Agenda item

The report provides an update on progress Since the Trust last attended the Committee in December 2017. Key areas covered in the report include progress made in relation to the Trust’s Improvement Programme, Better, Best, Brilliant as well as updates on the latest Care Quality Commission (CQC) inspection; work being undertaken to address the Trust’s deficit and information in relation to the workforce and vacancies.

Discussion

The hospital had faced difficulties due to winter pressures, including a snow event. The most significant challenge faced related to the Trust’s finances, with there being an urgent ongoing need to address the budget deficit while maintaining access to services. This would require transformation and new ways of working. A draft report had been received from the Care Quality Commission following the recent inspection but this had not yet been published. The report highlighted the challenges faced by the trust but also acknowledged the work taking place to respond to the challenges.

The Trust had a £62m deficit at the end of 2017/18 and had agreed a control total deficit of £46.7 million for 2018/19 with the regulator, NHS Improvement. This deficit represented the worst performance of any acute trust in terms of deficit as a percentage of turnover. Work was taking place to build more expertise in Medway rather than relying on external people. It was acknowledged that efficiency needed to improve with Medway paying more for medical staff than many other areas due to lower productivity, procurement costs and management of the administration function.

The Better, Best, Brilliant programme is the Trust’s improvement programme. The Better stage had helped to enable the Trust to exit special measures. The Best stage was currently being implemented to enable care to be consistently provided at the required standard. It was noted that the number of emergency department attendances across the NHS in May had been at its highest level ever. Medway had one of the best performances in the country for Delayed Transfers of Care with Medway being used as an exemplar for other areas to improve. Performance for cancer waits had been sustained. However, referral for treatment had deteriorated due to a national pause over the winter period. The figure of 82% was below the 92% target.

The ratio of substantive staff employed by the trust compared to agency staff  had increased, while a significant number of the agency workers only worked at Medway Hospital. The recent change to tier two work visas was welcome as it enabled the Trust to employ overseas graduates more easily.

It was anticipated that the nationally mandated  requirement to see patients in accident and emergency within four hours would be delivered by the end of the year.

The Deputy Medical Director of MFT chaired the Mortality Committee, which met monthly. HSNR, which was the ratio for the number of deaths for various diagnoses against an estimate of the number of deaths expected, had a tendency to increase on occasion, particularly recently. The crude mortality rate, which was the level of deaths compared to the number of patients treated had remained unchanged for two years. It had previously fallen from 8% to 6.5%. Between 20 and 40% of all deaths at the hospital were reviewed by a GP not directly involved in care of patient in order to identify trends and any concerns. It was noted that a number of patients at the end of their life had been admitted to the hospital when they could have been cared for in an alternative setting. There was a need to work on patient flows as a patient spending a night in the emergency department unnecessarily, rather than in a ward, could lead to increased mortality rates.

A Committee Member congratulated the Chief Executive of MFT on having been named as one of the top 50 chief executives within the NHS. She acknowledged the good work taking place and improvements being made and said that achievements should be acknowledged. The Member questioned whether anyone from Medway was contributing to the national discussion on the 10 year funding plan for the NHS and whether it was anticipated that the recently agreed NHS pay rise would be fully funded.  She also asked what additional information the Trust had been asked to provide by the Care Quality Commission and also, how estates management challenges were being dealt with given the significant funding challenge.

The Chief Executive of MFT welcomed the longer term view of NHS funding that had been announced. This included a 10 year funding plan with an initial five year boost. She had attended a roundtable discussion in relation to funding with the Secretary of State for Health, which all chief executives had been invited to. The Plan was due to be published in draft form by November, with Secretary of State having indicated that it would be clinically led. It had been indicated that the NHS pay rise would be fully funded and that MFT would receive its funding directly, which was welcome. 1,000 pieces of information had been provided to the CQC, with the showcase of achievements that had been attached to the Committee report having been the showcase provided  to CQC. There were currently a number of broken lifts at the hospital. A repair and replacement programme would be undertaken but it was expected to take 12 – 15 months for three new lifts to be installed and three years in total for all lifts to be replaced.

A Committee Member asked for some examples to be given of the transformational work being undertaken and whether staff redundancies were being considered. He also asked for an update on the staff survey and engagement with staff. In response, the Chief Executive said that redundancies were not being actively considered but that nothing could be ruled out. The staff profile and medical staff productivity were being carefully considered with there being several areas where staffing levels at Medway were above the levels that would be expected for a hospital of its size.

The Chief Executive was proud of the Trust’s staff Financial Wellbeing programme. An award had been won for work to support staff who were getting into financial difficulty. Staff had the option to work flexibly and be supported to retire early if they wished to do so. This was entirely voluntary. The total number of staff would need to reduce over time. The Trust had not had a tendency to outsource services previously. This could be considered but consideration would first be given as to whether the hospital could provide the service as efficiently as an external contractor would be able to. The  engagement rate in the latest staff survey had been lower than in the previous year. Work had been undertaken to understand areas where staff felt less engaged. It was requested that staff survey results be presented to the Committee and for data from the previous year to be included to enable comparisons to be made. 

In response to a Member question about the work undertaken to reduce Delayed Transfers of Care when patients were discharged from hospital, the Committee was informed that significant work had been undertaken with partners, including the CCG and Medway Council to find appropriate places for patients with complex care needs to be discharged to. This work had helped to support improvements in emergency department performance, which had improved 10% compared to 12 months ago.

Decision

The Committee:

i)     Commented on the progress report produced by Medway NHS Foundation Trust and agreed that a further update be provided to a future meeting of the Committee.

ii)    Requested that the next update to the Committee include:

a.    Details of the work of the Transformation Board.

b.    Staff survey results from the latest survey and data from the previous year to be included to enable comparisons to be made.