Update on issues affecting Barking, Havering and Redbridge University Hospitals’ NHS trust (BHRUT) from Neill Moloney, Director of Planning and Performance, BHRUT.
Minutes:
The Director of Planning and Performance at BHRUT explained that additional beds were being put in at King George Hospital to cater for in the region of seven births per day. A small amount of maternity activity had also been shifted to Essex (20-30 births per month). The Essex arrangements had been due to continue until April but this had now been relaxed due to capacity issues in Essex. Planned caesarean section deliveries would continue to take place at Homerton Hospital until the end of March at which point this arrangement would cease as the cap on numbers of deliveries at Queen’s would be lifted from 1 April. It was accepted by the Trust that transferring caesarean sections to the Homerton was not ideal but it was felt that it was now acceptable to bring these deliveries (approximately 3-5 per week) back to Queen’s. The Care Quality Commission was also supportive of this change starting from 1 April.
The capital funding of approximately £1.5 million for expansion of the maternity facilities at Queen’s had now been agreed. It was anticipated that works would be completed by November 2012 and this would be followed by works to expand the Special Care Baby Unit. The start date for the transfer of maternity services from King George to Queen’s had not yet been agreed. Capacity issues at Whipps Cross and Newham hospitals would also be considered as part of the Health for North East London programme. Members were anxious that maternity and other services at King George were not reduced until the new facilities were in place.
There were a range of options to accommodate the extra demand for A&E services at Queen’s including converting the current renal or sexual health units. The BHRUT officer would update the Committee further on these plans in due course.
Tenders had been released for the operating of the Barking Birthing Centre and the formal contract would be awarded shortly. More detailed work on this would also be needed.
Figures for staff assaults at BHRUT were as follows:
Calendar year 2011 – 149 incidents of verbal abuse and 113 of physical abuse.
April 2010 – March 2011 – 175 verbal abuse and 144 physical abuse.
April 2011 – December 2011 – 114 verbal and 80 physical
The Committee agreed unanimously that such amounts of abuse of staff were unacceptable and officers agreed to ascertain if figures for the proportion of assaults relating to drink or drug abuse could be provided. It was also noted that funding had been received for the installation of mobile A&E tents in Ilford and Romford town centres in order to deal with alcohol-related incidents.
£5-7 million funding was available for reablement and other local schemes to reduce readmission to hospital.
The incidence in the recent LINK report concerning a lack of ECG and blood pressure apparatus had been investigated by the Director of Nursing but such equipment was not considered necessary in low risk births (one third of the total). There was sufficient equipment available to cover all high risk births. Any broken machines were repaired by the contractor – Catalyst within a set turnaround time. Equipment was checked by the supervisory midwife for each shift as well as via the Trust’s Visible Leadership programme.
There were approximately 11,000 births per annum in the Trust area although this would be approximately 9,500 – 9,800 this year due to the effects of capping of delivery numbers. Mothers were given a choice of venues at which to give birth. The Health for North East London plans would also mean that it would be more convenient for some women to give birth at Whipps Cross once the maternity unit at King George was removed. Officers agreed that Whipps Cross was currently operating at full maternity capacity and plans for how the hospital would cope with this extra demand would be brought to the Committee once they had been finalised.
A Member raised the issue of people smoking outside the entrance to the maternity unit, the smoke from which then came on to the unit via the open windows. The BHRUT officer agreed to investigate this. Signs were put up and people smoking outside of designated areas were challenged but staff often received considerable verbal abuse when doing this. A member felt that the Trust’s expenditure on smoking shelters outside the hospital had been a waste of resources and that the main hospital entrance area was in a very poor condition.
A&E consultants were currently on call but BHRUT was looking to move to 24 hour consultant cover on site at A&E. A further 8-10 consultants would have to be recruited in order to achieve this.
It was clarified that Heather Mullin would lead the work on the transfer of services from King George to Queen’s but the final decision on when the move took place would be a decision for the relevant Clinical Commissioning Groups (CCGs).
The NHS ONEL borough director explained that midwives remained legally responsible for the care of a baby for 28 days up to birth. A Member explained that a haemorrhaging new mother had recently returned to maternity where staff had simply referred her to A&E. BHRUT officers agreed that this should not have happened and would investigate this further.
The norovirus was an issue at the Trust and it was accepted that there would always be some outbreaks at the hospital. The virus was of a sudden onset with a short duration (usually 2-3 days) but was not usually that serious. There was a comprehensive programme of staff training in place regarding norovirus in place at the Trust. Investigations were undertaken in all cases where there were two or more cases of diarrhoea or vomiting on a ward but results could take up to a week to be received. Affected wards were closed to admissions and discharges for 72 hours. Posters advising of the closure were also displayed at the ward entrance, the main hospital entrance and in A&E. Visitor numbers were limited and children were also discouraged from visiting affected wards.
A detailed cleaning schedule including steam cleaning was implemented for all wards affected by the norovirus. The ward was also “blitz cleaned” prior to reopening. BHRUT officers would e-mail to the committee officer information leaflets available for patients and visitors in order that these could be distributed to the Committee.
In 2010, 16 wards across Queen’s and King George Hospitals were at one point shut simultaneously due to the norovirus. In 2011, no more than four wards had been shut at once and this was only for a short period. At the time of the meeting, only one ward, the stroke unit, was currently closed. There had been no incidents of norovirus reinfection since the ward closure period had been lengthened to 48 hours.
It was agreed that a standing item on the Health for North East London work should added to the Committee’s agendas with effect from the next meeting.