Agenda item

Presentation on the Barking, Havering and Redbridge University Hospitals’ NHS Trust (BHRUT) Improvement Plan (attached) from Flo Panel-Coates, Executive Director – Nursing, BHRUT.

Matthew Hopkins, chief executive of BHRUT, explained that the Trust had been put in special measures in October 2013 and that an improvement director had been appointed. Support was being given to the Trust to deliver its improvement plan. A reinspection of Trust services by the Care Quality Commission was expected in late 2014 or early 2015 although such an unannounced inspection could in fact be launched at any time. The chief executive stressed however that the hospital also depended on the support of its health and social care partners if long term improvements were to be secured.

The Trust improvement plan had been developed in conjunction with the Council and Clinical Commissioning Groups (CCGs) in the BHRUT area as well as with relevant service providers. The improvement plan included a number of key themes. On workforce issues, the chief executive felt that BHRUT staff were on the whole very capable but were too few in number in A&E and some other areas. Nurses had been recruited both locally and from Portugal (who the chief executive felt were well trained and compassionate) and this cohort would be starting at the Trust in the autumn. There were sufficient nurses at the hospitals on a day to day basis but the reliance on agency staff meant that it was expensive to fully staff the hospitals. The recruitment of radiographers was also a challenge for the Trust.

It was planned to speed up the emergency care pathway and also improve discharge procedures. The improvement plan also emphasised better clinical governance and quality assurance as well as more effective handling and transportation of patient notes.

The chief executive accepted that outpatients was a source of frustration to patients and that procedures around appointments and follow-ups needed to be improved. It was also accepted that it was difficult for patients to find their way around outpatients and signage would be improved. The Trust Board would also be more visible as it sought to improve leadership and organisational development.

The improvement plan was currently 27% completed and the chief executive felt that Trust staff and partners were focussed on improving services for patients. Monthly progress reports would be published on the NHS Choices website and the chief executive was keen to come for further scrutiny at both the borough and joint committee levels.

The chief executive confirmed that he was the accountable officer for delivery of the improvement plan and that a Programme Board was monitoring progress. Each of the 5 domains of the improvement plan were given a RAG rating and outpatients currently had a red rating as not enough progress was being made.

It was emphasised that partner organisations were now much more engaged with the improvement process and saw themselves as part of the solution. External governance was led by the Trust Development Authority and the chief executive had performed a similar turnaround process at another Health Trust. Extra transitional funding was however needed this year to allow better management of patients and this was currently being discussed with the CCGs.   

The chief executive was confident that the Trust’s deficit could be reduced over the next 3-4 years. He wished to recruit and retain staff better which would lead to a reduced need for agency workers. It was anticipated that the Trust would record a deficit of £38 million at the end of the year, on a turnover of £450 million. It was planned to stabilise the deficit this year and reduce this over the coming years and the chief executive was happy to give further updates on the Trust’s financial position.

It was agreed that the Better Care Fund was an important change in the use of NHS resources. It was hoped people would spend more time at home and less in hospital and these issues were currently being worked on with the Trust’s partners. A quality summit had recently been held with partners and the chief executive was confident that the Better Care Fund could be implemented successfully.

The Committee NOTED the position with the Trust improvement plan.