Agenda item

In attendance from Worcestershire Acute Hospitals NHS Trust (WAHT) were:

Chris Tidman, Interim Chief Executive

Julian Berlet, Divisional Medical Director

Lisa Thomson, Director of Communications

Chris Tidman, WAHT Interim Chief Executive updated the HOSC on progress since the last discussion - including the Trust's vision, priorities and progress in the areas rated as inadequate by the CQC in July 2015, as well as future challenges. The CQC was due to revisit the following week.

Key facts of note were that WAHT employed 5,935 staff and 600 volunteers, had 968 beds, 3 hospitals, 19 operating theatres and served a large geographic graphic area, with an older demograph.

WAHT had been through a long, painful journey to deliver clinical sustainability as part of the review of Worcestershire's acute services, which had been contentious and led to uncertainty. Emergency, temporary changes had been necessary for Maternity and Paediatric Services. Public consultation on reconfiguration plans was due in December, and it was hoped that the future vision for the Trust was brighter. It was important to note that 95% of all patients would be treated at the same hospital as now.

'Buddy' arrangements with other trusts had helped strengthen governance and staff engagement and a Leadership Development Plan were in place.

Changes to Women's and Children's Services had led to improvements for those around the service, and feedback from patients and families around centralisation of Paediatric Inpatient Services, was very positive. These services had been the main reason for the CQC's inadequate rating, and the Trust's self-assessment in October 2016 was 'requires improvement'.

There continued to be incredible pressures on Worcestershire Royal Hospital's (WRH) Emergency Department (ED), especially from older patients, however triage times had improved, staffing had increased, equipment monitoring was tighter and there was a separate paediatric area. Expansion of ED was due to be completed in December and work going forward aimed to find new ways to manage demand and a less traditional 'bed-based' approach.

The Interim Chief Executive updated the HOSC on further progress and learning for radiology Services, following the Committee's recent discussion of the CQC's disappointing inspection of Radiology in August 2016. Staffing for extra radiologists had started and the inspection had been a catalyst for a new approach,

Emergency Surgery at the Alexandra Hospital was another area rated inadequate by the CQC in 2015. Since then, complex surgery had been transferred to WRH and serious incident and mortality rates had reduced. Options were being considered, with the need to identify more beds at WRH.

An update was provided of work against the key areas of question used by the CQC, used to assess whether services were safe, effective, caring, responsive to people's needs, and well-led.

Future challenges for the Trust included:

·         Emergency Department overcrowding

·         Medical and staff engagement

·         Addressing workforce issues – specific focus on Medicine Division

·         Committed to reduce hospital mortality rates

·         Service improvement – fractured neck of femur, stroke, radiology, outpatients

·         Future of Acute Hospital Services in Worcestershire  (FoAHSW) Review and partnership working via the Sustainable Transformation Plan

·         Reputation building

·         Stabilising finances without impacting on quality and safety.

The Interim Chief Executive was acutely aware of pressures on the Emergency Department.  Public consultation on FoAHSW and clarity on investment would help address workforce issues. He believed that the CQC would find progress had been made when it revisited the following week. 

Main discussion points

·         The HOSC Chairman sought assurance that there were no other areas of concern, such as the recently revealed backlog within Radiology. The Trust's representatives did not envisage similar shocks elsewhere and explained that preparation for the CQC visit had been very thorough

·         The experience with Radiology Services had been a significant shock, and staff learning had been had shared

·         The associate nurse role referred to, as part of work on safety, was an intermediate role, which could also facilitate assistants wanting to train up to become nurses

·         Cllr Vickery, a HOSC lead member for WAHT, appreciated the honest, straight presentation, visible progress and new exemplar approach to public engagement at public Board meetings – issues remained and winter pressures were still to come, but there was visible progress, which the STP would also help with

·         The Interim Chief Executive acknowledged that progress against the Patient Care Plan arising from the CQC visit, had not been as sufficient as had been hoped. However, sustained improvements would be possible, which was being driven by smarter working, addressing the '999 access point' and stronger diagnostics at the 'front door', to get people home and mobile

·         The Divisional Medical Director, who was not a member of the WAHT Board, praised the strength and joint working of the Board

·         Regarding reports of ambulances being unable to locate call locations, HOSC members were advised that an update from west Midlands Ambulance Service had been arranged for January 2017

·         An issue was also reported where a member's relative had been referred to the Queen Elizabeth Hospital for specialist cancer treatment, but could not get there and transport was unavailable as she lived out of area

·         The Interim Chief Executive undertook to look into a HOSC member's reports of problems with the ultrasound at the Alex, and also issues around poor care of a member's elderly friend at A&E, which had been deeply distressing

·         Contribution was invited from Caragh Merrick, the Trust's new Chairman, who said that she was grateful for the HOSC's interest and constructive feedback. She highlighted the recent news report of a patient's 57 hour wait on a hospital trolley; there was no room for complacency.  She also referred to work in hand to stabilize the Board, and to drive patient safety and care. The forthcoming CQC inspection would be an informed, objective assessment, which would reveal what had improved and what had not.

The HOSC Chairman wished the Trust well in its progress, which the Committee would continue to support, with constructive criticism.