To receive a presentation from the Chief Executive of Barking, Havering and Redbridge University Hospitals Trust (BHRUT) on the Trust improvement plan and other issues.
Minutes:
The Committee received a presentation from the chief executive of BHRUT on the Improvement Plan for 2014/15 at the Trust.
The Committee was informed that following Queen’s Hospital being placed in special measures the Trust had taken various steps to address the issues.
The Trust had an Improvement Director allocated by the Trust Development Authority (TDA) to oversee and support the Trust’s improvement plan. The Trust had to produce a plan and deliver improvements over a period of time whilst receiving support to make improvements. The Trust also had to report progress monthly which was overseen by the TDA.
The Committee was informed that the improvement plan for the hospital had five key themes to address the findings of the Chief Inspector of Hospitals’ review. Each theme had important objectives and supporting improvement actions:
l Workforce: recruiting, retaining, developing and deploying the right numbers of permanent staff needed to provide high quality care 24/7.
l Emergency Care Pathway: making sure patients were assessed and treated promptly and were supported to return home as soon as they were medically fit to leave hospital, and to ensure that patients were cared for in the right place with the right follow up care.
l Clinical Governance: supporting all care with effective management of patient notes and information, and systems which quickly alerted to problems.
l Outpatients: ensuring effective management of outpatient services so appointments ran on time, every time.
l Leadership and Organisational Development: putting the right systems, structures, checks and balances in place to make sure the Trust was properly managed from board to ward.
The Trust’s hotel services were being retendered in order to improve the quality of hospital food.
The new BHRUT IT system had the flexibility to meet hospital needs. Work was in progress with suppliers in order to get the system working for patients and it was agreed that the chief executive should report back in two months time on progress with the IT system.
The chief executive felt that there were not enough trainee doctors nationally. This was also an issue with emergency consultants due to the competitive nature of recruitment and it was emphasised that the Trust wanted to recruit more doctors.
There were already some outpatient services that ran from non-hospital sites such as the Victoria Centre in Romford. The chief executive was mindful of clinic capacities with for example ophthalmology outpatients being very busy.
There were a number of reasons why clinics might be cancelled. These included their not being set up properly on the system or the relevant doctors being on other duties or on leave. Action was being taken to enforce the Trust policy that no clinics could be cancelled within six weeks of their scheduled date.
The JONAH computer system for patient discharge was followed by some wards but not by others and the chief executive accepted that this needed to be addressed. It was felt that, in order to have an effective patient flow, 10 patients at each hospital should be discharged before 10 am with 20 discharged from each site by 12 pm. 85.5% of patients had met the four hour treatment rule in A&E in August, some 4.5% short of the Trust’s target in this area.
Shifts had been altered at the Trust’s call centre to match demand levels which had allowed more calls to be answered. More modern phone technology was also being introduced. The chief executive would look into why the ear, nose and throat department only had an answerphone and was unable to be contacted via the switchboard.
All tablets to take home could be dispatched from the hospital pharmacy within four hours but this required doctors to transcribe medication forms earlier. Funding had been allocated for extra staff to ensure this was done.
Trainee doctors were expected to undertake clinical audits and there was a programme of monitoring of this. This would produce changes in the way the hospital worked. Named management staff would follow up on changes and the chief executive felt there was a need to employ more clinical governance staff.
It was felt that more GP appointments should be made available via NHS 111 as this would reduce pressures on A&E. It was important to make alternatives to A&E more accessible but the chef executive accepted there was a challenge in this were often used to going to A&E.
It was noted that urgent care services were due to be retendered and that both money and the quality of service would be considered equally during the tendering process.
The chief executive wished to implement the Trust improvement plan before expanding A&E at Queen’s. The A&E would however be expanded in order to create space for the Urgent Care Centre. A target date for the A&E works would be set once progress on the improvement plan had been achieved.
As regards the Francis Report, the chief executive felt that this had shown a tolerance by staff in mid-Staffordshire of poor standards. There had been a lack of accountability and little use of clinical audit etc. The report had said that people needed to understand a Trust’s values. Non-compliance should be tackled and a culture of openness and transparency should be developed.
The response to the Francis Report from BHRUT had been to understand the current quality of care and create a culture where staff could report problems. The focus would be on putting patients first.
The director of quality and safety at the Trust wanted clinical services to check if patients were safe and that care was effective. There were also priorities to improve the patient’s experience and ensure that the workforce was engaged. Trust complaints and compliments were analysed and the chief executive signed off all responses to complaints. The Trust also had an Independent Patient Experience Group which included representatives from Healthwatch.
The Trust whistle blowing and raising of staff concerns policy had been updated. ‘Meet the chief executive’ sessions were held for staff who were encouraged to have a duty of candour. The Trust vision had been refreshed and it was accepted that the Trust needed to be financially viable in order to improve care for patients.
A PRIDE programme – passion, responsibility, innovation, drive, empowerment had been introduced for staff and the chief executive agreed that staff training and development were very important.
Other initiatives included walkabouts by Trust directors who completed a template about wards they had visited. Walkabouts were held at least once a week. The next steps for the Trust were to seek to improve public confidence in their services.
The chief executive wished to promote a culture where staff believed it was safe to speak up. He wanted staff to take ownership of processes but accepted this was a culture shift that would take time to implement. Progress had been seen with for example the friends and family test for in-patients which had recorded a 71% approval rate in August and 73% in July.
The Trust’s guardian services scheme to allow staff to discuss concerns confidentially had been working well and had been used by approximately 110 staff thus far. Junior managers needed to follow through on these commitments however in order for the programme to work fully.
The Trust was keen for staff to resolve complaints on the spot and to focus more on the patient experience. Matrons were expected to be visible on wards and photographs of staff were displayed at ward entrances. It was also important that board members talked to patients direct. It was felt essential that nursing staff adopted themes such as care and compassion in their work.
The Committee NOTED the position.