Agenda item

The report provides an update on the Improvement Plan developed by MFT in response to the findings of the Care Quality Commission (CQC) inspection of the Trust undertaken in November/December 2016. The report also provides updates on patient flows, Emergency Department and winter resilience, the workforce and Trust finances.

Discussion

The Chief Executive of Medway NHS Foundation Trust (MFT) introduced the update. The Chair of MFT was also in attendance. A presentation was given to the Committee, the key points of which were as follows:

·         Good progress had been made on the “Better, Best, Brilliant” improvement programme with delivery having reached the “Best” stage.

·         Four strategic objectives underpinned “Better, Best, Brilliant” -  integrated healthcare, innovation, people and financial stability.

·         The Trust had been previously been in the bottom 10 of trusts for times for seeing, treating and admitting or discharging patients within 4 hours. Performance was now around 46^th best of 138 acute trusts.

·         Improvements made had meant that patients were no longer cared for in corridors and this would not happen again in the future.

·         Figures for Delayed Transfers of Care had improved significantly and currently stood at 0. MFT was the only Trust that had been able to achieve this.

·         Performance for cancer wait times remained below target.

·         It was considered that the hospital was well prepared for winter pressures. The escalation ward was currently closed for refurbishment but it was hoped that capacity elsewhere would be sufficient to prevent it being used. Additional space in the Medical Assessment Unit was due to open before Christmas following the award of £1 million of funding.

·         The uptake of flu vaccine for this year was currently 63% compared to a final figure of 76% for the previous year. This was despite a donation being made to UNICEF for each uptake. It was acknowledged that the flu vaccine campaign would need to start earlier in the year in future in order to improve uptake.

·         £40.5 million had been spent on agency staff in the previous year, which was considered to be unsustainable. This figure had been reduced to £10 million due to successful recruitment of non-agency medical staff.

·         MFT was one of the few trusts to employ nearly 100% midwifery substantive staff against the backdrop of a national shortage. Two geriatrician appointments had been made recently.

·         The financial situation remained challenging but spending was forecast to be on plan by the end of the financial year.

·         Work was taking place with Medway NHS Clinical Commissioning Group to undertake system level transformation. The next year would be financially challenging with there being a savings target of 4%. Savings would be realised through transformation with there being continued investment in frontline services. 30 projects were currently taking place in order to identify efficiencies.

·         Staff were being kept informed of developments with efforts being made to ensure that they received information before external parties. An all day staff engagement event was planned for 26 January.

·         In relation to the Kent and Medway Specialist Vascular Services Review, it was likely that the arterial site would be located in east Kent with Medway hosting a non-arterial site. Change was needed as current provision did not meet national guidance and there was not sufficient workforce available to operate multiple sites.

·         The Kent and Medway Hyper Acute and Acute Stroke Services Review was due to commence public consultation in the New Year. It was hoped that Medway would be one of one of the sites chosen to host a hyper-acute stroke unit.

·         A Clinical Strategy was being developed for Medway, North and West Kent. This placed an emphasis on providing the best care for patients, with reduced reliance on acute hospitals.

·         The hospital had now been smoke free for over a year. Some enforcement challenges remained. A community engagement event was being planned and tougher action would be taken against staff who smoked on site or whilst in uniform.

·         Following the commissioning of a fire safety report in 2016, an action plan was being implemented. The number of fire wardens had increased to around 500 with all staff being trained to this level in the future. Full Implementation of the plan had originally been due to take five years but this was being expedited following the Grenfell tragedy.  

Members of the Committee asked a number of questions as follows:

Theatre starting times, pubic health engagement, workforce and flu vaccine – A Committee Member asked how the percentage of the time that theatre had started on time had increased from 20% to 80%. They also asked how the hospital was working with public health to improve the general health of the population, what the impact of re-profiling of the workforce had been on staff salaries and recruitment and why there had been a fall in flu jab uptake. In response, the Chief Executive of MFT said that the improvements to theatre starting on time had been realised through each theatre team having  a safety briefing and by improving communication between all parties. 

The hospital supported the Council’s Public Health team in their preventative work. One example of this was encouraging people to stop smoking. It was acknowledged that further work was required in relation to obesity and in supporting people to stay at home, where possible, and for this group to be as well as possible. It was confirmed that the re-profiling of the workforce did not involve reductions in salaries. New job roles were being introduced with the role of some existing occupations being extended. The role of volunteers was also being considered.

Staff were encouraged to have the flu jab to protect both themselves and patients. It was hoped that in the future, having the vaccine would be a requirement for new staff.

Cancer wait times – Some cancer targets were being met. Patient choice and patients being unavailable had some impact on meeting target timescales. Some additional funding would be available to increase capacity.

Accommodation for international nurses and smoke free status – A Committee Member asked whether there was enough accommodation for nurses recruited from overseas and also questioned what engagement there had been with local residents in relation to staff smoking in the vicinity of the hospital site. The Chief Executive said that there was sufficient accommodation available for overseas nurses. There had not been a drop in the number of nurses recruited from overseas or in the number of European nurses returning home since Brexit. The hospital had appointed a number of smoking champions to support the smoke free status of the hospital site. Further engagement with residents was planned.

Emergency Department Issues – In response to a Member who asked what the issues were that had hampered the development of the Emergency Department, when they would be resolved, whether the mental health of patients was a factor and why stroke appeared to be being prioritised rather than other areas, the Chief Executive said that there had been difficulties associated with the ED building and that there would not be additional capacity available until the third week of January. There had been an 18% increase in presentations to the Emergency department since 2015 and patients were presenting with increasingly complex needs. The number of patients with significant mental health needs was relatively small at around 4 to 6 per cases per week. It was acknowledged that the Emergency Department was not the right environment for this group to remain in for long periods of time. There were plans to create a separate space for people with significant mental health needs. There was a 24/7 liaison psychiatry service at the hospital. Patients with an emergency should attend A&E in the first instance and would be directed to the appropriate service.

With regards to stroke care, current provision did not meet national standards, therefore change was needed. There was a high demand for stroke services in Medway, in part due to the health of the local population. Figures for risk factors, including smoking and obesity were above the national average. The Director of Public Health said that for smoking there was a 19% prevalence in Medway compared to a national average of 15.5%. 65% of the local population was overweight or obese. It was estimated that there were 27,000 people with undiagnosed hypertension in Medway, while between 2014 and 16,  520 Medway residents under 75 had died from a cardiovascular incident.

Arterial site in East Kent – In relation to a question about the provision of an arterial site in East Kent and how it would affect Medway residents, the Chief Executive advised that a hub and spoke model would be used. It was necessary for the specialist provision to be provided at a single site to ensure quality, with specialists needing to perform a minimum number of procedures to maintain accreditation. A 24 hour emergency service would be provided in Medway. It was likely that the major arterial site would be at the William Harvey Hospital in Ashford.

It was noted that final decisions in relation to both vascular and stroke services were subject to public consultation and engagement and that no final decisions had yet been made.

Patients who smoke – Patients who normally smoke could be prescribed nicotine replacement products for their time in hospital. New patients were informed about the hospital smoke free policy. Some patients took themselves outside the hospital to smoke but hospital staff were not allowed to accompany them. E-cigarettes were not encouraged by the hospital but it was acknowledged that there was some evidence that they could help people to quit smoking.

Decision

The Committee noted and commented on the progress report provided by MFT and agreed that a further update should be brought to the Committee in June 2018.