To receive an update on issues facing the Trust from Stephen Burgess, Medical Director, BHRUT.
Minutes:
The BHRUT medical director explained that a wide ranging Care Quality Commission (CQC) inspection of both Queens and King George Hospitals had taken place in October 2013. The CQC report, received in December 2013, had recognised some improvements in e.g. nursing care. Issues concerning the emergency pathway and reconfiguration etc had however led to the Trust being put in special measures. The Medical Director accepted that more needed to be done concerning A&E, outpatients and Trust governance etc.
A capability review of the Trust had been undertaken, the report from which would be submitted to the National Trust Development Authority (NTDA). An Improvement Director had been appointed who had worked in a special measures Trust in South London, as had the new Director of Finance. A Buddy Trust – a well performing Trust of similar size to BHRUT, was also due to be announced.
The Medical Director emphasised that work was underway with staff and partners to move the Trust forward. A reinspection by the CQC was expected in the next 18 months. The NTDA would also expect to see progress over this period.
The Trust improvement plan was due to be submitted to the NTDA within the next week and an overview document could also be produced. As regards workforce issues, it was accepted that there were major staffing problems in A&E as well as in acute medicine and gastroenterology. This applied to both consultants and middle grade staff. Some recruitment problems were due to perceptions of the Trust and local area being poor.
The Medical Director felt that the entire emergency system was a problem including the wards and discharge procedures. He felt however that the major issues related to patient flows and finance. The maternity department had however improved significantly.
There remained a number of issues regarding transferring patients and notes and the Trust was seeking to institute a better system of governance. It was accepted that there had also been a lot of complaints about outpatient appointments and waiting times although these were issues in many hospitals. The Trust executive team wished to be more visible but there was often not enough time for this.
The Trust improvement plan was expected to be finalised by the end of March and would be published on the BHRUT and NHS Choices websites.
There were now some text reminders of outpatient appointments but the Trust needed to do more of this. There had been some problems with the installation at the Trust of the new Medway computer system. There was also a working group looking at outpatient issues.
It was not expected that the Trust would receive any further resources for this work other than perhaps a small amount of transition money. The Trust overspend was predicted to be £38 million for the next year. Five per cent efficiency savings were also required which would be in the region of £20 million.
It was confirmed that the Trust improvement plan would contain a section on health records. This would also cover issues around keeping records up to date. The Trust saw 648,000 outpatients per year with over a million patient contacts and the Medical Director felt there would always be occasional problems sue to human error etc.
The Medical Director agreed that the layout of outpatients needed to be improved and this would also be covered in the improvement plan. Queen’s Hospital generally was also not easy to navigate. Some signage had been improved but the new Trust Chairman remained unhappy with this. Hospital volunteers would in future be more pro-active and wear tabards in order that they were identified more easily. Feeding buddies on wards were also being introduced.
The alteration work in Queen’s A&E was currently being reconsidered but this would still need to be carried out in the summer. Changes to areas such as critical care and the moving of the renal dialysis unit were still being negotiated. The Medical Director accepted that A&E had been poorly designed originally.
As regards reconfiguration of the Trust, the outline business case was still being reworked. It was still planned to close the A&E at King George Hospital to blue light ambulances by December 2015. All Queens and King George activity was however being remodelled as the information used in the Health for North East London exercise was now too old. The new data was expected to be available in the next 4-5 weeks.
The current A&E target was to deal with attendances within 4 hours on 90.5% of occasions by the end of March. The current figure was 89% across both sites. There was poorer A&E performance seen in the evenings and at night due to a lot of locum staff having to be used. The Queen’s Urgent Care Centre was now open 24:7 on some days and it was a priority to implement 24:7 working at the Urgent Care Centre throughout the week.
Assessment units were being extended and altered to create more short stay beds. This would allow suitable patients to bypass A&E and go straight to an assessment area. An observation area was also being opened at Queen’s.
A new paediatric A&E consultant had recently started work with a second consultant starting in April 2014. A total of 17 doctors and 8 anaesthetists had also recently been recruited from India. It was accepted that retaining staff was also a problem. A package including retention premiums was in place for the staff recruited from India and the Trust was trying to be inventive with this issue. It was hoped to move to having a more regular recruitment cycle.
The recent NHS staff survey had shown improved overall results for BHRUT. Motivation and communication with managers had improved and staff also felt they could raise concerns. The CQC placed emphasis on the importance of the staff survey results.
A new Chairman had recently been appointed to the Trust – Dr Maureen Dalziel. Dr Dalziel was a public health doctor and had also previously been a Trust Chief Executive. With effect from 1 April, the new BHRUT Chief Executive would be Matthew Hopkins – a nurse by background who had previously worked at Barts and Guys and St Thomas’ Hospital Trusts. The Medical Director also confirmed that there would definitely not be any victimisation of whistle blowers at the Trust.
Smoking, drinking and hard drug use were harmful and costly to the NHS. The Medical Director felt that there was less evidence of harm from use of recreational drugs. The Trust saw more A&E attendances through misuse of alcohol than drugs.
It was emphasised that the original Health for North East London plans were still being used and it was not therefore necessary to consult on the current proposals. A&E activity had not gone down as predicted in the Health for North East London plans. Additionally, population growth had increased and activity levels had not gone down as anticipated in the original proposals. As such, a refresh of the relevant activity data was currently being undertaken.
The Medical Director emphasised that services would not be fully pulled out of King George Hospital until Queen’s was fit for purpose. The special care baby unit would be moved from King George once money was made available to expand the equivalent unit at Queen’s.
The Committee recommended that the BHRUT improvement plan be an agenda item at the Committee’s first meeting after the Council election.
It was explained that the improvement plan was designed to get BHRUT out of special measures and reconfiguration of the hospital would be the second phase of improvement. If improvement were not delivered then the Trust was likely to enter Special Administration.
The Committee noted the update.