Minutes:
Jacqui Scott, Chief Executive Officer – Bromley Healthcare (“Chief Executive Officer”) and Janet Ettridge, Director of Operations – Bromley Healthcare (“Director of Operations”) presented an update on Bromley Healthcare and the Care Coordination Centre.
As of the end of January 2019, Bromley Healthcare was ranked first out of all London providers, and joint second nationally for patient satisfaction, with a 98% rounded average score for patients that responded between January 2015 and January 2019. Bromley Healthcare’s average score of 98% was 1.3% higher than the second ranked provider in London.
The Care Coordination Centre had launched in January 2018, following a pilot in 2017. Services were migrated across during the rest of the year, bringing together all of the administration support. Currently the Care Coordination Centre provided the first point of contact to patients across 35 services, taking 26,000 calls and making 33,000 appointments per month, and drivers were based around ‘doing things the right way’. The Patient / Carer communications team focus was to manage waiting lists, DNAs / UTAs and adhere to patient pathways through the use of live dashboards to provide a consistent patient journey. The aim was to use this process to innovate and ensure that Bromley Healthcare, as part of the wider health economy was ‘doing the right things’ with proactive care coordination and development of patient pathways that reflected best practice and positive outcomes.
The Care Coordination Centre was used to manage the delivery of Key Performance Indicators, of which 20% of their contracts was based on the outcomes and were listed on a live dashboard. At the end of February 2019, 90.7% of Key Performance Indicators were achieved in Adult’s Services and 84.6% in Children’s Services, against the target of 70%. Overall, Adult’s Services achieved higher activity than planned in the first year of the contract, December 2017 to November 2018 being 0.4% above the baseline. For the same period, Children’s Services had overall also achieved higher activity than planned being 21.7% above the baseline.
In the 2017/18 Community Benchmarking, the Adult’s Services had a DNA rate lower than the mean benchmarking rate for twelve out of fourteen services, whilst Children’s Services had a WNB rate lower than the mean benchmarking rate for all six services. Since the establishment of the Care Coordination Centre, there had been a dramatic reduction in waiting times, whilst also ensuring that the right things were done in the right way. This had included the daily audit dashboard which had just been launched, and allowed outstanding issues to be passed on to the twilight team. There was also a bed based dashboard which allowed care gaps to be managed, and highlighted what specific services were needed on a particular day. It also noted the estimated date of a patient’s discharge to ensure that there were no hold ups.
Key messages from the National Audit of Intermediate Care (NAIC) were that patients under Bromley Healthcare were more dependent than the National averages on admission and their outcome was better than the national averages. Patients were also waiting less time to be seen, spending less time in the service, and a higher number of patients returned home, compared to the national averages.
In relation to the delivery of a value based contract, outcome measures from the start to the end of a patients journey were recorded on a dashboard, which showed the improvements made. An example included the Diabetes Care Essentials Dashboard for which three key measures, including blood pressure and cholesterol, which would be checked and recorded to see if they were improving due to interventions. A patient’s data could also be pulled together on the Integrated Care Network which was a platform to plot a patient’s journey, listing any interventions and the costs associated.
In terms of Bromley Healthcare’s culture for growth, there were a number of new stages in an employee’s journey including a staff forum, wellbeing services and an anonymous blog where staff could ask questions or put forward ideas. To tackle the issues relating to the recruitment of District Nurses, a Band 5 readiness programme had also been implemented. An apprenticeship programme was also being run by Bromley Healthcare, with fifteen apprentices placed over two cohorts. Bromley Healthcare had been a finalist for the Apprenticeship Employer of the Year Award, and two of their apprentices had been nominated for the Apprentice of the Year at the Runway Apprenticeship Awards in March 2019.
An example of a Workforce Report was provided, which showed a snapshot of how Bromley Healthcare measured performance. It included figures for Establishment, Vacancy and Sickness; Recruitment and Retention and Appraisals and Training; and Sickness Hot Spots. This highlighted who was leaving and why, and allowed them to drill down into the service or employee level of data. As of January 2019, Bromley Health Care had fifteen apprentices, thirteen trainees, two placement students, one NHS graduate trainee, nine new Band 5 nurses and four nursing associates. In April 2019, eight Band 5 nurses would be staring the readiness programme, and another three would start in September 2019. There had been a reduction in the vacancy rate from 12.8% to 8.5%; the length of time taken to recruit from 50 days to 34; and in expenditure on agency staff by 16% in the year to date. There had also been a reduction in District Nursing and CCC vacancies, which had previously been highlighted as hot spots.
A Member noted that there was a large proportion of Bromley Healthcare staff that were aged between 51 to 55 and 56 to 60 years old, and questioned if this would be problematic once those people chose to retire. The Chief Executive Officer responded that this was why the focus had been on recruiting Band 5 nurses and the apprenticeship scheme. Work was being undertaken with schools to make pupils aware of, and talk to them about the offer of a four year nursing apprenticeship with Bromley Healthcare. The Director of Operations said that work was being concentrated on newly qualified staff, an example of which was the Community Nurses Management Module which took place in the community over a period of twelve weeks. A Member suggested that visits could be undertaken to speak with Year 6 primary school pupils in order to ‘sew the seeds’ earlier, and target them with that incentive when then left to start secondary school. The Chief Executive Officer advised that they held careers fairs twice a year, one for Years 7 and 8 and the other for an older cohort. These were attended by clinicians who presented their role to the pupils, however if was noted that there was no follow up after the event.
A Member considered that there was a fantastic level of data provided on the Diabetes Care Essentials Dashboard with regards to predictions and prevention, and asked if this would be expanded to other areas. The Chief Executive Officer responded that there was scope to recreate this in all services, and that this was just the start of the journey in doing so.
The Chairman extended her thanks to Jacqui Scott and Janet Ettridge for their presentation to the Sub-Committee, and for arranging a tour of the Care Coordination Centre for Councillor Robert Mcilveen and herself.