Senior officers from Barking, Havering and Redbridge University Hospitals’ Trust will present on the development of the Trust’s improvement plan following the recent reports on the Trust’s hospitals by the Care Quality Commission.
Minutes:
The BHRUT chief executive explained that the Trust had been one of the first to receive a full inspection from the Care Quality Commission (CQC), in 2013. As a result of this inspection, the Trust had been placed in special measures in December 2013.
A reinspection had taken place in March 2015 and had found significant progress and some areas of outstanding practice. The chief executive accepted however that there also remained much to do. The overall Trust rating had improved one level to ‘requires improvement’.
The Trust remained in special measures although the chief executive pointed out that it was unusual for a Trust to be removed from this status following a first reinspection. A further inspection by the CQC would take place within six months.
One third of the inspectors in the current inspection had also been involved in 2013 and a cultural change had been noted in the organisation which was now more patient centred. Areas of good practice included the radiotherapy centre at Queen’s Hospital which was rated as one of the five best in the country, genito-urinary medicine and the oesophago-gastric department which had good outcomes. The elderly receiving unit at Queen’s had been found to have improved care and there were also now better outcomes for stroke patients.
There were also however a number of areas where the CQC had found the Trust needed to do better. These included reducing the waiting time for outpatient appointments, and being more responsive around children’s care in terms of theatre use and having a dedicated phlebotomy service. Out of hours staffing in A & E was considered as too low and it was also a requirement that all shifts on wards be fully staffed.
Other issues reported by the CQC included too long waits for scans and results in the radiology service and a need to improve learning from mistakes, incidents and complaints. The responsiveness of the Trust had received the lowest rating of ‘inadequate’.
Queen’s Hospital had also received an inadequate rating for responsiveness but had been classed as good for care provided. The CQC felt that the A & E service had improved but there remained concerns about staffing levels out of hours. King George had received two inadequate ratings for outpatients and diagnostics/radiology.
The CQC had made 30 must do recommendations that had been split under the headings safe, effective, responsive and well led. The Trust was pleased that no recommendations had been made under the ‘caring’ heading. The Trust chief executive emphasised that the focus over the next six months would be on improving what the CQC had classed as priority areas. A new Improvement Director had recently started at the Trust.
The Trust would share details of the increasing number of diagnostic scans and tests requested. The issue of which areas had too much demand for diagnostics had been investigated and the Trust was also looking to recruit more consultant radiologists and radiographers. The new breast cancer centre at King George would allow the faster turnaround of scans and results.
A Member raised the issue of ward staff having to leave the ward in order to take patients for radiotherapy. The Trust chief executive responded that the Care Quality Commission had been more concerned about the wait between a patient’s referral and their tests being carried out. He agreed however that staff should not have to escort patients to their tests. From 1 September protected mealtimes would be reintroduced on both hospital sites and this would mean staff not leaving wards at mealtimes.
Latest figures indicated the Trust had met the 95% target for treating A & E patients within four hours throughout the month of July thus far. The Trust wished for senior doctors to be available to assess patient seven days per week (16 hours per day) and this would require an additional ten consultants in each A & E. There were however currently only nine A & E consultants across both sites as well as a shortage of A & E consultants nationally, The Trust was likely to secure two additional A & E consultants shortly. Under Trust plans to replace the A & E at King George with an Urgent Care Centre, all A & E consultants would eventually move to Queen’s.
It was clarified that the Trust target for meeting the ‘four hour rule’ had been reduced to 87% in March 2015 as a result of the special measures. This had been increased to 91% and then reverted to the 95% standard by June. The Trust had met each of these targets.
The representative of Healthwatch Havering congratulated the Trust on its good rating for end of life care and felt this was reassuring given the high numbers of elderly people in the area.
The Trust improvement plan was currently being developed and could be brought to scrutiny from September. The Trust had also competed recently with 60 other Trusts to win mentoring support from the Virginia Mason Institute in Seattle, USA which had a reputation for improving patient safety and learning from incidents etc. The Trust chief executive felt this would be good for patients and also attract staff to the organisation.
The CQC had found a gap between phlebotomy services for children and adults and the Trust chief executive accepted that staff should have been more responsive to patients’ needs in these areas,
The Committee NOTED the update.