Agenda item

The Chair of Medway NHS Foundation Trust will attend and set out her vision for the Trust.  This will be followed by an update on progress against the CQC action plan by the Acting Chief Executive.

A representative from Monitor will also be in attendance to respond to Members’ questions. 

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.