Agenda item

Members are asked to consider a paper from the Medway NHS Foundation Trust on recent inspections by the Care Quality Commission.

Discussion:

Members consider a paper from the Medway NHS Foundation Trust on recent inspections by the Care Quality Commission.

Dr Sulch, Chief Medical Officer, introduced the report and clarified that the statement in the paper that the Care Quality Commission (CQC) had lowered the rating of the Emergency Department (ED) to inadequate was incorrect as this rating in fact related to the performance of the Trust as a whole.

Dr Sulch commented that the Trust’s Patient First approach was designed to improve patient flow, reduce ambulance handover delays and the time spent waiting in ED and to improve the quality of patient care. There had been a significant reduction in the time patients waited more than 60 minutes in an ambulance before they were handed over. Numbers of people visiting the ED since Easter were now much higher. The average time patients waited in an ambulance had improved significantly since the winter. The average times for patients wating for a decision to admit and also from then to a bed being available were still too high and the Trust was committed to improving this. In total, patients spent an average of 8-9 hours in the ED before being allocated a bed. The new Interim Chief Executive had made it clear performance needed to improve significantly.

Members raised the following issues:

·       Ambulance Station – reference was made to a visit in December 2020 and the disorganised nature of this area with no records being kept of which ambulance was in which bay. Dr Sulch responded that ambulance movements were monitored via a white board, which would become an electronic system. There was now better oversight with a clear focus on any patient identified as deteriorating, who was now brought straight into the hospital.

·       Positive staff comments – the positive comments made by staff to the CQC inspectors were welcomed, noting that this had not always been the case in the past where the CQC had consistently highlighted staff not taking management action seriously enough. Dr Sulch commented the aim was to make the hospital a genuinely clinically led organisation.

·       Communications – with reference to the consultation on the future of healthcare, what this was trying to achieve and how it related to other consultations in Medway was queried. Dr Sulch commented the Trust’s clinical strategy needed to be refreshed and seen in the context of the wider health system it was a part of.

·       Attendance at Emergency Department – the increase in the numbers of people attending the ED was noted but seen as connected to the difficulties in obtaining a GP appointment and the number of staff working on the vaccine programme. Whether data existed to identify the sources of people attending the ED was queried. Dr Sulch commented there was evidence some patients were presenting later with conditions and complications not seen for many years and the reasons for this were being explored. The MedOCC service picked up about 30% of those who attended ED who did not need to be there. The Trust was working with partners on alternative pathways to prevent unnecessary visits to the ED. He had not seen any evidence to suggest patchy primary care was the cause of these visits, although access to primary care was not yet back to pre-pandemic levels.

·       Action Plan – it was felt this should be made easier for staff to understand and some actions were seen as essentially routine matters, such as record keeping. The lack of timescales was criticised. Dr Sulch commented that the action plan suffered from a lack of smart targets with some issues included  which should be taken as read. He acknowledged the need for clear timescales and a sharper focus on improvements. The Interim Chief Executive wanted to prioritise a small number of issues and concentrate on making improvements, this included the Emergency Department. A point was made that the number of improvement plans were a concern. How these were communicated to staff and how staff wellbeing was supported was questioned. Dr Sulch commented the various improvement plans were managed through the Trust Improvement Board, which focused on five key areas, workforce being one of these. Staff welfare had been key during the pandemic. Well-being hubs had been set up and there had been a focus on staff taking leave. The Trust was looking at how it could help staff visit family members abroad. There would soon be an even cleared focus on priorities and this would then be communicated to staff. The Interim Chief Executive held weekly staff briefing and took questions from staff.

·       Learning lessons – whether the Trust was learning lessons from other Trusts facing similar demands but performing better was questioned. Dr Sulch confirmed this was the case and commented the new Interim Chief Executive brought experience from other organisations. In many areas it was about learning how to deliver services more effectively – such as speed up the flow to allow earlier discharges once a decision had been made.

·       12-hour shifts – In response to a concern about these long shifts, Dr Sulch commented that nursing shifts were 12 hours, but staff were not encouraged to work long blocks of this pattern.

·       Triage – Dr Sulch commented that patients were prioritised based on need and were treated and discharged quickly where this was possible. Where needs were more complex this was more challenging, and this was when  performance slowed down.

·       Discharges to nursing homes – how the hospital ensured patients were discharged quickly and effectively to the right nursing home was questioned. Dr Sulch commented that during the pandemic there had been a big improvement in accessing community care in cases where it was unclear where a patient should be discharged to. This had helped decision making to take place in a less intense environment. He did not believe that inappropriate discharge to the wrong care environment was a particular problem.

·       Hospital pharmacy – in response to a comment that there appeared to be problems in the hospital pharmacy dispensing medicines on time before a patient was discharged, Dr Sulch commented that improving the discharge process was still a work in progress. While waiting for medicines could be a key part of the process, that was not entirely down to the pharmacy and in fact the pharmacy service had seen big improvements.

·       Future Covid waves – whether there were plans in place to manage future waves was questioned. Dr Sulch commented the Trust had improved its ability to manage different waves and any third wave would not present the same problems as the second wave. There were clear plans in place how to manage wards and which ones would become covid wards. The Trust would also be more proactive in terms of deploying more junior staff. There was a comprehensive plan for the next wave and a wish to continue with elective surgery.

·       GP numbers – the point was made that the number of GPs in Medway and Swale was below the Kent and national average.

Decision:

The Committee agreed to note the report and request a further update in the next 3 -4 months on the next steps identified following the CQC inspection, including the Patient First programme and also details of where people attending the Emergency Department originate from.