Agenda item

The Sub-Committee received an update on performance at the Princess Royal University Hospital (PRUH) one year on from when the Kings College Hospital Trust had acquired the sites and services of the now dissolved South London Healthcare Trust. Representatives from Kings, Sue Field, Head of Capacity Planning and Service Development and Sally Lingard, Director of Communications, attended the meeting to present the report and answer questions. 

The Sub-Committee had a number of questions relating to staffing. Kings had put in place a recruitment plan and the PRUH was supported by bank and agency staff and staff from the Denmark Hill site; in September, 182 Band 5 nurses had started, and the Trust was on-track to deliver an extra 500 nurses in post by Christmas. In response to a question about over-reliance on agency staff in certain areas, such as for night-time services, it was confirmed that this was not the case, and that some agency staff were on long term contracts. Members requested further information about the numbers of bank and agency nurses used at the PRUH, if possible by the number of shifts covered compared to permanent staff.

Members also asked about retention of existing nursing staff. It was acknowledged that there had been a period of uncertainty the previous autumn, but the position was now far more stable. More matron posts had been put in across all sites as well as a number of specialist nursing posts. Staff now felt more developed and more involved.  

Linda Gabriel reported that Healthwatch had reviewed maternity services the previous year and found that there was significant pressure on midwives at peak periods. Recruitment was being carried out and levels of demand were being investigated. It was clear that patients were being drawn in from areas well beyond Bromley and the priority had to be serving the local catchment area. The representatives offered to provide more information on midwives after the meeting.     

Questioned about patient transport, the representatives confirmed that immediate transfers between sites were arranged when needed, but that it was not the intention to move patients from Orpington to Denmark Hill. The Denmark Hill site was under significant pressure and it was important to keep patients close to home where possible and to use the facilities at sites within the borough. For example, some neurology services were now provided at Orpington.  

Maureen Falloon commented that good quality food was important for recovery, and there appeared to be inconsistency around issues such as providing support for older people to eat and lack of choice.  It was acknowledged that there were some quality issues that needed addressing. The representatives also offered to provide information on the dementia care initiative.

The Trust representatives described the efforts that had been made to change the culture of the PRUH and improve staff morale. The sites at Denmark Hill and the PRUH had historically worked very differently, but the Kings vision was for there to be one organisation across all sites. Directors had responsibility for their services at all sites and all Divisions had been expanded and integrated. The most senior manager, clinician and nursing posts were filled by people with long-standing knowledge of Kings and key roles further down the organisation had been filled and posts back-filled at Denmark Hill as necessary. Team building was important and a series of staff events and roadshows had been held. A staff survey in November 2013 had identified issues which needed addressing, including the need for managers and clinicians to work closely together and the need for staff to have more responsibility and feel more empowered, without the need to always refer issues up the management chain for approval. Reporting of incidents had gone up at the PRUH – this was seen as a positive sign, that staff now felt more able to raise issues of concern.

It was acknowledged that the financial challenges for Kings in taking over the PRUH were greater than had been anticipated. This was due to low levels of staffing and funding for bank and agency staff being too high, and the levels of equipment found to be not fit for purpose.

The Sub-Committee discussed the issues around patient discharge and patients being kept in hospital too long. The PRUH was at 93% occupancy levels when closer to 90% was needed to cope with peaks and troughs of emergency admissions. It was estimated that around 80 patients were being kept at the PRUH when medically they did not need to be there. Often these were people with complex needs, and the biggest problem was putting in place care packages to enable them to leave hospital. It was estimated that about half of these patients would be from Bromley.       

Progress was being made towards achieving the four hour maximum wait for emergency care, and the 95% target had been reached on nine days during August. The service was still on trajectory to hit 95% by March 2015.  

Asked about what the Sub-Committee could do to help the Trust, the Trust representatives responded that Councillors could encourage residents to use the urgent care centres, to go the PRUH rather than Denmark Hill, where they would receive exactly the same quality of service, and inform the Trust if they were unable to attend appointments.

A Member raised the issue of patients who rang up for appointments being told that they would have to wait to receive a letter with a suggested date and time. The representatives responded that there was a major transformation project on these issues which should eliminate this. It was also acknowledged that the waits for blood tests were too long and this was being looked at.    

The Committee discussed Referral to Treatment (RTT) waiting times. Patients were entitled to choose a hospital close to home or with a shorter waiting list. The number of patients who had waited longer than 52 weeks had been reduced to 2, and would be none by the end of October. The two week maximum waiting time for suspected cancer had been achieved in September – increased outpatient and diagnostic capacity had been provided.  

The Chairman thanked the representatives from Kings for the excellent progress that had been made and for their expert update to the Sub-Committee.