Agenda and minutes

Apologies were received from Mrs M A Rayner and Mr C Rogers.

None.

Members of the public wishing to take part should notify the Head of Legal and Democratic Services in writing or by email indicating the nature and content of their proposed participation no later than 9.00am on the working day before the meeting (in this case 23 November 2018). Enquiries can be made through the telephone number/email address below.

None.

Previously circulated

The Minutes of the Meeting held on 19 September 2018 were agreed as a correct record and signed by the Chairman.

Attending for this Item were:

Clinical Commissioning Groups

Mari Gay, Chief Operating Officer and Lead Executive for Quality and Performance

Worcestershire Acute Hospitals NHS Trust

Paul Brennan, Chief Operating Officer and Deputy Chief Executive

Worcestershire County Council

Avril Wilson, Director of Adult Services

Matthew Fung, Consultant in Public Health

The Chairman welcomed Paul Brennan to the meeting and explained that he had come to Worcestershire after a number of years' experience at the John Radcliffe Hospital in Oxford. 

By way of presentation, which had formed part of the Agenda papers, Members were updated on the health and care system plan for the winter period, from 1 December 2018 to 31 March 2019.  Planning for this had commenced in May 2018. 

The Plan's themes included increased resilience to provide safe and effective care, sufficient capacity to meet likely demand and appropriate signage and support for patients and carers.

Plan partners were working to embed learning from previous winters, initiate robust daily monitoring, concentrate on prevention and take steps to work better across the whole system.

The Plan aimed to enable patients to experience a more seamless journey through the system, release extra capacity for the winter period and improve performance. 

The Worcestershire Clinical Commissioning Groups had commissioned consultancy Carnall Farrer to undertake a system wide demand and capacity analysis.  The result, based on a bed occupancy rate of 92%, which was an ideal number for patient flow, suggested a 1 bed shortfall across the Worcestershire Acute Hospitals NHS Trust during the Plan period.  However, this varied between sites.  At the Worcestershire Royal Hospital it was estimated that there was a 41 bed shortfall, meaning that the Alexandra Hospital in Redditch would have a surplus of 40 beds.  This was shown on pages 13 and 14 of the presentation.

As a result of this analysis, further improvements had been identified, including:

·         the opening of an Urgent Treatment Centre at the Alexandra Hospital from 3 December 2018

·         surge capacity across both Worcester and Redditch hospital sites, resulting in an extra 40 beds overall

·         an additional 16 beds at Evesham Community Hospital

·         a trial in Redditch where the Fire Service would support patients to settle at home after discharge

·         maximising the Kidderminster site to maintain elective surgery

·         additional pharmacy staff

·         utilising all staff, including clinicians in non-clinical posts, who would spend 20% of their time working in front line services.

Monitoring was well planned, and would need to be robust, with daily management systems in place and weekly forums across all A&E Delivery Board partners to access the situation and agree the system wide operational plan for the week ahead.  A live evaluation would also be undertaken of the Plan by the Commissioning Support Unit.

In the ensuing discussion, the following main points were made:

·         In response to a question, Members were informed that the capital work to build a link bridge at the Worcester site was still progressing, however, the work was delayed by four weeks and would not be completed until  ...  view the full minutes text for item 904.

Attending for this Item from Worcestershire Acute Hospitals NHS Trust were:

Vicky Morris, Chief Nursing Officer

Jackie Edwards, Deputy Chief Nursing Officer.

By way of presentation, Members were reminded of the Care Quality Commission (CQC) activity since 2015, most recently the unannounced inspection of urgent care in March 2018, which was reported on in June 2018.

Over time, there had been a number of positive findings and frequent references to caring, compassionate staff who provided emotional as well as clinical support. 

The negative findings and areas for improvement were well documented and to address these, in May 2018, the Trust Board had agreed a 3 year Quality Improvement Strategy (QIS).  In addition, each of the 5 Divisions also had a plan to underpin the QIS.

The Trust believed that the workforce was key to driving improvement and had developed a People and Culture plan.  Activity focused on the now established 4ward behaviours of:

-        Do what we say we will do

-        No delays, every day

-        We listen, we learn, we lead

-        Work together, celebrate together.

Systems had improved, quality audits had taken place since July 2017, and the Trust had introduced ward accreditation to support wards which showed strong leadership.  Members learned that Senior Leaders were also actively engaged with day to day activity, such as listening in to handovers, undertaking walkabouts and, with Trust Board commitment, having 20% of the week as clinical time and being part of a team.  Reducing the amount of meetings was also an aspiration.

In the ensuing discussion, the following main points were made:

·       One Member commented that the lag between the CQC inspection and their published report was months and questioned whether feedback was given at the time.  In response, Members were told that the process followed a national framework and factual accuracy checks were made, however, verbal feedback was given at the time.

·       It was important to work with staff on the implementation of action plans and focus on embedding and driving improvement.  Incentives, such as the ward accreditation and the 'back to the floor' initiative were welcomed

·       In response to a query about CQC engagement outside of inspections, Members learned that there was a new regional team, but monthly meetings took place through a Quality Improvement Review Group

·       The Committee commended the 'back to the floor' approach for Managers and wished for its success

·       It was acknowledged that sustaining improvement was a challenge, however, with strong leadership was achievable

·       Members agreed that the Trust was planning for a positive future but stressed the necessity of embedding improvements made whilst continuing to work to improve others.  It agreed to review the progress of the Quality Improvement Strategy at an appropriate time in the future.  

There was nothing to report at this time.