Agenda and minutes

In accordance with the Council’s Constitution, questions to this Sub-Committee must be received in writing 4 working days before the date of the meeting.  Therefore please ensure questions are received by the Democratic Services Team by 5pm on Thursday 9^th April 2015.

Following the conclusion of an investigation into financial issues at the Princess Royal University Hospital (PRUH), Monitor had published a statement of Enforcement Undertakings and a public statement. Monitor had agreed with King’s that the Trust would develop and implement a short term recovery plan  and a longer term plan to ensure that services were improved and provided in a sustainable way in future. Monitor had declined to attend the Sub-Committee’s meeting due to the purdah restrictions, but had offered to attend the next meeting.

Roland Sinker, Chief Operating Officer and Acting Chief Executive of the Kings College Hospital NHS Foundation Trust and Sally Lingard, Director of Communications, attended the meeting. Mr Sinker gave a presentation on King’s involvement with the PRUH. The presentation focussed on –

• The PRUH at acquisition in October 2013 – There was a high vacancy rate, poor emergency pathway performance on a downward trajectory, a low incident reporting rate, low rates of delivery on the continuous improvement plan, areas of concern in various services and issues with medical leadership in some areas. 

• Progress to date – Vacancies had been reduced to less than 10%, an elective orthopaedic centre had been developed at Orpington Hospital, “how are we doing” scores had been improved and complaints at the PRUH reduced, incident report rates had doubled, the Hyper Acute Stroke Unit had improved to 18^th position (of 180), the huge backlog in radiology had been addressed and quality had been prioritised over financial performance. The Trust had ended the year with a deficit of over £47m.

• Areas for further work – These included developing partnerships with stakeholders across South East London, whole-system changes of the emergency pathway and referral to treatment times (RTT), improving the staffing establishment, especially in the emergency department and acute care and in neurology, addressing areas of concern such as fractured neck of femur (NOF) and medical records and delivering the financial plan.

• Monitor Investigation – King’s had welcomed the assistance of Monitor to move the Trust into financial sustainability, improve emergency pathway performance and tackle Referral to Treatment; a one year emergency recovery plan needed to be agreed by the end of May, and a longer term 5 year plan by the end of October, but the Trust would have to ask the Department of Health for extra financial assistance in May.

Mr Sinker then answered questions from the Sub-Committee and made the following comments –

• There were three elements to improving quality – patient safety, patient outcomes and patient experience, and of these the latter was the most problematic.

• Mr Sinker was not able to provide details on how much of the £47m deficit was due to the cost of the PFI for the PRUH, but the Trust had received additional funding to reflect the higher costs of this early PFI deal compared to later PFIs. He later explained that the government had funded the difference between early and late stage PFIs when the Trust had acquired the PRUH and payment  ...  view the full minutes text for item 53.

The Sub-Committee received an update from Dr Angela Bhan of the Bromley Clinical Commissioning Group (BCCG) on Winter Pressures over 2014/15. The report summarised the current ED (Emergency Department) performance at the Princess Royal University Hospital (PRUH), the delayed discharge position at the hospital and the services commissioned by BCCG to increase the resilience of health and social care services to better manage changes in demand during the winter period. There had been an outbreak of norovirus just before Easter, necessitating the convening of the platinum coordinating group.

Significant progress had been made in reducing delayed transfers amongst patients fit for discharge. The Care Services Portfolio Holder stated that there had been no Bromley patients delayed awaiting completion of social care placements or home packages, and it was confirmed that about 30-40% of patients at the PRUH were not Bromley residents. Dr Bhan confirmed that Bromley Care Services had been very supportive in ensuring that people could leave hospital when they were ready.

The issue of how GPs supported residents in care homes needed to be considered, but it was confirmed that GPs now carried out ward rounds to support residents in Extra Care Homes. Measures were being put in place to improve access to GPs, although not all practices were taking up the new initiatives. Dr Bhan commented that a more radical approach was needed.