Agenda item

This report informs the Committee of progress made since the Chief Executive and the Chairman of the Trust attended the June 2016 meeting of the Committee. The report focuses on the improvement plan put in place following the Care Quality Commission’s (CQC) January 2016 inspection report on the Trust and the progress made to date. The Trust currently remains in special measures, with a further inspection due to take place on 29/30 November. The report also responds to a number of specific questions raised by the Committee at the June meeting.

Discussion

The Chairman advised the Committee that a further inspection of Medway NHS Foundation Trust (MFT) was due to take place, starting on 29 November. Ahead of this inspection, a summary of the scrutiny that the Committee had undertaken of MFT during the previous year had been submitted to the Care Quality Commission (CQC). This submission had been included as part of the work programme item on the agenda.

It had been announced that Shena Winning had stepped down from her position as the Chairman of the Trust. She had been replaced by Dr Peter Carter OBE, who had assumed the role of Interim Chairman.

Committee Members requested that Sheena Winning's service be officially recognised by the committee as she had stepped up to her role at a very difficult time and provided support for the CEO while Lesley Dwyer settled into the role.

The Chief Executive of MFT, The Director of Finance and the Lead Matron for Discharge at Medway Maritime Hospital, introduced the report. The report updated the Committee on progress made on the Trust’s improvement journey since its Chief Executive and then Chairman had attended the Committee in June 2016.

Further progress had been made on implementation of the new Medical Model, which had been introduced in March 2016. It was acknowledged that previous attempts to improve quality had not always had the desired impact. However, significant improvements had now been realised and MFT was confident that this would be satisfactory to enable the Trust to come out of special measures, which it had been operating under for the previous three and a half years. It was anticipated that the Trust would receive a ‘Requires Improvement’ rating in the forthcoming inspection. The Trust considered that some of its services, including neo-natal and children’s services, were already good. The Chief Executive had confidence in both the management and clinical leadership of the Trust to continue the improvement journey.

The Chief Executive considered that Medway Martime Hospital was now safer than it had ever been. Mortality rates, which had been one of the highest in the country in January 2014, were now in line with national averages with key lessons having been learned from previous patient deaths. A ‘call of safety’ had helped to ensure the safety of services and that staff were supported to carry out work. The hospital had previously had to resort to providing care to patients in hospital corridors. This was no longer happening. Waiting times for cancer patients were also being normalised. Other positive changes made had included ensuring that complaint logs were reviewed systemically to identify lessons to be learned, increasing engagement with the community, making the hospital cleaner and the introduction of a smoke free policy across the whole hospital site. Patient satisfaction had improved with 85.2% of patients now recommending the hospital.

Within the Emergency Department, the Medical Model was helping to reduce waiting times. 82% of patients were seen and treated within four hours, compared to 73% in March 2016. The ambition was for this figure to improve to over 90%. Nurse vacancy rates had improved significantly, from 65% in November 2015 to 23% in September 2016. These had since reduced to 17%. The hospital was now the best performing in the region with regard to ambulance handover. There had also been a 40% reduction in the number of people medically fit for discharge who remained in hospital. Significant work was being undertaken with partners in this area. MFT was, however, very concerned about the impact that winter could have on service provision and whether these could be managed effectively.

The CQC and feedback from staff surveys had identified the existence of a bullying culture, which the Trust was determined to address. Six ‘Speak Up Safety’ champions had been appointed to enable staff to share concerns. Other methods of staff engagement had also been adopted.

MFT had ended 2015/16 with a budget deficit of approximately £52 million, which was equivalent to 20% of turnover. The reasons behind the debt were now fully understood. Service provision in its current form was not affordable. The relatively high cost of agency staff contributed to financial difficulties as there was a premium of 35% on agency compared to non-agency staff.

There was a determination for MFT to stabilise its financial position with the hospital’s recovery plan focusing on delivering greater efficiency and cost reduction, while not compromising on patient safety and quality. Savings of £12.6 million were planned for the 2016/17 financial year.

The Committee raised a number of points and questions as follows:

Vacancies: In response to a Member questionabout the actions taken to improve staff recruitment and retention, the Chief Executive of MFTadvised that work was being undertaken to retain staff and that this was viewed as being particularly important. It was noted that some staff who had previously left the hospital had been re-employed and that, as advised previously, nurse vacancy rates in the emergency department were now under a quarter. The hospital worked with staff to support them and to provide development opportunities with the aim of increasing retention.

Staff nationality: The report provided by MFT gave figures in relation to the nationality of staff. This was in response to a question that had been asked at the June 2016 meeting. A Member stated their disappointment that the nationality of staff had been raised as she did not consider it to be relevant.

Progress to date: A Member said that it was evident that significant progress had been made to date and they hoped that the CQC would recognise the improvements made in difficult circumstances. However, there was still more work to be done by the hospital and in the wider public health arena.

Discharge of patients: It was questioned whether there was pressure for patients to be discharged when this may not be in their best interests. The MFT representatives said that suitability for discharge was assessed on a case-by-case basis. Engagement with patients and their families in relation to discharge was not always as effective as it could be. The discharge of frailer patients was a particular challenge and the need to discharge persons who were medically ready was heightened by the risk of complications, such as muscle wastage, infections or falls occurring if they remained in hospital. The Home First project that had been discussed earlier in the meeting would help to reduce discharge delays. The Interim Director of Children and Adult Services advised that figures for Delayed Transfers of Care (DToC) of more than ten days were improving, although it was recognised that there was still more for Adult Social Care and other partners to do. Six aspects of improvements made in Medway had been highlighted in the Department for Health / NHS England publication, Quick Guide: Discharge to Access.

Trust Finances: A Member noted that the Trust had performed £1million better when compared to the planned deficit of £44.5 million during the current financial year. The Chief Executive of MFT said that an obvious conclusion for the CQC inspectors was that the Trust should be in special financial measures due to its budget deficit. However, it was hoped that the transparency and measures being put in place to reduce and manage the deficit would help to avoid this.

The Committee thanked the MFT representatives for the update provided and congratulated them on the progress made so far, while recognising that there was more work to be undertaken.

Decision

The Committee noted the report and commented on the progress made by Medway NHS Foundation Trust.