over nursing home quality and wished to work with each of the local boroughs on this. The Group Director added that the Council’s safeguarding team needed intelligence from BHRUT on concerns the Trust may have. The adult safeguarding team would also look to pick up where apparent symptoms of dementia were in fact due to residents’ dehydration.
As regards measuring patients’ experiences, BHRUT officers were aware that many survey kiosks in the hospital were not working and gave an assurance that these would be repaired and extended. Patient experience data was not yet available on the Trust’s website.
A new process of patient assessment had been introduced at A&E which included arranging for appropriate patients to be seen by their own GP, on the same day if possible, as appointment slots had been reserved. Members were sceptical of this scheme feeling that it would not be possible to obtain GP appointments at such short notice. Officers emphasised however that GPs were now taking responsibility for managing the emergency care pathway and had suggested this system themselves. The Director of Public Health added that she would include comments about difficulties accessing GPs as part of the response to the current consultation on the Primary Care Strategy. Members were not convinced that this related purely to single handed practices feeling that it was often equally as difficult to access GP appointments at larger practices. Members were also welcome, during the consultation process, to feed back specific examples of difficulties in obtaining GP appointments.
BHRUT had developed an action plan in response to the Care Quality Commission report which had included a number of measures relating to maternity. Separate short-term changes implemented had included the transfer of caesarean sections to Homerton Hospital, not taking Essex based births at Queen’s and capping numbers of maternity cases at 20 for Queen’s and 7 for King George. Following concerns raised by local women about the transfer of services to Homerton, the Royal College of Obstetricians had been invited to validate the existing process. The plan was now to arrange a short-term increase in capacity at King George in order that planned c-sections could be undertaken there until the proposed midwife-led unit opened at Queen’s. It was expected that c-sections from the Havering area would cease being carried out at the Homerton from mid-December. BHRUT officers would supply details of the numbers of extra beds that would be needed at King George to accommodate low risk births.
It was reiterated that BHRUT was taking all aspects of the CQC report seriously and had already made progress against many of the recommendations. The Trust has one of the best midwives to mothers ratios in London and Queen’s also had one of the highest levels of obstetric cover in London.
Staff attitude problems in maternity were also being addressed and the Group Director agreed that the current Trust chief executive was committed to personally dealing with staff attitude and performance issues. In response to a Member enquiry, Trust officers agreed to supply figures for staff assaults at Queen’s. It was confirmed that assault cases were reported to the Police unless for example patients were not aware of their actions. It was also suggested that the Committee could consider the effect of alcohol in A&E.
The Chair of Havering LINk reported that an enter and view visit to maternity in November 2011 had found a lack of ECG and blood pressure apparatus in the labour room. Trust officers agreed to investigate this.
It was also confirmed that the business case for the proposed midwife led unit was currently with NHS London. If capital funds were secured, it was hoped work would start in March or April and the unit would open in late summer 2012. A business case was also being developed to redesign and increase the capacity of A&E. Trust officers would supply indicative figures for this project.
The Committee noted the update from BHRUT.