To receive an update on recent issues at Queen’s Hospital from the Director of Planning and Performance - Barking, Havering and Redbridge University Hospitals NHS Trust (BHRUT).
Minutes:
The Chairman explained that the Committee was sympathetic to the problems seen at Queen’s Hospital and was pleased with the way maternity services had improved. The Committee had however seen no improvement in A&E and wished to help. The BHRUT officer agreed that the Committee had been very supportive and that the Care Quality Commission (CQC) still had concerns over the performance of A&E. The Trust recognised that there were shortcomings in care and was trying to address the underlying causes for this. Particular issues raised by the CQC included staffing and the level of care offered.
Patients were kept too long in the majors area with, in some cases, waits of over 11 hours to be moved out of the department. In response, the Rapid Assessment and Treatment system had been extended to cover walk-in patients as well as those arriving by ambulance. The CQC was however also concerned about issues such as the dignity of patients, their storage facilities, the availability of washing facilities in A&E and a lack of consultants and junior doctors in the department.
It was noted that Queen’s A&E was designed to see 90,000 patients per year but was in fact seeing 134,000 per year. The department was also seeing 73 more patients per day in 2012 compared to 2011. Queen’s A&E also received the highest number of blue light ambulances in London. In December 2012, the four hour target for moving patients through A&E had been met on 80.68% of occasions compared to a target of 95%.
The pressure seen in A&E over the Christmas and New Year period was due to poor access to primary care at this time and less consultant presence in the department. Diverts were agreed with the London Ambulance Service when this was clinically necessary. Ambulances would normally be diverted to King George Hospital.
A number of changes had been implemented including the opening of a surgical assessment unit in February 2013. This allowed GPs to refer direct to the unit, bypassing A&E in suitable cases of orthopaedics, abdominal pain etc. Assessments of walk-in patients were not normally expected to take more than an hour. The Queen’s sexual health service was being relocated which would allow the creation of extra capacity in the Urgent Care Centre. The new location of the sexual health service was yet to be finalised. The renal dialysis unit (provided by Bats Health) was also being moved from its current location.
Clinics were being piloted in the evenings and at weekends and this had received a good response from clinicians. Steps were also being taken to improve patient flow through the hospital by ensuring access to the same consultant on a ward for a number of consecutive days.
The radiology service was also being extended to weekends although outpatients were not given priority as regards access to scans. Nurse led roles were also being developed to support diabetic patients. It was also confirmed that there were contingency plans in case of a winter epidemic which included stopping elective surgery if necessary. There would also need to be engagement with partners in this type of scenario.
There had not been a discussion as yet with the CQC as regards capping A&E numbers but Members felt that there remained far too many people going to A&E. The BHRUT officer felt that this feedback was very valuable and emphasised that King George Hospital A&E would not be closed until it was safe to do so.
Members felt that the Urgent Care Centre at Queen’s should be used an alternative to A&E rather than being part of the same unit, perhaps with its own entrance. It would also be helpful if the Urgent Care Centre was listed in the recently published “Don’t Go To A&E” booklet. The BHRUT officer responded that a lot of primary care patients did attend at A&E and it was wished to direct these patients back to their GPs. Patients with minor injuries would be dealt with at the Urgent Care Centre. Officers agreed that it would be better to make the Urgent Care Centre a separate area.
There were currently 9 A&E consultants in post at Queen’s but 18-20 were needed to staff the unit. Agency staff were used but the unit remained short staffed. Additional registrars were also now based in the department. The stroke pathway was now very clear and the good results of a recent audit of this area would be brought to a future meeting of the Committee.
The rapid assessment and treatment process had been used to reduce the number of breaches in receiving patients from ambulances. Officers would provide details of those breaches that had occurred. There was no general policy to redirect ambulances from King George to Queen’s.
Detail of the capital improvements across BHRUT was currently being worked on. It was accepted that A&E performance against national indicators had not improved but work was in progress to change the way in which care was delivered. Patient surveys were being carried out at Queen’s with a recommendation of level of 90% being seen in maternity and 80-90% in patient wards.
The issue of patients being discharged with incorrect medication from the hospital pharmacy was also raised and the BHRUT officer agreed to take this back.
The Committee NOTED the update.