Agenda item

Dr Chris Streather, Chief Executive, South London Healthcare NHS Trust, to attend the meeting and provide the Sub-Committee with an update.

To include questions from Councillors and Members of the Public to South London Healthcare NHS Trust, received in writing by the Democratic Services Team by 5pm on 13^th July 2011.

Dr Chris Streather, Chief Executive, South London Healthcare NHS Trust (SLHT), attended the meeting and provided the Sub-Committee with an update on the Trust following recent Care Quality Commission (CQC) inspections.  Dr Streather highlighted that the Trust had undergone three CQC inspections in the past year; this had not been entirely unexpected as the Trust had not declared compliance on all the targets.  The compliance review in September 2010 had identified some improvements to be made.  The unannounced inspection had found staff to be open and honest about the challenges they faced.  The CQC inspection in March 2011 found that the Trust met the basic standards for dignity and nutrition.  Some issues were identified with the “red tray” system for nutrition and these issues had been taken on board and the Trust was working to address them.  In April 2011, CQC identified that good progress had been made in improving maternity services.  The need to increase the midwife to patient ratio was a long-term challenge and one that was being faced by acute trusts across London.  Increasing early access to care was also an issue to be addressed and action needed to be taken to address this.

In terms of the issues already addressed since the September 2010 CQC inspection, following the implementation of the new on-line system for reporting incidents, the number of incidents recorded increased.  This was not unexpected as the new on-line system meant that data was captured in a more accurate way.

Work was ongoing to improve the process of ensuring staff working in high risk areas had the necessary CRB checks as well as highlighting the importance of ensuring medicines were kept securely.  In September 2010, the Inspectors had found that some medical notes had been kept in potentially publically assessable areas on wards, following the inspection there had been a Trust-wide awareness campaign to highlight the importance of ensuring confidentiality of patient records was maintained.

Dr Streather reported that over the past 12 months significant improvements in mortality rates had been made and it appeared that the figure was improving every three months.  In terms of maternity services, the Trust now had high quality midwifery and medical leadership in place.  The number of serious incidents had halved in the past 12 months and the number of caesarean sections preformed had also been reduced.  Dr Streather reported that in its first three months of operation the hyper acute stroke unit had admitted 103 patients and the feedback received from a number of the patients and their families had been very positive.

In terms of the future, Dr Streather reported that the Trust would be required to save £50 million a year for the next three years and this was against a backdrop of the need to increase quality, innovation and productivity.  Referring to waiting times, Dr Streather acknowledged that there were still significant problems with the waiting times for elective pathways.  In order to address these, the Trust needed to reduce blockages in the system, this would also improve patient experience and save money.  The Trust was also looking to move more elective surgery onto the Queen Mary Sidcup site and the Trust was currently waiting on commissioners in Bexley to develop their plans for the Sidcup site as this would help inform future decisions.  There was also a need for the Trust to consider the financial viability of extending theatre times over and above the current 36 hours per week.

Dr Streather highlighted the need to provide as much radiotherapy treatment as possible locally.  There was a national target of 45 minutes for the time taken by patients to travel to radiotherapy facilities.  Dr Streather advised that around 90% of Bromley residents would not meet this target due to the lack of locally provided radiotherapy facilities.  There was also a growing cancer network across London in which South London Healthcare had been heavily involved.

Responding to a question regarding the Trusts targets for waiting lists, Dr Streather stressed that there were three main elements to this: the Trust was required to improve the quality and safety of services and ensure that patients were treated within an appropriate time frame; all of which needed to be delivered within budget.  Dr Streather reported that in the previous year the Trust had met the target for A&E waiting times.  In the first three months of this financial year more patients had been treated than in the corresponding period last year.  In terms of the waiting lists for elective surgery, an action plan had been developed and work was underway to reduce the backlog that had developed.  Attention also had to be paid to speeding up the discharge process.

The Sub-Committee considered the Trust’s financial position and as way of an update, Dr Streather explained that the Trust was facing a number of cost pressures but that savings of nearly 11% of the turnover of the Trust had been made last year.  Whilst the cost pressures remained, the Trust had agreed to save 7% of its turnover in the current financial year.  In order to address the financial deficit the Trust would need to consider ceasing use of estates that were surplus to requirements.

The Sub-Committee was reminded that the deadline for Trusts to convert to foundation status was April 2014 and in order to meet this deadline savings of £60 million would have to be found each year.  Dr Streather reported that Trusts unable to convert to Foundation Status by the April 2014 deadline could be taken over by existing foundation trusts. 

Mrs Angela Clayton-Turner questioned whether the reduction in the mortality statistics was in any way linked to the movement toward enabling people, especially older people, to die at home.  Dr Streather responded that the majority of people who died in hospital were elderly patients who were in the emergency care pathway and the reduction in the mortality rate suggested improvements in care resulting from the changes that had been made to the model of emergency care.

