To receive a presentation from Trust officers on the improvement plan at Barking, Havering and Redbridge University Hospitals’ NHS Trust (BHRUT).
Minutes:
The BHRUT Deputy Chief Executive explained that, following the Trust being placed in special measures in December 2013, an improvement plan was now one year into operation.
In terms of leadership and organisation development, a new Trust Board and Executive team had been in place from November 2014. A Chief Nurse was currently being advertised for. Interviews for the position had been previously held twice but an appointment not made as it was felt important to secure the correct person. The Acting Chief Nurse role was currently being covered by the Trust Director of Midwifery. A Board development programme was in place and structure charts of the Trust could be shared with the Sub-Committee. Work was in progress with the Council to attract more people to BHRUT, including advertising some BHRUT jobs on the Council website. A jobs fair for ED nurses had also recently been held.
The outpatients call centre was now answering 95% of calls compared to 48% previously although it was accepted that more work was needed on this. Phone numbers still needed to be changed on some appointment letters. The call answer times on the Trust switchboard were still too long on occasions. It was accepted that direct hospital phone numbers should be publicised better and more use made modern phone technology.
Appointments cancellations had been greatly reduced and in particular there were now only very few instances of multiple appointment cancellations. This had been done by more rigorous application of staff rules concerning booking of leave etc. It was also planned to offer patients more choice of appointment times. Patient pagers had also been introduced meaning patients could wait elsewhere in the hospital should a clinic be running late.
Other initiatives had included a four-day training course for reception staff and the introduction of a new uniform, developed by staff. It was accepted however that a lot of work remained to reduce waiting times for a first outpatient appointment.
On patient experience 3,000 BHRUT staff had undergone training around the causes of Sepsis and this had reduced outbreaks of the condition at the hospital. New nursing documentation that was more simple and concise had been introduced and a version for short-stay patients was also being developed. Work to make wards more dementia friendly had included the purchase of reminiscence pods and the introductions of menus with food that was easier to eat and did not require cutlery to consume.
It was accepted that more progress was needed with clinical governance and there needed to better learning from serious incidents. The Trust was working with the Good Governance Institute to improve this.
Work with partners on patient flows had included the introduction of a Joint Assessment and Discharge Team as well as the Majors Lite area and having local GPs working in the Urgent Care Centre. There was a new Elders Receiving Unit at Queen’s and geriatricians now worked in A&E, allowing some admissions to hospital to be avoided.
Around 93% of A&E patients were now treated within four hours. This had proved challenging to maintain over the winter period and it was accepted that overall targets for the ‘four hour rule’ were still not being met. This was principally due to there not being sufficient A&E consultants available out of hours. More patients were however now getting hospital beds within four hours of admission.
There remained workforce issues at the Trust although more A&E middle grade doctors had been recruited. The Trust’s recruitment process and ‘time to hire’ measure had been streamlined which it was hoped would aid recruitment. 95% of Health Care Assistant posts were now filled with permanent staff, a significant improvement on the position. The Deputy Chief Executive accepted however that the Trust needed to do further work to improve its recruitment and related workforce issues.
BHRUT had received announced and unannounced inspections from Care Quality Commission (CQC) in March 2015. The Trust expected to receive in the next two weeks with the final CQC report to follow. A quality summit would be held, possibly in June. The outcomes of the report could be that the Trust was taken out of special measures immediately, after a further period of time or continue in special measures. The Trust Deputy Chief Executive felt that coming out of special measures would help the Trust’s recruitment but also felt it was important that the improvements the Trust had made were recognised.
The reputation of the Trust in some areas was improving which had helped with recruitment. Other Trusts had come to see how BHRUT worked and better word of mouth helped with e.g. the recent recruitment of 25 more nurses to the ED. It was felt however that the perception of the Trust by junior doctors still required improvement. The consultant recruitment process had been changed and these posts would only now be filled if candidates were thought to be suitable.
It was confirmed that there was a zero tolerance policy at Board level to patients abusing staff, If however the abuse was due to the patient’s condition, staff would also be trained in conflict resolution. If abuse was not directly related to a patient’s condition, they would be written to by the Trust and could be refused all but emergency treatment.
The Deputy Chief Executive accepted that people were waiting too long to have blood tests and felt that more blood tests should be carried out in the community. Work was in progress with the GP Federation to have more blood tests take place in local facilities. There was no overall target time for a maximum wait for a blood test. It was felt more phlebotomists were needed at the hospital but equally that most blood tests could be carried out away from the hospital. There was also no alternative site within Queen’s Hospital where blood tests could be carried out.
The Urgent Care Centre now saw 110-120 people per day (compared to 80 previously) and it was clarified that the Centre had its own reception desk but not a separate entrance. Registration was needed at the main A&E reception although treatment would be carried out at the Urgent Care Centre and it was accepted that this may need to be communicated better to NHS 111.
The Deputy Chief Executive agreed that there were still delays in delivering discharge medication to patients. Some discharge prescriptions were now written up the day before a patient’s discharge was expected and a dispensary operating at ward level was now being piloted.
Members reported that some people had missed appointments at Queen’s Hospital as they had been unable to find a parking space. The Deputy Chief Executive understood that the Trust had secured some further off site parking that would be used for staff, freeing up more parking patients and visitors. Details of the location of this would be provided.
The Sub-Committee was pleased with the good reputation of Queen’s Hospital for stroke and neurology services and that it had not received any negative reports on these areas.
The Deputy Chief Executive agreed that patients should always leave hospital with a discharge summary. More work was needed on these however and he noted reports that patients were often discharged back to care homes with no discharge summaries or other notes to explain treatment had been received etc.
The Sub-Committee NOTED the presentation.