Agenda item

Discussion:

Members considered a report on the findings of the unannounced Care Quality Commission (CQC) Inspection of the Emergency Department at Medway Maritime Hospital on 26 August 2014. The Inspection report had been published on 26 November 2014.

The Chair of the Medway Foundation Trust outlined the main findings of the CQC inspection in August 2014 and provided an update on progress in improvements being made in response to the CQC’s findings.  The Chair advised that CQC had carried out a further inspection on 9 December. The Trust’s Chief Operating Officer then described in detail the measures that had been put in place in response to the August inspection, which mainly related to the Emergency Department (ED) and included the following:

• Clinical leadership in the Emergency Department had been strengthened and additional consultant capacity had been brought in
• More than 96% of patients were now assessed within 15 minutes of arrival in ED and those who were not had been reviewed to see if they had come to any harm. No-one who had waited longer than 15 minutes had come to harm
• Patient flow through the hospital had been improved, with three new models of care introduced to help with this
• A new frailty unit was expected for early summer 2015 to improve services to the frail elderly. In the meantime a multi disciplinary team (including a geriatrician) would assess all frail elderly patients. A new children’s emergency department was due to open on 22 December
• Note keeping had been improved and regular audits now took place
• A move to an electronic registration system would take place in February 2015
• New chief nurses had been appointed with one focusing on learning and development
• Medical care at weekends had been improved with patients now seen by consultants and specialists
• A new patient administration IT system would give real time information

With the exception of the redevelopment of the ED there were, within reason, no restrictions on funding to implement these improvements.

The Chief Operating Officer then reported on the informal feedback the Trust had received from the CQC following the 9 December inspection. CQC, in informal feedback, had recognised that small improvements had taken place and expressed their confidence in the new management team. They had witnessed evidence of better teamwork between doctors and nursing staff. The CQC had observed that people were not being released quickly enough from theatres and documentation was poor. In conclusion, the CQC still rated the Trust as inadequate but were encouraged to see some improvements.

The Chairman thanked the representatives from the Trust for their honest appraisal of the issues.

The Committee then had a wide ranging discussion and raised a number of questions and issues as summarised below:

The Action Plan in response to the CQC Inspections

Some members expressed frustration that the CQC expected dramatic improvements in such a short period of time. There was also some concern at the numerous action plans produced by the Trust since it had gone into special measures which were never completed. It was not surprising therefore that some staff struggled to know what was expected of them.

A member asked why the action plan contained 100 measures and commented this was too detailed for staff to absorb. In response the Committee were advised that the action plan covered a wide range of issues. Some of the actions were small but nevertheless important. The Chair of the Trust added that the action plan was dynamic and focused on turning the organisation around. The aim was to ensure staff took responsibility for actions relevant to them to help drive the organisation forward.

A member asked if the Trust had any plans to achieve ISO accreditation in order to achieve the systems and structures that were needed. In response members were advised that the Trust did wish to look at ISO accreditation for some of their systems.

Accident and Emergency

There was general frustration from members that the redevelopment of the ED had not yet started, particularly as this could have prevented some of the problems highlighted by the CQC inspections. The Chief Operating Officer for the Trust replied that the business case had been signed off and was with the Department of Health for approval before capital funding could be released to enable the work to start. She acknowledged it would relieve some of the existing pressures and solve some of the environmental problems.

Several members asked why the funding had not yet been approved and whether the Committee could do anything to help progress this. It was agreed that the Committee should make representations to the appropriate body to establish the latest position and why funding had not been released. It was suggested that the portfolio holder for health should be asked to add his support to these representations.

The CCG representatives commented that many people who attended the ED did so as they saw it as a convenience. The Medway on Call Centre (MedOCC) service had been moved to the hospital and non-essential visits to A&E were now redirected there.

Staff Training and Development

The lack of systematic staff training and development was a serious concern for members who asked why this had not been taking place. In response the Chief Operating Officer agreed about the importance of this and replied that the new Director of Workforce would address training and development needs, specifically in A&E. Whilst the Trust could provide a framework for training and support nothing would change without the commitment of staff. Staff would receive training on the new IT systems.

Engagement with Patients and Public

A member expressed surprise at the lack of involvement with patients and the public in the new action plan and asked what engagement was proposed. In response the Chief Operating Officer agreed on the importance of patient and family involvement and had been struck by the absence of this in her brief time in post. She advised that the Trust planned to use national models of engagement and would link with Healthwatch on this. In response to a comment that some staff had been told not to speak to Healthwatch, the Committee were assured that the new Board actively encouraged staff to talk to appropriate bodies about any concerns. The Medway Pensioners Forum representative reported that at recent meetings with staff at the hospital it had been apparent that staff were committed to patient and public engagement. She reported a sense of working together.

Comparative Information and Data

A member asked what plans were in place for the Trust to arrange for independent verification of its data.

In response to a query about comparative information on visits to the Medway hospital and staffing levels, the Chief Operating Officer undertook to provide this information based on nationally set parameters.

The New Trust Board                                    

The Trust representatives commented that the new Board was stable and committed to seeing through the improvements needed.

Flow and Discharge of Patients

The Clinical Commissioning Group were looking for an assurance that everything was being done to support and improve the discharge process, acknowledging that not all issues were within the Trust’s control and all partners had a role to play.

Beds

In response to a question about whether the Trust was able to cope with increased demand over winter, members were advised by the Trust’s Chief Operating Officer that an increase in the number of patients and more severe illnesses was expected over winter and the new models of care referred to would help with this. Additional beds had been opened but an urgent review was needed to see if there was enough capacity. However, the critical issue was not the number of beds but having systems in place to make sure people were moved to a more appropriate environment as quickly as possible and where they were released home that support was available for them. Members also requested further information by way of a briefing note from the Medway CCG on action being taken to address the particular needs of frail elderly people for whom services away from a hospital setting would deliver better outcomes.

Decision:

The Committee:

a)        agreed to write to the appropriate body to ask why funding for the redevelopment of the Emergency Department had not yet been released and seeking urgent action to enable this to happen

b)        agreed to place on record their thanks to the representatives from the Trust for attending and answering members’ questions