Agenda item

Report attached.

A programme to improve the financial position at BHRUT was under way with a target of £28m savings in the current financial year. It was anticipated that approximately half of this would be achieved on schedule. Work to reduce costs included improving the planned flow of elective procedures so that the current 50-60% use of theatres was increased to 85-90%. Achievement of this target would generate financial improvement of around £25m.

Work was also in progress to reduce outpatient activities of which the trust saw around 2,000 each day at Queen’s Hospital alone. It was felt that up to half of outpatients could be treated in other ways including by phone or in primary care. There was a target to reduce outpatient numbers at the Trust by 30% over the next three years. Reducing spend on agency staff would also save as much as £12m.

The Trust was continuing to fail to meet targets for the ‘four hour rule’ in A & E although the Trust had seen a 10.2% rise in attendances over the last year. The Trust saw up to 1,100 A & E patients per day as well as up to 200 ambulance transfers. Internal processes and systems at A & E were being reviewed although there were also space constraints on the department.

Initiatives to improve performance had included recruitment of Advanced Care Practitioners and the Red2Green system to allow clinical staff to highlight delays in patient care. A new frail elderly unit had been opened at King George Hospital to support winter pressures as well as new short stay elderly care beds. 

Referrals for hospital treatment had grown in recent years and BHRUT was working with the CCGs to better understand referral patterns. The longest waiting patients were reviewed on a twice weekly basis. Improvement work was also focussing on improving booking processes and clinic utilisation.

The Trust had struggled recently to meet targets for starting cancer treatment for some specialities within 62 days. A cancer services recovery plan was in place with a target to return the Trust to compliance by March 2020. Standards for diagnostics had been met in October & November 2019 and waiting lists, which would continue to be monitored, had reduced from 14,000 to 8,000.

Net recruitment to the Trust had increased and officers were pleased that there had been an increase in the response rate at the Trust to the NHS Staff Survey. The establishment of an Academy of Surgery had shortened the time to recruit and a senior intern programme had improved nursing retention rates.

Patient experience scores for maternity were still below target although ratings for both inpatients and the Emergency Department were both exceeding targets. Uniforms had recently been introduced for hospital volunteers and work was in progress to improve accessibility for deaf and blind patients. Changing Places toilet facilities were scheduled to be installed at both Trust hospitals.

A Care Quality Commission inspection had taken place between September and November 2019 and the Trust had been rated as good on three domains. The Trust had retained an overall rating of Requires Improvement.

It was clarified that no patients were left in ambulances and each arrival was brought into the hospital building, even if the transfer from paramedics could not be completed at that point. Nursing and medical staff would assess all ambulance arrivals even if the transfer had not yet been completed. Patients did sometimes wait in a corridor prior to being transferred to the RAFTing area for assessment and treatment. 

Officers agreed that additional information and narrative on performance issues could be placed on the Trust’s website. With the assistance of the CCGs, it was felt that the Trust would hit its overall target for the year and hence would avoid being fined by the regulator. Officers accepted that the Trust needed to improve its underlying processes and reduce waste and work on this would continue to be shared with the Committee.

The reopening of winter pressures beds at King George as a wider remodelling of how these hospital services were provided. This had been discussed with local residents via the recent clinical strategy events. The Trust wished to be open and transparent but it had not been possible to undertake formal consultation on this issue. Work was planned to allow diagnostics to be provided as quickly as possible and a plan on this could be shared once available.

Members remained concerned at the position with A & E at Queen’s and felt it was alarming that four hour rule figures were now below 40%. Requests would be made from Redbridge Health Scrutiny to meet with the Trust Chair and the London lead for NHS England to discuss this in more detail and it was suggested that some members of the Joint Committee could also attend these meetings, once they had been arranged. Members agreed that the performance report should be more transparent about problems at the Trust.

The Chairman agreed that the reopening of the elderly beds at King George was very good news but felt that this remained a significant variation and that news of this development should have been shared earlier. It was agreed that the Trust should provide further details of the purpose and performance of the new area (Foxglove ward). The Foxglove ward had been paid for via BHRUT reserves. It was also noted that performance information for the primary care sector should also be considered.