Minutes:
The Sub-Committee received a presentation from Matthew Trainer, Managing Director for the Princess Royal University Hospital (PRUH) and South Sites and Sao Bui-Van, Director of Communications, King’s College Hospital NHS Foundation Trust providing an update on the progress of the Trust and the PRUH Improvement Plan.
Although it continued to be extremely challenging to meet emergency performance targets, there had been overall improvement at the PRUH over the past year with aggregate performance of 87.8% in September 2017 against 82.53% on September 2016, despite a significant increase in attendances. Implementation of the King’s Way Programme, which aimed to increase the quality of services and make them more efficient and productive, was ongoing at the PRUH and Orpington Hospital sites. The Trust had a national ranking of 23 out of 123 Trusts which placed it in the top fifth of Trusts in terms of performance, and had performed well on the national Summary Hospital Mortality Index at 89.8%. Friends and Family test scores remained high with 94% satisfaction for Inpatients’ services in September 2017, although issues had been identified in Outpatients’ services including with appointment booking and clinic waiting times which would be addressed through a transformation programme.
In considering other developments, the electronic record system would be rolled out in November 2017 and would enable full patient records to be accessed by hospital staff as well as streamlining discharge processes. Recruitment remained a key area of priority and staff had been recruited to address specific issues including the need for experienced nurses to provide 24 hour ward cover and additional Health Care Assistant posts in the Emergency Department. The Trust was on track to deliver the cost improvement programme for 2017/18 and had worked with PWC to identify further cost savings; however due to the increased demand for services a re-forecast compliant with NHSI protocol had been submitted representing an overall full-year deficit of £70.6M forecast for 2017/18.
In considering the current financial position of the Trust, the Managing Director (PRUH) confirmed that the demand for services was increasing significantly faster than funding levels for the majority of hospital trusts which was causing financial pressure and was an issue for the Government to address. The Trust’s ongoing cost improvement programme had realised significant savings in recent years; however the scope for further efficiencies would be increasingly limited going forward. Work had been undertaken with other hospital trusts to address escalating agency costs and a pan-London agreement was now in place that set standard agency rates for staff in particular specialisms.
With regard to contingency plans for EU staff following the UK’s exit from the European Union, the Managing Director (PRUH) reported that the proportion of EU staff at the PRUH was relatively low. The message from the Government was that the residency status of EU health professionals was secure, and the Trust would work to retain as many EU staff as possible. The Director of Communications, King’s College Hospital NHS Foundation Trust would provide a breakdown of EU and non-EU staff including departure data to Members following the meeting.
The Managing Director (PRUH) reported that work was underway to establish an Acute Hub at the PRUH to reduce pressure on the Emergency Department. This service was aimed at treating those ‘fit to sit’ that did not require hospital beds and supporting them to return home without the need to be admitted. Social staff from the Transfer of Care Bureau would be located in the Acute Hub to arrange any wraparound care necessary to support people to return home or to ‘step-down’ provision. In response to a question from a Member around waiting times for some services, the Managing Director (PRUH) confirmed that an increased amount of weekend working was being undertaken by consultants to reduce waiting times. This included in the Ophthalmology specialism where two new consultants had recently been recruited. The backlog of CT scans at the PRUH had now been cleared following the replacement of the hospital’s two CT scanners.
A Member raised a query regarding ‘never’ events which were those events that should never have happened, such as an operation on the wrong organ. The Managing Director (PRUH) explained that the Trust had a range of processes in place to prevent the occurrence of ‘never’ events which were continually updated to reflect learning and changes in surgical culture. A Member raised a concern around increased Emergency Department attendances by children aged 16 years and under with mental health support needs. The Managing Director (PRUH) confirmed that the Trust continued to work with Oxleas NHS Foundation Trust to improve treatment times for Child and Adolescent Mental Health Services and ensure that appropriate specialist services were in place. The provision of inpatient beds for young people with mental health needs in the London area had been identified as a concern, and the Portfolio Holder for Care Services queried whether insufficient provision of specialist mental health placements for children should be treated as a ‘never’ event.
In response to Members’ concerns around the capacity of the PRUH car park for staff and visitors, the Managing Director (PRUH) advised Members that this had been identified as a priority. Two options to increase car parking were being explored that comprised maximising the use of the existing estate or adding an upper deck to a suitable area of the car park with the aim of identifying the preferred option by Summer 2018. The Managing Director (PRUH) invited Ward Councillors to attend a meeting with himself and the Director of Capital, Estates and Facilities to review the proposals for car park expansion.
Members discussed a recent Healthwatch Bromley report on Discharge which had identified a number of positive aspects of service provision but had also raised some concerns. The Managing Director (PRUH) advised that the PRUH had already acted on the report and that the Discharge area had been relocated to be closer to the PRUH main entrance. This area had been designed to provide both seating and space for trolleys, as well as side rooms for infectious patients. Facilities were also in place to supply patients with any necessary prescribed medications prior to discharge as well as provide meals where needed. The Chairman led Members in thanking Healthwatch Bromley for its excellent report and the PRUH for the service transformation work that had been carried out.
Members generally discussed how impressed they had been by the enthusiasm of staff and the holistic way patients were prepared for discharge during a recent Member visit to Orpington Hospital. Members also considered the potential for the Trust to develop closer links with secondary schools, including outreach work in schools and work experience opportunities.
Members requested that an update on the Trust’s plans for service delivery in August 2018 be provided to the next meeting of Health Scrutiny Sub-Committee on 6th March 2018. An update on the outcome of transformation work within the Outpatients’ Service would also be provided to the next meeting of the Health Scrutiny Sub-Committee on 6th March 2018.
The Chairman led Members in thanking Matthew Trainer and Sao Bui-Van for their presentation which is attached at Appendix B.
RESOLVED that the update be noted.