Agendas, Meetings and Minutes - Agenda item

Agenda item

Quality of Acute Hospital Services - Update

Minutes:

The Chairman welcomed Matthew Hopkins, Chief Executive and Richard Haynes, Director of Communications and Engagement, representatives from Worcestershire Acute Hospitals NHS Trust (the Trust).

 

The Committee received the Trust’s latest Care Quality Commission (CQC) report, following inspections in May and June 2019. The Chief Executive explained that the report contained details of a range of quality and safety improvements which had led the CQC to lift the Trust’s overall rating to ‘requires improvement’ from its previous rating of ‘inadequate’. He also highlighted that the Chief Inspector of Hospitals had recommended that the Trust should be removed from special measures, but he stressed that with some of the ongoing challenges identified, this would only take place when a system-wide support package involving local and regional partners had been agreed. The Committee was advised that a meeting of partners was due to take place the following week to agree a support package, to then put forward to NHS England on 12 November.

 

The Chief Executive explained the details of the inspection process which had commenced in February and had involved 408 data requests being responded to; 40 inspectors carrying out core service inspections, and re-inspections in May/June; 35 well-led review interviews followed later in June with a wide range of personnel and then the draft report being received in August for a detailed accuracy check. In terms of the Core service inspections, the Committee was informed that Maternity, End of life and Critical Care had not been included in this inspection, as the ratings for these areas were not of concern.

 

Turning to the details of the report, the Chief Executive gave a presentation of the key findings incorporating the following:

 

·         Improvements had been made across 41 of the 79 domains rated across 6 core services, with 9 of these going up 2 ratings. Previous ratings had been maintained in 35 other domains.

·         Surgery and outpatients had been lifted up two ratings in ‘well-led’.

·         Every single service across all hospitals received at least a ‘good’ rating for ‘caring’.

·         Key findings showed that there had been some significant improvements in:

- outpatient services and diagnostic imaging at the Alexandra hospital, with the latter now rated as ‘outstanding’;

- services for children and young people at Worcestershire Royal Hospital 

- the overall hospital rating for Kidderminster.

·         Other areas for further improvement were highlighted including medicines management, infection control and staff engagement. The Chief Executive was pleased that the CQC had noticed a significant improvement in terms of a culture of openness with staff who now felt much more engaged and able to speak out and be listened to.

·         The CQC had recognised the improvements that were taking place with regards to leadership. The development programme had resulted in Managers feeling well supported, and with a renewed sense of purpose.

·         A site by site comparison between 2017 and 2019 was shown to the Committee and Members were pleased to see that there was an overall improving picture. It was agreed that the colour versions of this data would be circulated to members. In respect of the reduced rating for Evesham hospital from a previous position of ‘good’, the Chief Executive explained that the Inspectors had viewed an issue regarding compliance with a policy, which had since been resolved, but which had directly led to the reduction in the rating.

·         The Chief Executive reported that staff had been pleased with the CQC report’s findings and particularly for the external recognition of their ongoing hard work and efforts to improve the performance of the Trust.

  • In terms of areas for improvement, 4 Requirement Notices had been received covering 38 ‘Must do’s’.  These related to managing patient flow more effectively; the need to embed quality improvement work in patient care and treatment; consolidation and improvement of financial management and ensuring full compliance with mandatory and safeguarding training.
  • The Chief Executive advised that they had already provided a response to the CQC report. Overall, he felt that great progress had been made, although there was still much more to do. In terms of the next steps, the Trust would be developing a detailed action plan using a regulated activity improvement tool (RAIT). Work on quality initiatives and key service initiatives such as Home First Worcestershire, which involved working with partners, would be crucial going forward. Alongside this, financial recovery and workforce transformation plans, development of the Clinical Services Strategy and support for the STP were all highlighted as key actions to take forward.

 

Members asked a range of questions about the detail of the report’s findings and related issues:

 

·         In terms of stroke provision, it was asked whether patients receiving a scan within one hour was feasible given the availability of radiographers out of hours? It was confirmed that all stroke patients were reviewed quickly by a clinician, and although potentially CT radiographers were available out of hours, the target of a scan within the hour, was not always achievable.

·         With reference to the length of time patients spent waiting in ambulances outside the Worcestershire Royal before being transferred, the Committee was advised that the target was a maximum of 15 minutes wait. There had recently been an increase in the demand for ambulances and the Trust was working with other agencies to ensure that only patients requiring emergency care were brought in by ambulance. With the West Midlands ambulance service regaining the 111 service from 5 November, and their clinical staff to be answering the initial telephone calls, it was anticipated that by the start of the New Year, improvements would start to be very noticeable. It was noted that a member of the National Ambulance Team was currently helping to review current practices to improve the flow. In addition, work was being done to ensure clear pathways were in place so that paramedics on the ambulances could be confident in the system and the process of transition would be speeded up.