Turning to the issue of pressure ulcers, Dr Streather acknowledged that the Trust had higher instances of pressures ulcers than expected and whilst the position was generally improving this was not happening fast enough.  Dr Streather regarded the instances of pressure ulcers as a marker of the quality of care and whilst a clear improvement on the numbers of grade three and grade four pressure ulcers had been recorded, in reality, there should be no instances of ulcers this severe.  The Chairman requested that Members be provided with a breakdown of where pressure ulcers originated, for example whether patients had been admitted from residential homes, nursing homes or their own homes, as this would assist the Adult and Community PDS Committee with its wider scrutiny.  Dr Streather agreed to provide this information and suggested that it would be helpful if the Interim Director of Nursing attended the next meeting of the Health Sub-Committee to answer Member’s more detailed questions.

The Health Sub-Committee considered issues surrounding safeguarding adults training for staff.  Dr Streather reported that this was a relatively new focus for the Trust and the 60% compliance figures reported since the September 2010 CQC inspection was continuously improving.  Internal training was being provided by the Trust’s Learning and Development Department and staff also participated in multi-agency training.  The Director ACS highlighted that Bromley’s Safeguarding Adults Board had a particular focus on providing support to SLHT.

A Member expressed concerns that, in terms of care for the elderly, when standards fell short, patients and their families did not complain to the Trust for a variety of reasons.  Dr Streather acknowledged that the complaints actually received by the Trust were the “tip of the iceberg”.  There was currently a greater focus of outcomes and what was needed was a greater focus on patient experience.

A Co-opted Member queried the reporting around venous thromboembolism (VTE) and questioned whether more patients were now being assessed.  In response, Dr Streather clarified that initially 25% of patients admitted had been assessed and this figure had increased to 67%, demonstrating that improvements had been made.  Dr Streather stated that, in his opinion, no patient should be admitted to hospital without having undergone the necessary assessments.

In terms of infection control, Dr Streather reported that any instances of infections were followed-up with a serious incident investigation.  The two cases of MRSA within the PRUH had been on different wards and were unrelated which demonstrated that there had been no cross infection.

Turning to the ratio of patients to midwives, Dr Streather reported that the biggest single reason for the closure of the maternity unit had been recruitment.  The Trust had been unable to deliver the high quality of care required across the three sites due to problems with the recruitment and retention of staff.  The new state-of-the-art unit at the PRUH was now delivering high quality care.  Feedback had shown that patients were happy with the new unit and this had made it easier to recruit staff.  Dr Streather highlighted that SLHT had not experienced problems that were any different to other hospitals and the recruitment of midwives was a national issue.

A Co-opted Member asked for an update on the Trust’s Dementia Strategy and Dr Streather undertook to provide a written update to the Sub-Committee.

In responding to a question around pharmacy delays Dr Streather acknowledged that there were opportunities for the Trust to improve quality of care and make financial savings in the area of medicine management.  The Trust was currently awaiting the implementation of a new IT system that would assist in ensuring that medicines were ready for discharge.

The Sub-Committee considered the issue of Urgent Care Centres (UCCs) and questioned whether enough was being done to direct patients to the services available at the Centres.  The Chairman suggested that it maybe helpful if the Trust arranged for information about UCCs to be distributed in Local Authority publications such as council tax bills and information about waste collection.  Patricia Choppin suggested that Bromley LINk could also help spread information regarding the services offered at UCCs.  Another Member suggested that it would be useful to review the scripts used by NHS Direct and GP surgeries to ensure that they signposted patients to UCCs.  Dr Streather acknowledged that more needed to be done to advertise the Centres.  As a general rule, if a patient needed an ambulance they would be taken to A&E, if a patient could get themselves to hospital they could be treated in an urgent care centre.  One of the main benefits of a UCC was that treatment times were much quicker.

In response to a question from the Portfolio Holder regarding discharge processes, Dr Streather reported that there were relatively few problems in Bromley.  From the Trusts perspective, more work needed to be undertaken to agree on the best model of intermediate care.  The Director ACS stressed that the longer patients remained in hospital, the more difficult it becomes for  for them to regain their independence and  this is not desirable for individuals or  their families and is also much more costly for Health and the local authority.  With this in mind it was in the interests of patients and the Council to ensure that  stays in hospital were as short as possible.  The Chairman also stressed the need to include families when discharge arrangements were being considered and that this should be done at an early stage following admission.

The Portfolio Holder highlighted that Bromley LINk had produced a very thorough report on discharge at the PRUH and the Chairman suggested that the Sub-Committee should review the report at its next meeting.

In considering the new Hyper Acute Stroke Unit at the PRUH, Dr Streather reported that there were currently 6 beds in the unit and this would rise to 14 in the autumn.  The Unit was also staffed at the necessary levels and Dr Streather reported that he felt it would be easier to recruit staff to fill vacancies in a specialist unit.

Following a question regarding why the Trust was not implementing telemedicine, Dr Streather stressed that he felt that patients should be seen by consultants where possible.  In Bromley there were no geographical reasons why consultations should not be able to undertake face-to-face consultations with patients and this would provide a better patient experience.

The Chairman thanked Dr Streather for attending the meeting and providing the Sub-Committee with an update.  Members agreed that it would be helpful to have the next meeting in November 2011 at which Dr Streather and the Interim Director of Nursing could provide a further update to the Sub-Committee.