Agenda item

A range of concerns about the Acute Hospital Trust had been identified and had resulted in a Risk Summit on 25 March and a Care Quality Commission Inspection on 24 March.

There had been three main areas of concern:

1.    Performance - which included issues around

i)      Key targets,

ii)     Urgent care – work was underway to improve this area which would be monitored through the systems resilience group,

iii)    Mortality rates – Provisional data was given at the Rick summit which suggested that rates were up to 10% higher than expected.

2.    Workforce – which included the resignation of 5 Emergency Department Consultants, although appointments had now been made, and staffing in general surgery and women and children's services.

3.    Leadership and Culture – which included accusations of bullying and harassment that had led to a review by the Good Governance Commission, the results of which were awaited.

There had been a question at the Risk Summit that the Trust Board did not know about some areas of concern, but assurances had been given the Trust Board was functioning adequately. 

The HWB did not have direct accountability for the acute hospital services but did have a responsibility to ensure concerns were placed on public record and to seek assurances that they were being addressed.

Chris Tidman, Deputy Chief Executive, gave a presentation about what the Trust was doing now and would do in the future to address the concerns.

·         Key performance targets were being pursued but further improvements were required and would be monitored closely,

·         Additional support had been brought in with an interim Chief Medical Officer and an Improvement Director,

·         Improvements had been made in the Emergency Department, the Urgent Care pathway had been improved and a Patient Care Improvement Plan had been produced,

·         There had been increased openness and transparency in reporting and through the Trust Board agenda,

·         Their approach would be to look for support and advice from partners,

·         An Organisational Development plan would be put in place to support staff,

·         Protocols had been signed off concerning ambulance handovers and delayed transfers of care numbers.

In the ensuing discussion the following points were made:

·         HWB Members thanked Chris Tidman for his presentation and commented that it was much more positive and a marked difference to responses that had previously been received from the Trust,

·         It was suggested that closer collaboration would be useful with other health and social care providers, for example using the same definitions and data for targets,

·         The Acute Trust should work with Healthwatch to gain the views of Worcestershire residents to whom they were accountable,

·         An improved, more open communications strategy would be useful, which was more pro-active and produced jointly with partners,

·         It was clarified that a review by a specialist would occur within an hour in the Emergency Department but out of hours specialists would visit people on the ward within 12 hours,

·         Mortality rates took age and case mix into account so that data could be standardised. Worcestershire rates were higher than average and a robust procedure was to be introduced to review all deaths and escalate any concerns,

·         The use of the term 'bed blockers' should be seen as offensive and it was not a term used by the Acute Trust,

·         A whole system finance response had been mapped by the CCGs, County Council and the Acute Trust so that joint savings can be achieved through combining resources through programmes such as Well-Connected,

·         The Risk Summit included actions for all the Health and Social Care Partners and not just for the Acute Trust so action needed to be taken jointly,

·         It was suggested that patient and staff experience had improved in certain areas of the hospital, but it was acknowledged that the CQC view was still awaited,

·         The Systems Resilience Group would be monitoring progress against the actions listed at the Risk Summit in respect of urgent care and the HWB would seek reassurance from them,

·         The Chairman of the Acute Trust concluded by stating that patient safety and care was the top priority for the Trust Board and if concerns arose they should be informed as early as possible. They would welcome a HWB member at Board meetings and wondered if including someone from the Acute Trust on the HWB would improve partnership working.

RESOLVED that the Board;

a)    Thank Harry Turner, Chris Tidman and Dr Phillips for attending the meeting, and

b)    Continue to monitor the situation and receive a further report at the next HWB meeting.