The report at Appendix 1 provides an update on progress since the Trust last attended the Committee in March 2019.
The key points of the report were summarised as follows:
· Strategic objectives - MFT was making clear to staff the direction the organisation would be taking in the next 3 to 5 years. This had included refreshing the Clinical Strategy and the People Strategy. A fifth strategic objective, ‘high quality care’ had been added to the existing four objectives. In addition to the strategic objectives there were also core quality objectives that set out what the hospital was planning to achieve in the next 12 months.
· Local care - work was taking place with NHS Medway CCG to provide local care closer to where people live.
· Finances - The Trust had met its budget control total last year and achieved the cost improvement target of just over £21 million. This was the first time for ten years that both had been achieved, with it being expected that both would also be achieved for the current year. However, a large budget deficit remained. Spending on agency staff had further reduced with an expected spend of £11million in the current year, down from £16 million the previous year and £50 million previously.
· Staff survey results – the aim was to be in the top quartile of trusts for survey results. The latest results showed an increase in the percentage of staff who would recommend Medway as a place to work or to be treated.
· Discharges – work continued to ensure that patients were discharged effectively and efficiently. This included work to ensure that patients were streamed to the most appropriate department and to prevent patients staying in acute beds longer than necessary.
· Executive changes – The former Chief Executive, Lesley Dwyer, had left towards the end of 2018, with the current Chief Executive, James Devine, having initially taken over on an interim basis and substantively from April 2019. The number of chief operating officers had been reduced from 2 to 1 and a Deputy Chief Executive appointed. The Medical Director had left their post while the Director of System Transformation had been seconded to the Medway and Swale Integrated Care Partnership.
· Patient numbers – July had been busy with a similar number of patients to during the winter. Performance in relation to the four-hour Emergency Department wait target was 80% compared to a national average of 79% and a target of 95%.
· Same Day Emergency Centre – MFT was the first hospital in Kent and Medway to have one. The Long Term Plan specified that all acute trusts should have such a facility. It was treating 60 to 80 patients each day with patients either discharged the same day or referred for further treatment.
· Diagnostics - 92 per cent of patients referred for diagnostics in June had tests undertaken within the target time compared to a trajectory of 99%. MRI testing was challenging with the hospital needing to use a mobile scanner for the next 4 to 6 months.
Members asked a number of questions which were responded to as follows:
Staff Survey results, efficiency savings and MRSA data – The Chief Executive had not expected better staff survey scores in view of the work undertaken, partly because there was likely to be a degree of cynicism for a period of time following appointment of a new Chief Executive. It was anticipated that the next staff survey results in January would show improvements. Assurance was given that savings made would not put service quality at risk. Data in relation to MRSA would be provided to the Committee.
Prevention and building repair – Noting that the condition of many people attending the emergency department was worse than it otherwise would be due to lifestyle factors, a Member asked if there was scope for a poor health prevention team to be placed in the emergency department. The Member also asked about building repairs and whether any new funding was available. The Chief Executive said that 30 to 40% of patients attending were redirected to primary care as they did not need treatment in the emergency department. Communications work was being undertaken with NHS Medway CCG to encourage patients to consider whether they need to attend the hospital or whether they should instead see their GP or other health professional.
The Director of Public Health said that care navigators were based at the hospital and that the aim was to increase this provision. The navigators worked with colleagues in acute and community settings to signpost patients to available support. People requiring operations for cancer were being supported to help them to get fitter before their operation. This had a positive impact on recovery time.
The Deputy Managing Director of NHS Medway CCG said that the development of Local Care included the provision of Integrated Local Review teams. These were staffed by GPs, consultants and multi-disciplinary teams. The teams worked with the frailest patients to ensure that care received was optimised.
The Chief Executive of MFT said that the Trust’s capital programme was a significant challenge. Replacement of lifts was being undertaken as part of a three year programme and broader redevelopment on the hospital site was taking place as part of a five year programme. An Estates Strategy was currently being developed. The recent Government announcement of capital funds had not made an allocation to any hospital in Kent and Medway.
Addressing health inequalities – The hospital was working with Public Health on how to address inequalities and where to focus this work. Patients in Medway tended to be in relatively poor health, sometimes presenting with conditions that would be expected in those who were twenty years older. Much work had been undertaken to reduce smoking in Medway, particularly smoking during pregnancy. The number of smokers in Medway had decreased from 50,000 to 20,000.
An initiative, ‘Grow your Brain’ saw midwives at MFT looking at how disadvantaged women could be persuaded to adopt more healthy lifestyles.
Bed turnaround and staff survey response – A Member said that patients should be moved from their bed while they were waiting to receive prescriptions and invited back another day if the wait was going to be long. The Member also asked what the response level to the staff survey was. The Chief Executive said that bed turnaround was a challenge as occupancy was typically 94 to 98%. The hospital now arranged for patients to wait for prescriptions in a discharge lounge. The pharmacy was small and it could sometimes take time to dispense prescriptions. The Medway staff survey response was 40% compared to a national average of 49%.
The Director of People - Children and Adults highlighted significant improvements made in relation to hospital discharge Delayed Transfers of Care, both overall and those attributable to Adult Social Care. Medway was now one of the best performing areas in the south east, with the work to address it being a positive example of partnership working. Medway also had a low hospital readmission rate.
The Committee noted and commented on the report and requested that diagrams presented to the Committee as part of future reports also be provided as PowerPoint slides.