To receive an update on current issues effecting the Hospitals Trust from the Director of Planning and Performance, BHRUT.
Minutes:
The Director of Planning and Performance at BHRUT explained that the Trust had admitted liability and apologised to the patient’s family following the recent highly publicised case of a woman who had died during an operation to remove her appendix. The Trust had implemented a 30-point plan in response to the incident which included having a named consultant and clinical lead for all in-patients, ensuring that only a consultant surgeon and anaesthetist were allowed to operate on pregnant women and using the World Health Organisation surgical safety checklist at all times. All abnormal test results were now reported immediately and steps had also been taken to support and develop clinical leadership in practice.
The current performance of the Emergency Department showed that the four hour target for completing treatment in the department was being met on 88.59% of occasions. This compared to a target of 95% and the Trust was on target deliver this figure by the end of August. It was also noted that there had been a rise in the number of more complex patients received in the department with 9% more ambulances now arriving at Queen’s.
The main reasons for breaches recorded in the four hour rule had been delays in assessments, bed waits and delays in specialised responses where e.g. consultants needed to carry out an assessment in the emergency department. A further report on Queen’s A&E was expected from the Care Quality Commission in July 2013. The Director of Planning and Performance recognised that the Trust had made improvements in the operation of A&E but also accepted that there remained a long way to go.
If patients were delayed in the Emergency Department for a long time, arrangements were now being put in place to ensure these patients received a hot meal. The Trust was also gradually implementing seven day working in order to improve patient flow. Senior consultant input on wards would be made available on a seven day basis in order to improve the continuity of care.
The Trust aimed to reduce the number of patients having to be referred via A&E and it was clarified that GPs could refer directly to the surgical assessment unit at Queen’s.
While A&E performance at King George Hospital was now operating ahead of target, Queen’s remained some way below target. It was noted that record attendance numbers had been seen at Queen’s A&E in the last few months but the Trust director felt that performance was gradually improving. The Rapid Assessment and Treatment (RAT-ing) system had now been extended in order to speed up the handover of patients from ambulances. The number of patients held in ambulances for more than an hour had reduced and the focus was now on those ambulance patients waiting in excess of 30 minutes. The Trust was also working with the London Ambulance Service to find out why more ambulances were arriving at Queen’s.
Discussions were also under way with Barts Health who managed the renal dialysis unit at Queen’s about moving this unit to another site which could potentially allow for an expanded A&E assessment unit.
The level of consultant input on the elderly care ward had been enhanced which had resulted in a reduction of two days in the average length of stay on the ward. Discussions were also being held with partners in an attempt to streamline the hospital discharge process. It was AGREED that the Trust Director should send to the Committee Officer the A&E action plan in order that it could be distributed to the Committee.
The business case for capital improvements in A&E had now been split into several smaller documents. This included the move of the cardiac catheterisation unit from King George to an unused ward at Queen’s and works to the front entrance of A&E including separate entrances for paediatrics and adults.
The Director of Public Health confirmed that the Council was working with BHRUT and Havering CCG on developing a data dashboard for A&E. She felt that about 80% of the problems in A&E were issues the Trust could address internally while around 20% related to other partners. The Urgent Care Board, set up under the Integrated Care Coalition would also produce data regarding issues such as winter pressures. The Director of Public Health pointed out however that Queen’s A&E remained one of the worst in the country. The BHRUT director agreed but felt that there was now more clinical engagement in the department.
The Director of Public Health felt it was good that BHRUT was bringing specialists from other areas into A&E but was concerned that A&E was still 50% understaffed at consultant level. The Trust Director of Planning and Performance agreed that it was a challenge to recruit and retain A&E clinicians and the Trust was therefore looking at the possibility of some joint appointments with a major trauma centre such as Barts Health. There was also a new senior nurse and clinical director in A&E as well as improved signage and chairs.
It was explained that the Trust was investigating a list of 20 high intensity users of A&E and seeing if these people could be treated elsewhere. Some A&E users exhibited mental health problems although the NELFT representative explained that this only applied to 6 of the 20 people on the BHRUT list. The NELFT care plan for patients of this type could also be shared with the Committee. A joint working protocol had been agreed between NELFT and BHRUT on dealing with mental health problems in A&E. The BHRUT director agreed to investigate how appointment letters were dealt with if they were for a family member suffering from dementia who could hide the letters. More funding had been received from commissioners this year to support Queen’s patients with dementia. NELFT dementia specialists were also delivering training across acute sites. It was also pointed out that people with mental health issues often also presented with physical ailments.
Since the King George Hospital maternity unit had been closed in March, the revised services had been operating well. BHRUT met regularly with local CCGs and it was confirmed that population growth had been built into maternity capacity through, for example, use of the birthing centre at Queen’s Hospital. Regular surveys of maternity patients had been undertaken showing a predominantly good experience for mothers. The Care Quality Commission cap and warning notice on BHRUT maternity had been removed for some time.
The new oncology day unit – Sunflowers Suite had recently opened and included a teenage and young adult area.
The Committee NOTED the update and the Chairman thanked the BHRUT officer for his input to the Committee and wished him luck in his new role.