Minutes:
The BHRUT Chief Executive explained the period October – December 2014 had been very challenging in terms of patient flows. The benefits of the Trust’s new initiatives in this area were however now starting to be seen. The Trust’s winter resilience procedures had been planned for several months and had been drawn up with the Council, CCG, NELFT and the London Ambulance Service.
Flu jabs had been provided to reduce on both staff and public. There were now approximately 45% of front line staff who had received the vaccination although the Trust’s target was 75%.
A Majors Lite unit had been introduced into A&E to speed up dealing with patients who may not need admittance onto a ward. These patients were seen in a separate area. An increasing proportion of discharges (around 30%) now took place in the morning. The majority still occurred after 12 pm however.
The number of patient admissions to BHRUT was very consistent at 95-100 per day. Daily discharge numbers were however more variable. A bed manager was now based in A & E and a bed manager was present in the assessment units. It was important that the pace of work in A & E was matched in the rest of the hospital.
The Chief Executive emphasised that clinicians had not been told to discharge patients too quickly and had to give a good clinical case for doing so. Admissions and discharges should be decided by consultants rather than junior doctors and this was the position the Trust was aiming for across its wards.
It was confirmed that it was monitored which nursing homes sent patients to A & E most often. A pilot scheme was in progress whereby a senior geriatrician was based in A & E in order that decisions could be reached more quickly on whether patient from care homes needed admission into the hospital. It was also noted that most Havering care homes now had a GP aligned to them. By the GP visiting the home on a weekly basis, the number of residents needing to go at A & E could be reduced.
The Trust Chief Executive agreed that it was unacceptable for triage to be carried out in clear sight of people queuing at A & E reception and the environment was not conducive to confidentiality. The issue of privacy would be addressed in the forthcoming reconfiguration of the A & E department.
The JONAH system was still used in discharge work as this was a consistent predictor tool for discharge. The Trust as a whole needed to discharge 100 patients daily, seven days per week. The elders receiving unit had consultant presence seven days per week but there remained vacancies to fill before this could be achieved on the Medical Receiving Unit. The Trust has been pleased with the response of the medical teams during the peak winter period.
It was noted that the Joint Assessment and Discharge Team had been put together by the health economy and that this helped discharge by for example compiling care packages more quickly. People waiting in the hospital discharge lounge were likely to be less complex discharge cases.
The Chief Executive accepted that there were still issues with people receiving their medication promptly on discharge. Early writing up and dispensing of prescriptions was needed and pharmacists were present in the Elders Receiving Unit in order to facilitate this. Medication could be delivered to patients after discharge but this depended on the complexity of the case. It was also accepted that it was not acceptable for a residential home not to be advised of a patient’s discharge from hospital. Communication the hospitals and homes needed to be improved.
The Trust was legally required to treat people who may be very intoxicated and it was noted that mental health issues could also be present in such patients. It was suggested that the Council could assist with public health issues such as alcohol abuse but this was a national problem. Temporary units were deployed in Romford town centre for example at New Year. The Trust Chief Executive indicated he was happy to be involved in work on drafting the Council’s new licensing strategy.
The Trust was due to receive a new inspection from the care Quality Commission starting on 2 March. It was noted that the Trust’s Chief Nurse was leaving and that a replacement was being recruited. As regards recruitment and retention at the Trust as a whole, 85-90% of nursing posts in A & E were filled. Poor performing staff were moved on and it was accepted that there remained vacancies for e.g. intensive care nurses and A & E doctors. These were however also national issues. A recent recruitment day for Health Care Assistants had generated a lot of interest. Details would be supplied to the Committee of the Trust’s next recruitment day.
It was confirmed that the Trust ran a Return to Practice scheme where nurses who wished to return to the profession could receive appropriate training.
The Committee NOTED the update and thanked the Chief Executive for attending.