To receive an update from officers of Barking, Havering and Redbridge University Hospitals NHS Trust on how the Trust is responding to a recent Care Quality Commission report on its services.
Minutes:
The Committee received a presentation on the BHRUT response to the CQC inspection from Averil Dongworth, Chief Executive at , BHRUT.
Following the CQC inspection in October 2013 and the subsequent report in December 2013, BHRUT had been put into Special Measures in order to meet the scale of future challenges. The report recognised the good quality of care and the improvements made since the previous inspection, however long standing problems with performance and finance had not been effectively addressed and the Trust were now working with the Trust Development Agency (TDA).
An executive capability review was being carried out by Sir Ian Carruthers who would report back to the TDA. The name of a “Buddy Trust” had yet to be announced. A draft improvement plan was in place which had been developed with staff and health partners and an Improvement Director had been appointed. The improvement plan set out the issues with corresponding actions including the five work streams as follows:
Workforce
Recruitment, retention, development and deployment of the right number of permanent staff to provide high quality care 24/7.
Patient flow and emergency pathway
Ensuring patients were assessed and treated promptly and supported to return home as soon as they were medically fit and were cared for in the right environment with the appropriate follow-up care.
Patient care and clinical governance
Supporting care with effective management of patient notes and information systems so that problems were promptly addressed.
Outpatients
To ensure effective management of outpatient services so appointments run on time.
Leadership and organisation
Implementing the right systems, structures, checks and balances to make sure the Trust was properly managed from Board to ward.
In response to a query regarding A&E, members were advised that further improvements were being made to patient flows by streamlining care. A medical assessment unit was in place and short stay capacity was currently being developed. The Committee were asked to note the appointment of two new Paediatric A&E Consultants, and following a recruitment drive in India, further posts had been filled. Currently, 9 out of 21 consultant posts were filled and 2 out of 18 junior doctor posts. The Committee AGREED that a written response be forwarded to the Committee Clerk giving a full breakdown of staffing levels in A&E.
It was noted that the draft improvement plan had been forwarded to the CQC and the TDA and that feedback was expected shortly. The plan would be finalised before being presented to the Trust Board for approval by April/May 2014. The plan would be published on the Trust website with regular monthly updates to report on progress. The CQC would revisit the Trust in 12 – 18 months. It was AGREED that the Committee should have sight of the plan once available.
The Chief Executive acknowledged that it would be a challenge to retain staff particularly whilst under Special Measures. The Trust had introduced PRIDE workshops for staff looking at issues around culture, attitude and behaviours.
A member of the Committee expressed their concern regarding outpatient cancellations and high A&E attendance levels as well as issues around the transfer of patient information. The Chief Executive explained that a new computer system had been installed where patient information was in the process of being transferred and that there was a five year plan to improve technology at the hospital. There had been several serious cases where patient information had been lost and there was still currently a system of paper records at Queens and King Georges hospitals. Electronic communications and transfers of patient information electronically were planned and a system where GPs could order blood tests and x rays would be available from April 2014.
The Chairman asked the Chief Executive what she would recommend that the JOSC continue to oversee and was advised as follows:
Looking at local systems and how they work together – Primary Care, Social Care and the local authority and that they need to ensure that they are modern and fit for purpose.
Special Measures – the Committee should keep challenging and supporting but note that there will be no quick fixes.
In response to a member query about medication prescribing, the Committee were informed that electronic prescribing will be available for outpatients and GPs and was part of the overall plan. It was AGREED that the Pharmacy programme, service and delivery should be a future agenda item.
Members of the Committee wished the Trust well with the improvement plan and noted that it was important that the Committee continue to monitor all NHS facilities within the JOSC boroughs. The Chairman advised that the NHS as a whole had altered very much and that many hospitals were experiencing difficulties.
The Chairman and Committee members thanked the Chief Executive noting this was Ms Dongworth’s last meeting before her retirement and wished her well for the future.