Agenda item

Chris Tidman and Harry Turner from the Acute Hospital Trust attended the meeting and gave a presentation.

Following the Risk Summit and the CQC actions the main issues causing concern were all improving and the Trust had rated most of them as as 'green'. Staffing levels and patient flow through the Emergency Department (ED) were rated by the Trust at 'amber': the flow through the ED had improved but more needed to be done, and 2 of the 5 A & E consultants who had been recently recruited were locums. Progress had been made in improving relationships with partners.

An Urgent Care transformation team had been established. The numbers of delayed transfer of care (DTOC) had been agreed and were falling. The number and causes of medically fit for discharge (MFFD) patients needed further clarification. Some physical changes such as a larger discharge lounge were planned for before Christmas. Greater efforts were being made to plan discharges right from hospital admission and to discharge patients earlier in the day.

The HSMR (Hospital Standardised Mortality Ratio) and SHMI (Summary Hospital Mortality Indicator) were high. Analysis of data by cause of death showed that the main outliers were acute bronchitis and liver disease. 35% of deaths occurred after hospital discharge and a process had been agreed with CCGs to carry out further analysis of deaths post discharge.

The Trust had introduced a central register of all safeguarding adults' referrals, which had enabled cases to be better tracked. Of the 9 cases that remained outstanding at the end of June, 6 had been closed and of those 9, 4 related to discharge issues. Themes and learning were be disseminated via Matrons meeting and reported via the QGC.

Staffing levels were being reviewed monthly at public board meetings. For fractured neck of femur, performance had improved against the target to get patients to theatre within 36 hours. Work was on-going to recruit a 5^th stroke consultant in order to move to a 7 day service.

A number of other outstanding actions required follow up:

·         The Systems Resilience Group (SRG) needed to review out of hospital capacity for the winter.

·         Long term chairmanship of the SRG needed to be resolved.

·         The Trust and needed to agree a plan to address the fragility of Maternity and Emergency Care services.

·         Issues raised by the Deanery based on Junior Doctors' feedback.

·         The outcome of the Good Governance Institute report.

·         Recruitment to substantive executive posts.

During the ensuing discussion the following points were made:

·         When asked about mortality rates in emergency surgery and perinatal care it was explained that nothing stood out in emergency surgery. There had been a spike in perinatal incidents but this had now reduced and a peer review had been commissioned to check there were no further concerns. All deaths would be reviewed by the end of the year.

·         When queried about when the Leadership positions would be made permanent Harry Turner explained that once the current review had been completed and the skills mix of people currently undertaking the roles had been assessed permanent appointments were likely to be made in the Autumn.

·         Board Members commented that there had been an improvement in communications from the Trust and they now appeared to be more open and available for comment.

·         Agency staff were only used if bank staff were not available so the amount paid to agencies was relatively low.

·         It was agreed that a further report should be considered at the November HWB meeting, although it was pointed out that it would be useful to have an overview of the whole healthcare system, rather than just one element in the acute trust.

RESOLVED that the HWB:

a)    Thank Chris Tidman and Harry Turner for attending the meeting; and

b)    Requested a further update place at the November meeting, which may also need to include information from other health partners.