Agenda item

Attending for this Item from Worcestershire Acute Hospitals NHS Trust were:

Matthew Hopkins, Chief Executive

Sarah Smith, Director of Strategy, Planning and Improvement

Richard Haynes, Director of Communications and Engagement

The Clinical Services Strategy to 2025 had been approved by the Trust’s Board in October 2019 and provided a strategy to enable clinical sustainability and financial viability.

Members noted that the hospital reconfiguration had not yet been completed and the final business case for the capital investment was yet to be submitted.  However, some of the planned changes, such as the changes to maternity services and paediatric services, were now much more sustainable.  

The shortage of available beds was being addressed.  In 2018 work undertaken in the health service had identified a shortage of 109 beds.  By the end of February 2020, 89 new beds would be in the system.

There had been significant changes to Leadership and Management and Consultants had become disengaged over time.  Stability at Board level had already resulted in positive changes to workforce engagement and Staff were increasingly able to see how their future needs would be met.

A presentation had been provided as part of the Agenda pack which highlighted priority areas.  There were three areas of activity in the Strategy which would shape the future:

-       End to end integrated care

-       Comprehensive and responsive urgent care and emergency care

-       High quality, dependable acute and specialist planned care.

Further detail was provided in relation to each of the three areas of activity, which included plans for such as those in relation to end of life care, care for people living with frailty and across workstreams such as maternity systems.

It was reported that the Strategy was designed to provide sustainability and aimed to work in partnership with the whole health and social care system, especially recognising this was important to build a resilient workforce.

The Acute Trust Board had recently approved a move to digital care records, which clinicians were quite excited about and this would assist achieving the vision for a fully integrated care system.

In the ensuing discussion, the following key points were made:

·         Local media articles had suggested that doctors were spending time out of Community Hospitals and helping in the Acute Hospitals.  In response, it was reported that this was not reflective of the situation

·         Keeping frail older people out of an acute setting was a priority and there were a number of pathways to support this and it was an area of focus in the Trust’s annual plan for 2020/21

·         It was noted that End of Life care was excellent, but more could be done to help individuals and families plan for the future by joining up work on the RESPECT initiative

·         The Committee was encouraged with the number of beds being introduced into the system

·         The Committee agreed that clear communication to residents was vital, especially in relation to the Alexandra Hospital and their acceptance of children’s cases.  It was noted that as a matter of course Ambulances conveyed children to the Worcestershire Royal.  The Committee recommended that residents around the Redditch area needed to be constantly reminded of their best options when in need of urgent care for children

·         Members also recommended that the Trust communicated the reasons why a patient may need A&E over other facilities such as Minor Injury Units, a GP or another healthcare professional

·         In addition, residents needed clarity on the role of Community Hospitals, a resource which was very well respected by the public 

·         It was noted that the appropriate access to health services was a national conversation, but the lack of consistency across sites would suggest that as Emergency Departments were always open, residents chose that route for certainty

·         Since West Midlands Ambulance Services had taken over the NHS 111 service in November 2019, the Trust commented that the number of inappropriate cases conveyed to A&E from 111 calls had decreased, from 13% prior to November 2019 to 10%, with the national average being 7-8%

·         Members learned that by using the previously reported Capital investment, patients were no longer being cared for in inappropriate places, such as the endoscopy unit, and that those places were being used as originally intended

·         The Trust believed that it was important to complete the Capital work programme as initially planned, not just the link bridge which had already been delivered. The proposals included updates to maternity services, paediatric services, general and acute bed capacity and car parking at the Worcestershire Royal Hospital.  The Alexandra Hospital proposals included elective care, endoscopy, paediatric ambulatory care and theatres

·         There had been a 60% increase in care packages funded by Worcestershire County Council as part of work to enable patients to be discharged to home more quickly.  The multi-disciplinary Onward Care Team was being launched in early February to support improvement in discharge rates

·         The Cabinet Member with Responsibility for Health and Well-being reported that County Council Officers had recently spent a huge amount of time and effort to ensure 10 beds were available ready for discharge, to be informed after 16 hours that only 3 were to be used.  The Cabinet Member believed this was totally unacceptable, a point with which the Committee agreed.  The Chief Executive acknowledged that it was an unfortunate and difficult situation but reiterated the improvement in overall performance highlighted by the CQC at its inspection in 2019 and the Trust’s continued focus on improvement.  He also reported that timely discharge was not always in the gift of the Trust as family and patient views had to be considered.  He gave as an example where discharge arrangements had been refused by families because of transport issues

·         In response to a question about the current Care Quality Commission rating of the Trust, the Chief Executive clarified the situation, by reporting that following the inspections in May and June 2019, the CQC recognised the steps the Trust had taken and moved the Trust from Inadequate to Requires Improvement from the September 2019 published report

·         In relation to removing special measures, the CQC had also recommended that the Trust work towards this, but only if a system wide improvement support package was signed off by all health economy partners

·         The Chief Executive outlined the way in which the Trust was working with Clinicians and all Staff on engaging with them and moving forward in a strategic way.  The Committee recognised the difficulty in doing so with over 42 separate clinical teams

·         The current vacancy rate was less than 10%.  Locum staff was an expensive option, but it was hoped that this rate would be reduced further.  The Committee acknowledged that there was a national shortage in some clinical areas

·         Finance pressures continued although the Trust was on target to deliver the planned deficit.  A new Finance Director had been appointed but the Trust was seriously financially constrained.  The Chief Executive reported for example that digital care improvements had to be funded from revenue rather than capital funding

The Chairman of Healthwatch Worcestershire was invited to contribute to the discussion and made the following comments:

·         The Chief Executive and the Board were praised for their openness and clear understanding of the current situation, however, Healthwatch supported the Committee’s view that positive action was required quickly

·         There was a constant requirement to keep the public informed and engagement was vital.  In addition, system partners needed to be supportive of the Trust in their efforts to improve

·         The Government’s upcoming Budget would be of interest to Worcestershire’s leaders, who had a role in lobbying decision makers

·         Healthwatch had noted that there was no mention of Community Hospitals in the Clinical Strategy.

The HOSC Chairman thanked those present for the discussion and asked that Members be updated on progress with implementation of the Clinical Strategy, which had been approved by the Trust Board in October 2019.