Agenda item

The Chief Executive of Worcestershire Acute Hospitals NHS Trust (the Trust) attended for this Item, reminding Members of the Quality Improvement Plans that had been developed and put in place since the last Care Quality Commission (CQC) visit.  Members had received these at the HOSC on 19 July 2017 when Trust Board Members attended.

The Chief Executive made reference to the following points from the Plans:

·         There was a clear focus on quality and safety for senior nursing staff

·         A series of standards had been agreed and implemented

·         Patient Flow was vital, especially through the Worcester site

·         Discharge targets were to be introduced

·         A new frailty model was being developed with partners

·         NHS Improvement, along with Healthwatch Worcestershire had helped in monitoring improvements

·         The number of medical vacancies within the Trust had dropped, with a reported 40% of current vacancies being filled by the end of 2017

·         There was a decrease in the use of agency staff  

·         A culture shift was required and a programme of four signature behaviours (4ward) had been introduced for all Staff.  4ward consisted of:

o   Do what we say we will do

o   No delays, every day

o   We listen, we learn, we lead

o   Work together, celebrate together.

During the subsequent discussion, points included:

·         The footprint of the A&E unit in Worcester would increase to enable some patients to be seen by a consultant earlier.  This had proven to have better outcomes for patients, as seen with paediatric services, with a 15% reduction in admissions in children since the reorganisation

·         There would be co-location of Primary and Out Of Hours care

·         Although there was a time lag between the CQC visit and published report, the Committee was reassured to hear that verbal feedback was given to the Trust immediately following the latest inspection

·         Concern was raised about the number of medical vacancies and the premium paid for Agency cover, however Members learned that the Worcestershire position was not unusual and was in line with other Trusts nationally

·         It was hoped that the progressive link with the University of Worcester would reduce the number of nursing vacancies in the future and although the nursing vacancy rate stood at 10%, this was in line with the rest of the region.  When challenged by Members the Chief Executive responded that whilst some practitioners considered this to be an acceptable rate, she considered this was too high and that Worcestershire should aim for full staffing

·         All present agreed that although Worcestershire was a lovely place to live and work, the uncertainty around the Future of Acute Hospital Services and the Trust being placed in Special Measures had impacted on the situation

·         Active recruitment of clinicians from outside of the UK had proved successful

·         Ambulance waiting times continued to be inconsistent, with a programme in place to try and elevate pressure on A&E.  Patients who arrived by ambulance may be assessed as 'fit to sit' enabling the crew to leave.  Although the facility in Redditch was different to Worcester, improvements had been made. On occasion the Trust would move a patient to a ward in anticipation of another patient being discharged for example.

·         One Member asked about Staff morale and was informed that surveys had taken place and would continue to do so.  It was important to recognise the part that individuals played in the big picture and look for key behaviours across the organisation

·         Members agreed that it was clear that the new Chief Executive had provided some strong steady leadership since her appointment in March 2017

·         In addition, it was noted that the substantive Board was assessing their own effectiveness

·         The Committee was pleased to learn that £29.6m capital funding had been secured from the Department of Health, however, it was unfortunate that it was suggested that this funding would be allocated subject to a further business case.  The Trust, with high level engagement with Stakeholders, was hopeful for a successful outcome and it was planned to have the capital works completed by May 2020

·         The Chairman understood that MPs had written to the Minister and he would attempt to obtain a copy, or to establish the latest position

·         When asked about the Trust's position in relation to Winter Pressures, it was reported that a plan was already in place, including increasing capacity by introducing an extra ward on the Worcester site and working with partners to look at access of the Out of Hours GP Service.  The Trust was also encouraging all appropriate people to have the Flu vaccine

·         When asked whether the Sustainability and Transformation Plan would have any impact on the Improvement Plan, it was suggested that it was too early to say when changes would be considered by the HOSC

·         On a positive note, the Birth Centre was recently recognised as being the UK's best.  

The Chairman of Healthwatch Worcestershire was invited to comment and explained that Healthwatch had exposed some of the challenges the Trust had, making 38 recommendations to the Trust Board.

The HOSC Chairman summed up by stating that there were signs of improvement and the Trust was moving in the right direction under the leadership of the Chief Executive.  It was obvious that the capital funding was vital to move forward and increase capacity across the Trust.