To receive an update on issues affecting Barking, Havering and Redbridge University Hospitals’ NHS Trust (BHRUT) from Neill Moloney, Director of Planning and Performance, BHRUT.
Minutes:
The Director of Planning and Performance at BHRUT admitted that there were significant financial challenges at the Trust but felt that the Trust had the support of its partners in addressing these. H4NEL was also seen as part of the solution.
The Trust had recently agreed a cost improvement plan with support from the local NHS cluster. This would be shared with the Committee later in the year. It was emphasised that the transfer of services between Queens and King George Hospitals was subject to a Gateway Review confirming that the existing services were sufficiently robust in quality.
The current sexual health service at Queen’s was being relocated in order to allow more space for the reconfiguration of A&E at the hospital. A site for the service was currently being sought in Romford Town Centre. The Committee felt that the site identified for the service was too high profile and that such a service should not be housed in a separate, self-contained unit. The BHRUT officer agreed to feed these views back.
The transfer of A&E services from King George to Queen’s Hospitals was currently being planned and updates on the timescale etc. would be brought to future meetings of the Committee.
The Care Quality Commission (CQC) had now given feedback to the Trust and had indicated they considered satisfactory progress had been made against most of their recommendations. The CQC had however highlighted continuing concerns around A&E and the Trust’s Reset programme was designed to address emergency care transformation. The Rapid Assessment and Treatment system which had been successfully used at Queen’s would shortly be introduced at King George. This system was intended to be consultant led but there remained a need to recruit further consultants to A&E at the Trust. Four more consultants had however recently been recruited to start work in September. It was also hoped to extend the hours in which the system operated. This would also require the extension of consultant cover at weekends etc.
The Trust now had a new management structure with 11 clinical directors and had received support from NHS London to recruit senior doctors. It was accepted that there remained a lot of work to be done but the BHRUT director felt there had been significant improvements in the last year.
It was explained that the A&E at King George would not be closed until work on the A&E at Queen’s had been completed. Work was in progress with the CCGs and NELFT on the clinical model of care with the aim of enhancing community provision in order to reduce hospital admissions.
It was agreed that the BHRUT officer would seek to obtain figures for he redundancy costs etc. associated with the recent changes at Trust Board level and supply these to the Committee. It was pointed out however that several staff affected were currently still employed by the Trust.
A Member related problems a constituent had encountered concerning extremely long waits for appointments at the hearing aid service. The BHRUT officer agreed to look into the specific details of the case as hearing aid service appointments were normally required to be provided within six weeks. The design of the overall outpatient function was currently being reviewed with the possibility of introducing a partial booking system where initial appointments were made six months ahead with the exact date being agreed with the patient six weeks before the appointment was due.
Details of debts outstanding from health tourists were regularly reported to the Trust’s finance committee. It was acknowledged that the Trust often had no choice but to provide treatment in urgent cases. The BHRUT officer agreed to obtain figures for debts of this sort that had been written off.
It was accepted that the Trust’s identification of patients with dementia had not been as good as it should be. The Trust was now required to identify patients suffering from this condition and to provide appropriate treatment.
A detailed action plan had been developed in response to the CQC report and the Trust asked for evidence showing that each recommendation had been completed. This work was also subject to external scrutiny via a clinical quality review meeting chaired by the Director of Nursing at NHS North East London and the City. A new chief operating officer and new director of transformation had been recruited and reconfiguration work at the Trust was being led by Nick Hulme.
A ward had now been freed up at Queen’s in order to be converted into further maternity beds. Proposals for the expanded A&E unit at Queen’s were due to be considered by the Trust board on 1 August. Some current Queen’s services would have to be relocated in order to allow for the expanded A&E department. The predicted growth in A&E activity had been factored into the plans although further work was needed on the bed capacity at Queen’s.
Records were kept on why people attended A&E and the BHRUT officer’s views was that many patients did not need to attend A&E and could be treated in the Urgent Care Centre. A scheme had also been run to supply patients who did not need to be seen in A&E with appointments with their GPs which had been supported by the CCG.
Consultants were recruited on a full-time basis although locum staff were also used. Figures would be supplied to the Committee on the proportions of locum and permanent consultants. It was accepted that the use of agency staff was more expensive and the Trust wished to reduce the resources spent on using temporary staff.
It was reiterated that patients would not come across from King George to Queen’s until the relevant facilities were in place. 65% of current patients at King George A&E would still be treated on the site and 58% of patients admitted at King George would be transferred to Queen’s. The Committee was pleased at the planned reduction in overall births at Queen’s to 8,000 per year.
BHRUT officers would also report back plans for dealing with rising rates of diabetes. It was accepted that it would be better to prevent hospital admission by treating diabetes and related conditions in the community.
The issue of toric lenses had been raised with commissioners but these would not be routinely commissioned. Individual funding requests could be made which would be considered on a case by case basis.
The Committee NOTED the update.