To receive an update from senior BHRUT officers on key issues facing the Trust.
Minutes:
The Barking, Havering and Redbridge University Hospitals NHS Trust (BHRUT) officer explained that the Care Quality Commission had recently acknowledged improvements in maternity services at the Trust and had removed the remaining restrictions placed on the service. He felt that the maternity unit at King George would most likely close in mid-2013 but final decisions on timescales had not yet been taken.
A midwife-led unit would be based at King George with more special care and neo-natal beds installed at Queen’s. Work was also under way with commissioners to ensure more capacity at other hospitals once the maternity unit at King George was closed. It was confirmed that the cap on maternity cases from other areas being seen at BHRUT had now been lifted. There was no longer any daily limit on numbers of births at BHRUT but an annual cap of 8,000 births per annum was still in place.
Monthly reports of maternity activity would continue to be presented at the BHRUT Board. It was emphasised that it would not be safe for there to be in excess of 8,000 births per year carried out at BHRUT and that deliveries would have to be carried out elsewhere once this limit was reached. The issue of women’s choice had been considered as part of the Health for North East London (H4NEL) consultation but officers were happy to have further discussions around this.
The vacancy rate at BHRUT maternity was now only 2-3% which was considered negligible. The Trust would provide information on where midwives were recruited from as well as retention figures for maternity staff.
It was accepted that BHRUT continued to face a considerable challenge in meeting the four hour target for A&E treatment. Discharge issues were also being considered in order to reduce the average length of stay in hospital. Work on this was under way with community services, social care and other stakeholders. A reduction in length of stay would be required if Queen’s was to accommodate the larger A&E department needed in light of the Health for North East London reconfiguration.
Members were sceptical that A&E at Queen’s could cope with any further increase in demand, even if other parts of the hospital offered good care. The BHRUT officer responded that he was taking the lead on the outline business case for the extension of A&E. These works would include more resuscitation bays, six more beds in Majors and improvements to the general flow of patients in A&E. The department would be both expanded and redesigned. The BHRUT officer agreed to bring the plans for A&E back to the Committee once they had been considered by the Trust Board in August 2012. He was also happy to take the plans to the individual borough Health Overview and Scrutiny Committees.
It was emphasised that the A&E at King George would not be closed until it had been confirmed that Queen’s A&E could cope with the larger number of patients. The date for when A&E was transferred from King George to Queen’s depended on establishing that Queen’s A&E could cope safely, obtaining the relevant approvals and the building process itself. The officer estimated that the expanded A&E at Queen’s was therefore unlikely to open for at least two years (i.e. summer 2014) but this was only an estimate at this stage.
It was anticipated that one third of current patients a King George A&E would not need to attend an alternative facility once the A&E closed. Work was also continuing on keeping people in hospital for less time and on the number of beds that would no longer be required. It was also being considered how King George could be used for rehabilitation facilities. It was accepted that there was a risk of the assumptions made on levels of demand not being correct but the Trust was managing this.
The officer accepted that there was a significant cost impact of the Health for North East London plans. Capital costs would be significantly higher than stated in the Health for North East London business case and precise figures were currently being worked on. Patient flows were also being looked at to ensure that the Clinical Commissioning Groups understood the revenue implications and that more people would be going through Queen’s Hospital. A £30 million reduction in BHRUT’s cost base also had to be achieved this year. All areas of work were being looked at in order to safely make savings including procurement and the numbers of temporary staff used.
There would be capital build issues at Queen’s in order to accommodate activity displaced from the King George site. The original timescales to take the outline business case to the BHRUT board had been missed but this meant there would now be more information on actual activity expected at Queen’s Hospital.
As regards the King George site, 65% of current A&E activity would continue to be treated there, at the Urgent Care Centre. Outpatients would continue to be seen at King George and some elective work would be transferred over from the Queen’s site. Clearer plans on the use of King George would be brought to the Committee during autumn 2012.
The BHRUT officer accepted that, if the Trust’s financial position did not improve, it would have a deficit over the next five years of in excess of £150 million. In order to reach Foundation Trust status 5-7% cost improvements would need to be made each year and this was not realistic. As such, an integrated business plan was being developed for BHRUT to become a Foundation Trust over the next five years. The plan would require the Department of Health agreeing to an extended Foundation Trust timetable for BHRUT and be the subject of public consultation. Commissioners would also need to sign up to this plan. BHRUT would also have to show a clear strategy for engagement with local people and that it had addressed the issues raised by the Care Quality Commission.
The officer explained that other organisations had successfully and safely reduced their length of stay. He felt that one third of patients in acute hospitals at any one time did not in fact need to be there. Other savings could be made by e.g. reducing the number of cancelled appointments (30-40,000 per year across the Trust). All processes and systems were being looked at that did not add value to the patient experience. One area of saving could be to make patients’ next appointments whilst they were still on the premises, as happened in many other Trusts.
The officer accepted that there were significant issues with the sending of duplicate appointment letters etc. He felt that patient confidentiality was not a reason that appointments could not be sent by e-mail and that hospitals should accept patients’ e-mail addresses. This would be considered as part of the Trust’s systems and process work that was already under way.
The BHRUT officer felt that the Joint and Borough Overview and Scrutiny Committees could help the provision of healthcare by being a critical friend. The relationship between scrutiny and the Health and Wellbeing Board also needed considering. It was inevitable that BHRUT would have to make unpopular decisions and it was important that scrutiny informed this debate. It was certainly the case that some hospital services may no longer add value or need to be provided elsewhere. The officer also agreed to take issues around the relationship between the Trust, scrutiny and the Health and Wellbeing Board back to the Trust Board for consideration.
Members agreed that they wished to be a critical friend but remained concerned that little real improvement had been seen, particularly at Queen’s A&E. The Chairman hoped that the plans the BHRUT officer had outlined would come to fruition.
The Committee NOTED the update.