Discussion:
The Chair of Medway NHS Foundation Trust set
out her vision for the Trust and explained that she had joined the
Trust last year as a non-executive director and Chair of the Audit
Committee prior to being made Chair.
She stated that her aim was to ensure that the
Trust was well lead, clinically lead, offering good quality care
and working well with stakeholders. She
referred to the long journey that the Trust was on and emphasised
that for some time the Trust had been internally focussed, having a
silo mentality. It has also been
reactive rather than proactive with a disconnect between management
and nursing staff and this needed to change.
Numerous agencies had become involved with the
Trust over the past year and she was keen to ensure that the
various action plans drawn up in response were merged into one with
measured improvements set for short and longer term. The initial plan would be for a period of 18
months, this plan should be able to demonstrate clear
improvements. A 3-year plan would then
build sustainability and the 5-year plan should bring
stability. She stated that leadership
training would be put in place and the intention was for the
clinicians to take responsibility for their area of
work. An experienced Emergency
Department clinician had been brought into the Trust from Homerton
Hospital to assist in this process and it was hoped his contract
could be extended. New appointments
would be made on the basis of a year’s contract minimum.
Further recruitment was underway to appoint to
the new management structure following the resignations of the
Chief Nurse and the Director of Strategy and
Governance. The deputy Chief Nurse was
covering the Chief Nurse post at present. It was hoped that a new Chief Operating Officer
would be appointed within the next week and that person would be
responsible for the day to day running of the hospital.
The Chair and Acting Chief Executive of Medway
NHS Foundation Trust explained the following in response to Member
questions:
- One of the key pieces of data being
supplied to the Care Quality Commission on a daily and weekly basis
was evidence relating to there being an assessment of every patient
in A&E within 15 minutes of arrival
- Rather than needing more beds, the
Acting Chief Executive felt that more use could be made of the
cottage hospitals in Minster and Sittingbourne and Barts Hospital
in Rochester for ‘step up’ facilities aswell as
‘step down’, particularly for patients with long term
conditions and the frail elderly, to reduce pressure on the
hospital
- The Chair agreed that the vision of
the key important things for the hospital to concentrate on was
shared by the Board and clinical staff
- The role of the Audit Committee at
the hospital had been around controls and discipline and issues
such as problems with mortality figures
- Although the latest written report
from the Care Quality Commission had not yet been received the
Acting Chief Executive stated that the findings were that the
initial assessment process in A&E was not as it should be. The
clinician from Homerton Hospital had also picked up on this
point. The rapid assessment and triage
system was not working successfully. Changes in A&E would now
mean that each patient would have a formal assessment including
vital signs and pain relief within 15 minutes of arrival
- A senior nurse from Homerton
Hospital had also worked with staff at Medway Maritime Hospital and
this had been very helpful in bringing fresh ideas and more
effective ways of working
- The Acting Chief Executive referred
to some early supportive discharge schemes from hospitals in East
Sussex following hip operations which had been successful by
ensuring that community services were put in place to support the
patient and schemes like this could be helpful for Medway
- The rates of day care surgery at
Medway Maritime Hospital were around 65% compared to 90% at Kings
College Hospital and more would need to be done to ensure this
improved and that patient safety measures were paramount
- Confirmation was given that there is
close working between the hospital and NHS Medway CCG
- It was stated that the hospital
responded well to major emergencies and reference was made to the
successful way that the multiple vehicle road traffic accident last
year on Sheppey bridge had been handled
- The Chair confirmed she was
confident that the new Board at the hospital would bring about the
much needed stability for the hospital and that the model used to
structure the Board was similar to other areas as was the vision
for the Trust
- During debate the Chief Operating
Officer, NHS Medway CCG offered to the representative from Medway
Pensioners Forum an opportunity to participate in a meeting about
the whole system approach to frail elderly patient pathways and
services.
Members thanked the Chair and Acting Chief
Executive and then directed questions to the Regional Director,
Monitor who responded as follows:
- He stated that he had absolute
confidence in the Chair and Acting Chief Executive at Medway NHS
Foundation Trust and in their ability to bring about change but
emphasised that progress would be slow as it was a complex
situation. The problems had been partly
cultural but also practical and he saw it as a huge
challenge. In response to a question
about how best the Committee could scrutinise the hospital he urged
Members to concentrate on general progress rather than pointing out
specific single issues
- Prior to the hospital being placed
in special measures Monitor had been concentrating primarily on the
financial stability of the Trust as they had not been made aware of
any specific quality issues. He pointed
out that it is not the regulator’s role to performance manage
the trust in that way.
- There had been no pressure applied
from Monitor on Medway NHS Foundation Trust in relation to the
proposed merger with Dartford and Gravesham Trust. The merger was a suggestion put forward by the
Trust to resolve the financial problems being experienced.
- He confirmed the measures that
Monitor had taken to replace the management at the Trust at the
point at which it appeared the leadership was failing
- Further to a question about the
external factors that may hinder the Trust’s progress he
stated that the system needed the hospital and would all need to
work together to ensure that the required recovery took place
The Regional Director, Monitor was thanked for
his response to questions.
Decision:
The report was noted.