To discuss the BHRUT Improvement Plan with Matthew Hopkins, Chief Executive, BHRUT.
Minutes:
The Trust Chief Executive reported that Steve Russell had now started as Deputy Chief Executive. A number of nurses from Portugal had recently been recruited to the Trust and there were 85-90% permanent nursing staff in A&E (compared to 50% last year). Some 40% of midwife posts were vacant however. The overall nursing vacancy rate across the Trust was 11%.
Reasons why nursing staff moved on were being investigated. Nationally, demand for the nursing workforce was outstripping supply particularly as the Francis report had made hospitals recruit more nurses. The South Bank University Nursing School based in Havering was still used to recruit nurses. The Chief Executive would check if BHRUT had withdrawn funding to nursing students at the South Bank University site.
As regards recruitment of doctors, all training grade posts were filled but A&E rotas meant there were a lot of locum mid-grade doctors. Twenty posts had been offered following recruitment in India and four doctors had now started. Some of the remainder were however now asking for more money and negotiations were in progress. BHRUT were meeting with UCL Partners in the next week to discuss how to attract new cohorts of junior doctors to BHRUT. It was also hoped to attract a visible consultant leader for A&E.
It was suggested that the Trust should get the relevant Colleges to support its recruitment work. The Trust also needed College support for its work looking at different models of staffing with senior doctors. The Board agreed that recruitment was a wider system problem and that greater awareness of the issues would help. It was agreed that recruitment across the system should be raised at the next Chairman’s briefing.
The Trust Chief Executive stated that the aim was to treat all patients on a waiting list within 28 days. There was however a backlog of around 4,500 patients awaiting treatment with 250-300 of those still untreated beyond 18 weeks. It was hoped the Trust would stabilise the position by March 2015.
The Queen’s Hospital pharmacy was already operating seven days per week but with shorter opening hours at the weekend. The Chief Executive confirmed that approximately the same number of people were discharged from Queen’s each day but 40% of these were discharged after 8 pm. It was essential that medication was got to people earlier to allow a quicker discharge. Day before discharges could be undertaken but only if a junior doctor had written up the prescription. Of approximately 100 discharges each weekday, it was aimed to discharge 10 people by 10 am and 20 people by 12 pm.
Extra pharmacy posts had been funded but these still needed to be filled and this work needed to start by the end of September. Work was also ongoing with college principals to fill pharmacy posts. The Group Director offered to assist in getting this message to local college principals. The Trust Chief Executive agreed to consider allowing local pharmacies to fill hospital prescriptions in order to speed up the discharge process. There was a VAT issue on certain medications being dispensed locally but it was felt this could be managed. Atul Aggarwal would discuss the matter with Angela Hellur and it was agreed that an update should be given at the November meeting of the Board.
An interim solution had been developed for the issue of accommodation for the joint assessment and discharge team. Work was also underway to produce a more long-term solution which would involve co-locating people. It was felt this would be more effective at King George rather than Queen’s. All posts in the joint assessment and discharge team had now been filled. It was accepted however that staff would only be retained if the accommodation was suitable. The Trust Chief Executive accepted that a clear timeline and communication with staff was needed and a weekly update to staff on accommodation could be produced.
The Queen’s renal dialysis service, run by Barts Health, needed to move elsewhere. This did not need to be on an acute hospital site. It was accepted that it had not been possible to secure the site for the service that had originally been proposed. The sexual health service location was not a significant problem although retendering of the service may lead to a move. Accommodation issues could be raised at the next meeting of the North East London group and a report back given at the next meeting of the Board.
A recruitment consultant had been engaged to assist the Trust’s recruitment of a Medical Director. It was hoped that existing Medical Directors or senior clinicians would apply for the position. Interviews for the position were expected to be held in late October. It was felt useful if representatives of the CCG could be on the interview panel.