To receive a presentation from Sir Peter Dixon, Chairman, BHRUT.
Minutes:
The BHRUT Chairman agreed that the recent Care Quality Commission (CQC) inspection of Queen’s Hospital A&E had confirmed that the way in which patients were dealt with was not good enough and not as safe as it should be. The demands on A&E at the Trust were growing and both internal flows and length of patient stay at Queen’s needed considerable improvement. Dialogue was in progress with the CQC in order to agree how the situation could be improved.
The Chairman felt that the condition of A&E at Queen’s on a Monday morning was often in an unacceptably dirty state and this had been mainly caused by people who did not need to attend A&E in the first place.
The Trust wished to recruit well qualified permanent staff and the Chairman wanted to make it clear that BHRUT had a future and could offer a good career to the right people. It was accepted that there were too many locums in A&E and the Chairman wished to change this. Discussions were also in progress with the UCL partners organisation in order to recruit new staff to the Trust.
The maternity department at King George Hospital had now closed and there was not believed to be a major issue concerning the recently publicised final birth to take place at King George. The restriction of number of births at maternity had, in the Trust Chairman’s view, led to an improvement in the maternity service.
It was accepted that BHRUT had been losing money for the last 10 years and become something of a scapegoat. The Chairman wished to restore pride to the organisation and highlight the areas in which the Trust provided good services such as maternity, stroke and cancer (where the Trust saw 10% of all London cancer patients). Members agreed that the Trust offered good services in these areas.
The Trust Chairman also felt that too much use had been made in the past of management consultants etc and that the Trust should do more of this work itself. There was no date for the closure of A&E at King George Hospital which the Trust Chairman felt could be some years away. This would not take place until an improvement had been recorded in the A&E at Queen’s including the completion of additional capacity. The two hospital services would move over time towards providing different services at each location. This would however take place in a safe and measured way.
The Chairman thanked the Trust Chairman for his presentation which it was felt gave confidence in the Trust’s future direction. It was confirmed that BHRUT was now working more closely with primary care and the Trust Chairman was pleased that some GP surgeries were planned to open at weekends.
Safety statistics such as Dr. Foster were reasonable overall for the Trust and it was confirmed that the Trust did monitor these regularly. It was also confirmed that plans were progressing to significantly increase capacity at Queen’s A&E and it was hoped building work would commence by the end of 2013. The plans assumed that 40-50,000 A&E cases would move from King George either into the community or to Whipps Cross and these additional cases could not all be taken at Queen’s. Further details of these proposals would be brought to the Committee in due course.
A series of plans would be developed from the overall Health for North East London model. These would be developed via discussions between BHRUT and commissioners but there were no detailed plans as yet. It was accepted that BHRUT had problems in attracting sufficient staff to A&E. Learning from other Trusts was also being used in order to seek to improve the A&E at Queen’s. The availability of rehabilitation beds at a redeveloped St. George’s Hospital would also have an impact on A&E and further discussions would be needed with the CCG and NELFT on this.
A representative of the CCG felt that the biggest problem was the culture prevalent at Queen’s A&E. He felt there was a limit to how much extra work primary care could take on and that only very few GP appointments had in fact been referred from A&E. It was difficult to improve GP access, partly due to the high ‘Did Not Attend’ rates and the lack of any penalty for patients who did not attend appointments. It was agreed that community services could reduce the number of people attending A&E although most patients were still happy to receive treatment there. The main problem was those who could not access A&E. The Committee and the Trust Chairman agreed that there needed to be more joint working in order to resolve these issues. It was felt that Healthwatch could also play a role in the discussions.
Members were concerned that problems remained in the discharge process and that delays continued to occur. This was often due to a lack of communication between staff and patients and BHRUT officers agreed to feed this back.
The CCG representative clarified that, in his practice at least, patients presenting with minor injuries were treated at the surgery and not sent to A&E. Members commented that this was not the position at Harold Wood polyclinic and the CCG representatives agreed to investigate this.
The Committee NOTED the presentation from the BHRUT Chairman.