Agenda item

This report informs the Committee of progress made since the Chief Executive and the Chairman of the Trust attended the March 2016 meeting of the Committee.

Discussion:

The Chief Executive of Medway NHS Foundation Trust introduced this report which informed Members of progress made since the report considered at the last meeting of the Committee held on 17 March (minute no. 874).

Members raised a number of questions and comments as follows:

·         Medical Model – in response to a comment that the reduction in the average length of stay on acute wards may not be a positive development as some people discharged themselves voluntarily, the Chief Executive advised that the figures did not include this group. However, the fact that some people voluntarily discharged themselves probably showed a breakdown in communications.  A Member asked for more information on how the Trust had achieved this reduction. The Chief Executive commented that this Model was a contemporary way of providing care and was based on an established model elsewhere. She undertook to provide more detail in writing about how the Model worked.

·         Home First – in response to a comment that there was a lack of confidence in community services being available to provide care to people when they needed it and that it had been a case of a redistribution of funds rather than an injection of funds into community services, the Chief Executive commented on the positive feedback she had received regarding this service. There was a need for the whole system to work together and provide support on a 24 hour basis as happened in acute services and a need to provide Home First at scale.

In response to a comment made about a negative experience of a , whose individual needs had not been met, the Chief Executive undertook to discuss this case with the Member outside the meeting but commented it appeared the circumstances, as described, suggested the constituent had not been cared for under Home First. 

·         Staffing – a Member asked how many nurses had left the Trust due to inadequate performance. The Chief Executive was unable to give figures but emphasised that staff were managed through a performance management framework. In terms of recruitment, she responded that the Trust was now attracting more interest when vacancies were advertised but would like to see more experienced nurses applying as opposed to people wishing to become a nurse. She was pleased to report that more staff were now remaining in employment each month than were leaving.

·         Emergency Department – a Member asked about the roadway improvements and access to the hospital from Windmill Road. The Chief Executive responded that this was part of the improvements to the department and the Trust would be working with the Council to address what was a bottle neck.

·         Next phase of the Recovery Programme -A Member commented she had been impressed on a recent tour of the hospital by the new facilities and it was clear that visible progress had been made. Other Members congratulated the Trust on the progress made whilst recognising that further improvements were still needed. A Member asked how confident the Chief Executive and Chairman were that the Trust would come out of special measures this year. The Chairman of the Trust commented that the Trust had no choice but to get out of special measures. They were the last Trust to be in special measures for more than three years and the other two that had been in that postilion were no longer stand alone trusts. The Chairman of the Trust commented that the Board was confident the recovery was becoming embedded but there was a need to quicken the pace of progress and no longer be subject to special measures by the end of the calendar year.

·         Finance – in response to a question about the implications of the £52.5m 2015/16 year end deficit and plans to address this, the Chief Executive explained that the background to this had been an over reliance on agency staff, who were more expensive than permanent staff. The Trust hoped to agree a budget deficit for 2016/17 of around £45m and savings of £40m were planned over the next three years. The plans to address the deficit were part of what was a single recovery programme. There was a need to improve the quality of care and make efficiencies and reduce the over reliance on acute care where it did not add value.

The Chief Executive commented, following a question from a Member, that the amount spent on compensatory payments when mistakes had occurred was not significant in proportion to the deficit.

The point was also made by a Member that the Trust was not alone in operating at a deficit.

·         Going smoke-free – there was widespread support from Members for this policy. The Chief Executive commented that this had been well supported by the Council and Public Health. Patients and staff would need to be supported in the run up to becoming completely smoke free in October 2016. Some Members had concerns about the impact of the ban on nearby residents and streets but were confident this was being addressed and asked that local councillors be kept informed. Regarding queries about enforcement, the Chief Executive acknowledged that more surveillance would be needed in the initial period. The Trust was working with the Council on providing support in nearby streets. A Member queried if e-cigarettes were included in the ban and, if so, whether this conflicted at all with the position of the Council’s Public Health team on this matter. The Chief Executive confirmed e-cigarettes were included. The Interim Director of Public Health advised that he fully supported the policy and commented that whilst e-cigarettes were less harmful they should not be used in an environment where people were being encouraged not to smoke, given that they could normalise smoking.

·         Other issues

The Chief Executive confirmed that no analysis had been carried out into the implications for the NHS in Medway if the decision in the EU referendum was to leave the EU.

As to whether the hospital’s reputation was deserved, the Chief Executive acknowledged they had lost the confidence of the community and some staff although she felt the reputation at times was not fully deserved. This had an obvious impact on staff morale and the Trust were keen to showcase excellence.

Reference was made to a review of lifestyle services such as Wi-Fi and TV for patients. The Chief Executive referred to contractual issues which prevented her from giving an update but undertook to look into when she could report back to Members on this review.

A Member queried the use of private hospitals and whether patients were being directed there to relieve pressures in the NHS. The Chief Executive and the Accountable Officer for the CCG clarified that all patients had the right to decide where their care was provided. If there were long waiting times then a GP may suggests private treatment, but it would be for the patient to decide. However, the vast majority chose the NHS. The Trust successfully contracted out a number of medical services.

The Chief Executive undertook to provide details of the percentage of staff who were EU (non British) nationals.

A Member asked if food menus at the hospital could detail calorific values.

Decision:

The Committee noted the progress report from the Trust.