Minutes:
The Sub-Committee received a presentation from Paul Donohoe, Deputy Medical Director, Princess Royal University Hospital (PRUH) and Sarah Willoughby, Stakeholder Relations Manager, King's College Hospital NHS Foundation Trust providing an update on the progress of the Trust and the PRUH Improvement Plan.
In considering performance across the Trust, performance against the Accident and Emergency four hour 95% target remained challenged due to multiple capacity and demand-related factors, with 88% and 82% achieved, respectively, at the PRUH in August and September 2016. Performance against cancer waiting targets continued to be good, and diagnostic waiting time performance had greatly improved, exceeding the national target of 1% in September 2016 with 0.96%. Significant progress had been made on achieving the savings target and reducing the deficit, and just under £10m of additional savings had now been identified. The implementation of the Trust’s new organisational arrangements was ongoing with the aim of improving patent experience and ensuring services ran as efficiently as possible. The next steps in the implementation of the new cross-site Electronic Patient Record system were under development and Sunrise EPR would be rolled out across the PRUH, Orpington Outpatients and King’s services based at Queen Mary’s Hospital, Sidcup during Spring 2017.
With regard to the PRUH, excellent progress had been made in addressing the Standardised Mortality Rate which had dropped in 2015/16 to the 10th lowest out of 136 Trusts which was in the top 8% of performance. Patient experience ratings had also increased to 92% in September 2016 for standard inpatient feedback. The first case of the Norovirus for Winter 2016 had been confirmed in late October 2016, and had been appropriately isolated, managed and discharged, with additional measures in place to minimise risks of further outbreaks including extra clinical sinks in key ward areas. Emergency performance remained a significant challenge with performance reducing from 89% in August 2016 to 82% in September 2016, and the Emergency Pathway Recovery Plan was being implemented to address this. Work was also being undertaken to fill a number of vacancies in key clinical posts at the PRUH and Orpington Hospital and reduce the need for agency workers, including a recruitment campaign. The Outpatient Dermatology Service had now moved to Beckenham Beacon, enabling key development works to begin at Orpington Hospital. The new pathology service run by Viapath was also now in operation and the Local Care Record initiative that would enable electronic information to be shared with local GP practices was expected to be rolled out to 50% of GP practices by May 2017. The Care Quality Commission had recently visited the PRUH and formal feedback was still awaited.
In considering the presentation, a Member noted the challenges impacting emergency performance and asked what had been put in place to deal with winter pressures. The Deputy Medical Director, Princess Royal University Hospital (PRUH) confirmed that a number of measures had been introduced to improve performance, including the Emergency Pathway Recovery Plan which was based around key themes including transfer of care, admission avoidance and winter planning, frailty pathway redesign and integration and Emergency Department transformation. Approximately a third of patients in the Accident and Emergency Department at any one time were waiting to be seen by a clinician or for a bed to be available. To address this, action was being taken to reduce admissions including directing patients to more appropriate health provision and introducing a rapid response team to respond to non-emergency incidents in care homes. The Transfer of Care Bureau was working to support more efficient discharge processes through initiatives such as the ‘safer bundle’ where clinical staff took ownership of patients’ discharge process. Additional support from the community nursing team was also being provided to care homes following discharge of patients to reduce readmission rates. The Chairman noted that it was important for clinical staff to work in partnership with patients and their families to ensure that patients were returning home to a safe environment, and for estimated discharge dates to be communicated clearly.
With regard to the reduction in the Standardised Mortality Rate, the Deputy Medical Director, Princess Royal University Hospital (PRUH) advised Members that this was mainly due to better governance systems and staffing. A range of work was being undertaken in care homes around setting limits of care and avoiding unnecessary admissions, and this would help to drive further reductions in the mortality rate by supporting those receiving end of life care to remain in their own homes. The Chairman was pleased to announced that Bromley had been commended at a recent meeting of the Our Healthier South East London – Joint Health Overview and Scrutiny Committee for its work in assisting people to die in their preferred place, and led the Sub-Committee in thanking all staff involved in providing higher levels of care to those receiving end of life care.
The Chairman queried if the cleaning protocols at the PRUH had been reviewed to ensure that the risk of spreading the Norovirus infection between wards was minimised. The Deputy Medical Director, Princess Royal University Hospital (PRUH) reported that cleaning was at the forefront of infection control, and that further information regarding cleaning protocols at the Trust would be provided to Members following the meeting.
In considering other elements of the presentation, a Co-opted Member underlined the need to include the views of patients in the ‘clean sheet redesign’ of services across the Trust. A Member also queried whether recruitment and retention campaigns currently underway had considered availability of housing for new staff, and the Deputy Medical Director, Princess Royal University Hospital (PRUH) confirmed that accommodation was considered as part of the recruitment programme, and that local housing had been procured for a number of overseas doctors who had recently been recruited to work at the PRUH.
The Chairman requested that further visits to key health facilities across the Borough be arranged for Members during Winter 2016/7.
The Chairman led Members in thanking Paul Donohoe and Sarah Willoughby for their presentation which is attached at Appendix B.
RESOLVED that the update be noted.