Agenda item

The report provides an update on progress since the Trust last attended the Committee in June 2018.

Discussion

Medway Maritime Hospital had received a rating of requires improvement in its most recent Care Quality Commission (CQC) inspection, the same rating as in the previous year. The report highlighted the improvement journey of the hospital with progress having slowed during the previous winter. The most recent inspection had not inspected any areas that had previously been rated as good. A Well Led inspection and use of resources assessment had also been undertaken by the CQC with the rating for Well Led having reduced to requires improvement. The safety of services had been maintained and improvements made previously sustained.

It was anticipated that performance would improve sufficiently in the next year to enable the hospital to achieve a good rating. The last inspection had identified 12 must do actions for the hospital to take with there also being 28 should do actions. These were being progressed. The CQC was due to inspect End of Life Care, with the Trust looking forward to being able to demonstrate the significant improvements made. The improvements being made by the hospital were being guided by its transformation plan, ‘Better, Best, Brilliant.’ One target for the current year was to reduce the average length of patient hospital stays by two days.

The hospital had established an Acute Frailty Unit which enabled frail, elderly patients to be cared for in the best environment possible, with the required medical expertise available. 80% of this group were being discharged to an appropriate setting for that person within 48 hours of the patient having been identified as being ready for discharge. Work was also taking place to meet the target of seeing Emergency Department patients within four hours of admission. In relation to ambulance handovers, the Trust now had the best performance of any of the acute trusts across Kent, Surrey, Sussex and Medway.

MFT aimed to position itself in the Kent and Medway healthcare system as a specialist emergency centre. It was acknowledged that acute hospitals were not always the best environment for the provision of extended health services. In relation to dermatology services, MFT had provided notice to the CCG that the service was considered to be fragile and could not meet the demand for referrals. There was currently a national staff shortage in dermatology. Work would continue with Medway CCG until the end of March 2019 to investigate how the identified issues could be resolved. There was also a need for the hospital to look at how it could continue to deliver stroke services as the recommended option was developed for the provision of hyper acute units at three hospital sites in Kent and Medway, the preferred option for which did not include Medway. In relation to vascular services, a need had been identified for the establishment of a single arterial centre in Kent. There was now a proposal for interim provision at the Kent and Canterbury Hospital in Canterbury. This was disappointing as MFT considered that it could have hosted the service, particularly in view of the fact that the Kent and Canterbury Hospital did have full acute healthcare provision. The Committee was advised that a Transformation Board of local health providers and partners was looking at how to develop stronger local care at front door. This Board included Council representation.

The latest staff survey was being undertaken. The response rate for the previous year had been comparable to the national average with the lack of change in staff satisfaction from the previous year being thought to be down to the period of significant change that the hospital was undergoing. It was not anticipated that the results of the latest survey would show significant improvement in view of the financial challenges facing the Trust. Over 3,000 of the 4,400 hospital staff had attended the hospital’s ‘You are the Difference’ programme’, which aimed to help embed positive changes to staff culture and encourage staff to take personal responsibility for the hospital’s improvement journey.

In relation to finances, the Trust was required to deliver £21 million of savings in the current financial year, which it was well on course to achieve with an additional £1.2 million in savings having been identified. It was important to ensure that quality of care and patient safety were not compromised as a result of the savings made.

A Committee Member asked what factors made Medway a more appropriate site for the interim vascular service than the Kent and Canterbury Hospital. The Chief Executive of MFT said that South East Clinical Senate guidance stated that where a hospital provided vascular services, there should be appropriate support services in place. It was considered that Medway had a strong intervention radiology service. It also had a fully functioning Emergency Department and was a trauma site. Other services, such as Neurology could also require vascular surgery. The Kent and Canterbury hospital did not have this range of services.

A Member said that the case put forward by MFT in support of it hosting stroke and vascular services did not appear to have demonstrated workforce mitigation measures as well as some of the other Kent hospitals. This was disappointing given that Medway faced similar workforce challenges to other Kent hospitals. The Member did not accept the suggestion that the situation had changed since the public consultation and emphasised that she felt Medway was better placed to provide stroke and vascular services than a number of other hospitals. The Member also asked what the financial impact on the hospital would be of not hosting particular stroke and vascular services in the future and also asked about capital investment at the hospital. 

The Chief Executive said that there was no evidence to suggest that other hospitals were better placed to deal with workforce challenges and that Medway had a stronger interventional radiology service. It also had a well staffed and run emergency service and a good trauma service. It was considered that MFT had done more to attract staff to work at the trust than some other hospitals in Kent. Stroke services would continue to be provided by MFT until there was a viable alternative for the people of Medway. There was an expectation that Medway would continue to be fully paid for services provided and that the new hyper acute units would not recruit Medway staff while a service was still being provided locally. It was anticipated that, subject to the preferred option identified by the NHS of hyper acute stroke units being developed at Darent Valley, Maidstone and William Harvey Hospitals, 80% of Medway stroke patients would be taken to Maidstone. Some related services, such as the treatment of Transient Ischaemic Attacks (TIAs) would remain at Medway.

In relation to locating the interim vascular option at the Kent and Canterbury Hospital, clinicians were also concerned about the ability to treat people within recommended timeframes and the supporting non-acute provision. The Kent and Canterbury and MFT would appoint an independent clinical lead to take forward development of the services.

The repair and replacement of lifts at MFT were part of a three year programme. It was acknowledged that there had previously been a lack of investment in essential maintenance and that it would take time to address this.

MFT had just launched its new rehabilitation unit. This development had already received international recognition, with the MFT team having been invited to present a paper in the Netherlands. They had also been invited to present their work in Montreal with McGill University having selected Medway to partner with on a related project.

It was noted that it was likely to be the Chief Executive’s last attendance at the Committee before she left her role to return to Australia. Members of the Committee thanked the Chief Executive for all her hard work in leading the significant improvements made by the hospital during her tenure and the strong partnership working with the Council. The Chief Executive also thanked the Committee for its support.

Decision

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