To receive a presentation on recent issues at Queen’s Hospital from Alan Steward, Chief Operating Officer, Havering Clinical Commissioning Group (CCG).
A response will also be received from Dorothy Hosein, Chief Operating Officer, Barking, Havering and Redbridge University Hospitals NHS Trust.
Minutes:
The Clinical Commissioning Group (CCG) chief operating officer explained that the CCG wished to have services in the community that would reduce the numbers of people attending A&E. It was accepted that there were difficulties in A&E at Queen’s Hospital in particular. This was partly due to high numbers of ambulances attending Queen’s A&E and to people not being able to be seen in primary care. Other reasons for the A&E problems included slow responses from other parts of the hospital and slow discharge of patients from wards.
In response to these problems, an improvement plan had been developed stakeholders including the community treatment and integrated case management teams. This also covered issues such as increasing the use of the Urgent Care Centres and having more GPs assigned to care homes. Primary care had also been piloting weekend GP opening and ensuring that correct advice was given via the NHS 111 service.
BHRUT had also developed its own improvement plan concentrating on recruitment and retention issues as well as areas such as improved pathways to avoid people having to go to A&E, improving patient experience and implementing seven-day working at Queen’s. Patient discharge was also being considered with the joint assessment and discharge team having gone fully live from 1 April. The BHRUT improvement plan had been agreed with the CCG, CQC, NHS England and the Trist Development Authority.
The CCG had a contract with BHRUT based on meeting the A&E four-hour rule for 95% of patients. The BHRUT chief operating officer accepted that this target had not been met by August 2013. The Trust met with the CCG weekly to review progress on the improvement plan.
The local CCGs had recently commissioned an independent clinical review of the proposed overnight closure of A&E at King George Hospital. This had concluded that there was no immediate safety risk from retaining A&E at both King George and Queen’s and had hence found that A&E at King George did not need to be closed overnight. The review had found that BHRUT should look at recruitment and retention and be clearer about the overall plan to close A&E at King George.
System-wide efforts to improve A&E included the establishment by the CCG of an Urgent Care Board. This met monthly (in private) and covered all stakeholders including the Council and Healthwatch.
BHRUT was leading on introducing seven-day working at the hospital although this would also impact on NELFT and social care issues. The use of Urgent Care Centres was being investigated and the CCGs were also looking at services for the frail elderly and how the demand on the hospital could be reduced. A communications campaign that aimed to reduce use of A&E was being planned by the CCG, NELFT and BHRUT and the CCG chief operating officer confirmed that Councillors would also be involved in this.
In response, the chief operating officer at BHRUT felt that the biggest challenge was recruiting senior A&E consultants. This was a problem nationally, not just at BHRUT. Only 8.8 of 21 senior A&E consultant posts at BHRUT were currently filled permanently and two more members of staff were due to leave over the next two months. The remaining posts were filled by locums etc. Queen’s A&E was very busy with in excess of 500 patients seen each day and this made it difficult to recruit. Advertising had been taken out in the Evening Standard and also overseas but there was a lot of competition nationally to fill A&E vacancies.
Five joint posts had been advertised with Barts Health but no applications had been and the posts would be readvertised. Staff shortages were covered by putting in more senior registrars and more specialist cover. The chief operating officer emphasised that Queen’s A&E was safe and added that the medical and nursing directors signed off staffing rotas on a daily basis.
The Trust had made progress with initiatives such as the new surgical assessment unit at Queen’s and improvements to pathways for care of the elderly. There were also now more nurses applying to work in A&E and it was important to retain these.
Queen’s was seeing up to 150 ambulance patients a day – a 15% increase. The main reasons for attending A&E were falls and trauma but more detailed information was available. The CCG felt that the rise in number of ambulances at Queen’s A&E was partly due to the high number of care homes in the area. It was important to stop care homes automatically referring residents to hospital. It was also important to be clearer about where people can go as an alternative to A&E.
It was felt that many people still chose to attend A&E particularly if they perceived that they would be unable to get an appointment with heir GP. It was essential to change people’s mindsets re this. The BHRUT officer confirmed that there were GPs assessing people at the front of Queen’s A&E but agreed that the current layout of A&E meant this was not obvious for patients. BHRUT was working with the CCG to redesign the A&E estate over the next 12 months. An outline business case for the redevelopment of Queen’s A&E was due to be submitted to the Trust Development Authority by the end of December.
It was clarified that weekend GP opening would consist of one surgery per cluster, giving a total of six practices open at weekends across Havering. The CCG was also talking with NHS England about issues such as the lack of a GP to see walk-in patients at Harold Wood clinic.
It was noted that the NHS 111 service did not give advice in the way the previous NHS Direct had done. The CCG was through with NHS 111 how their ranking strategy worked as regards suggesting alternatives to A&E.
As regards the Department of Health winter money, a list of initiatives had been submitted via the urgent care board to the Department Health. £10 million of projects had been proposed but only £7 million had been received. This meant that items with less priority had been dropped in order to prioritise areas such as extending the opening hours of the urgent care centres. A list of what projects the winter monies would be used could be supplied to the Committee. The overall aim was to use the winter monies in both A&E and in the community to reduce the numbers of people attending A&E.
The CCG chief operating officer was happy bring the plans for A&E redesign at Queen’s to the Committee once the business case had been published.