Agenda item

Michelle McKay, Chief Executive for Worcestershire Acute Hospitals NHS Trust, attended for this Item and took Members through the Agenda Report.  In the general discussion, the following details and questions were addressed:

·         Since the Care Quality Commission (CQC) had served a section 29A notice on the Trust in January 2017, requiring significant improvement, a number of inspection visits had taken place, both expected and unannounced.  Most recently, service reviews of 4 services (out of 22 core services) and a focussed assessment on governance was undertaken in November 2017 and the report published on 17 January 2018

·         Positively, the report showed that all 4 core services inspected showed improvement since the last inspection, however, given the fact that not all core services were reviewed, the overall judgement for the Trust had not changed

·         The CQC had also advised that they would conduct a 'well led' review at the end of February 2018 and review further core services over the coming weeks

·         Members were very pleased to note the progress made, the positive effect that substantive leadership was having and it was clear that the Chief Executive was driving forward the agreed change programme.  When asked, it was clarified that all Board Member positions had been successfully filled

·         In response to a question, the Chief Executive commented that it was not a surprise that there had been no movement on 'well led' for Urgent Care as the Division was newly formed (following the split from the Medicine Division) with a new Leadership Team, a fact which CQC acknowledged

·         Training was a key focus in the improvement programme and the signature behaviours of 4ward was a part of this:

§  Do what we say we will do

§  No delays, every day

§  We listen, we learn, we lead

§  Work together, celebrate together

·         Winter Pressures had seen a massive increase in activity and for the period 22 December 2017 to 16 January 2018, an additional 418 patients presented to the two acute hospitals A&E departments and there was an additional 264 ambulances.  It was pleasing to note that there had only been 3 12hour trolley breaches in this time, compared to 135 for the same period last year and the amount of time patients spent in corridors was considerably less than last year

·         During this period, ambulance waiting times also deteriorated and handover delays were especially problematic when there was a surge in activity

·         Prior planning across all health economy partners had built on previous practice and an additional £2.6m of winter pressure funding had helped, however, patient flow continued to be an issue and therefore focus for the Trust and other partners

·         In response to a question, Members learned that only around 30 to 35% of patients presenting at A&E were admitted to hospital and the Committee discussed other options available to residents, including GP access, pharmacies and Minor Injury Units.  It was felt that clarity was needed across the health sector to inform residents of the options and services available across different sites throughout Worcestershire

·         The role of Community Hospitals was vital, both in relation to hospital avoidance, via GP referral, but also rehabilitation after an Acute Hospital stay

·         When asked how the health system would cope next winter, the Chief Executive expressed concern, especially given the County's demographic profile and the increasingly older and more frail population.  It was noted that the importance of making every contact count was an opportunity to highlight potential issues and address them early by signposting

·         Nationally, planned surgeries were cancelled during the winter period from 12 December to 5 February, however, locally it was planned to be less time than this and patients had not been booked in during the time of highest pressure to avoid potential cancellations

·         Members were surprised to hear that the Trust felt the uptake of the flu vaccination amongst staff was pleasing, despite the figure being 75%

·         Although the £29.6m capital funding bid was secure from an outline business case approved by the Department of Health in December 2017, a final business case was still required and the funding for this would be a challenge.  However, the Trust had successfully argued that £3m be drawn down early to fund the link bridge work at the Worcester site.  This work was therefore on track to be completed by next winter.  The additional funding would be used to provide extra beds, assessment units and enhance theatre provision, especially at the Alexandra Hospital in Redditch.  The Committee asked for a summary of the proposed projects for the capital expenditure

·         It was clarified that the new Ambulatory Emergency Care (AEC) Unit was funded separately to the capital bid and had been in use since November 2017

·         At a previous meeting, nursing vacancies had been discussed.  It was reported that currently, of 2,500 funded nurses, there were 158 vacancies and of those, 56 offers had been made but Staff had not yet started.  It was hoped that by working with Worcester University on a nursing programme, it would help with future workforce planning.