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.