·         The lengthy delay between a patient being discharged and being allowed to leave the hospital was raised. The Committee was informed that this process was being reviewed to see how the process could be speeded up. It was also felt that communication about the length of discharge was key so that patients understood the likely timescales involved and the reason for the wait.

  • A Member queried what the anticipated timeframe was for the improvement work. The Chief Executive explained that there were many examples of issues which would increase the efficiency of the service, for instance electronic prescriptions would free up staff time; a half day reduction in hospital stays would help with patient flow and efficiency levels and an increase in the recruitment and retention of permanent staff would save money and add to productivity.
  • In response to a query, the Committee were informed that there had been an overall reduction in the vacancy rate from 13% to 9% so there was now less reliance on temporary doctors and nurses. A key focus for this year had been the recruitment and retention of nurses. The Trust had been working hard to try to encourage current nursing staff to remain in post, whilst also seeking to increase recruitment at home and overseas. They had recently been successful in recruiting qualified nurses from India, which had significantly contributed to the vacancy rate for nurses being halved within 6 months. Upon arrival the nurses completed a 6-8 week orientation to the NHS working in the wards as healthcare assistants, following which they would be ready to carry out their allocated role.
  • In response to a question, the Chief Executive explained that they were very much aware that when considering pathways of care, they needed to look at geographical areas and how organisations worked together in those areas. The NHS long term plan would see much greater integration of services and patients benefitting from seamless care. He was currently  meeting regularly with other agencies and these occasions were used to challenge each other and work together in the best interests of health care locally.  Quality of care was crucial, and his key focus was on ensuring that the Trust was providing this.  He felt it was valuable to gain an external view of the service and saw the CQC report’s findings as an opportunity to help the Trust improve.
  • The impact of ‘health tourism’ was raised. The Committee was informed that due to the geographical location of Worcestershire, this was not a major issue locally. The Chief Executive explained that when the situation arose, Department of Health guidelines were followed to pursue the recovery of monies.
  • In response to a query, the Chief Executive commented that staff had been placed under tremendous pressure in recent years and that a ‘good’ rating was a realistic ambition at this point. He stressed that with continued momentum and hard work, there was no reason why the top goal couldn’t be reached in time.
  • Fundraising by the voluntary sector for a specific piece of equipment was highlighted as an area of concern, in situations where the hospital later advised that the equipment wasn’t able to be used. The Committee was advised that it was vital that a proper procedure was followed which approved the need for any specific new equipment, in advance of any fundraising initiatives, hence avoiding this type of situation arising.
  • The issue of lengthy waiting times in the accident and emergency department was highlighted. The Committee was informed that the Trust was currently working on reducing waiting times. It was highlighted that residents also needed to be made aware of the alternative options for treatment.  If they were able to travel to a Minor Injuries Unit, for instance, the same treatment may be available, yet the wait may be much shorter.
  • A query was raised regarding plans to cope with Winter pressures. The Chief Executive explained that interestingly Summer was no longer a quiet period with July this year having the highest ever figures for attendances. The Committee was informed of plans to cope with extra pressure which included extra capacity in A&E and the opening of a further ward in the Aconbury building in 2 weeks-time. The overall increase in capacity would be over 100 new beds at the Worcestershire Royal site.
  • A Member asked what would happen if the Trust did not come out of Special Measures as recommended by the CQC.  The Chief Executive advised that it was unusual, but not unheard of, for NHS England to disagree with the CQC recommendation. If that were to happen, however, the Trust would continue on the path it was currently taking, focusing on the 3 key priorities and accelerating progress wherever possible. They would continue to work together with the other local agencies and the NHS Regional team which had been very supportive.
  • In terms of the meeting the following week with partner agencies, the Committee was informed that the key areas of focus would be on discharge planning and Home First. It was highlighted that much more was now able to be done in the Community teams and staff needed to be aware of the capabilities in all areas, so that they could work more closely together for the benefit of patients and the health service as a whole.
  • The sharing of good practice was raised, as to whether there was provision for this to be being carried out across all the sites. It was confirmed that leadership teams were currently carrying out performance reviews to look at the consistency of service across the different sites. The Director of Communications and Engagement also referred to the Respect programme which had a clear plan to bring all parts of the health and care system together.

 

 

Supporting documents: