Agenda item

UPDATE FROM KING'S COLLEGE HOSPITAL NHS FOUNDATION TRUST

Minutes:

Meredith Deane, Director of Operations – PRUH and South Sites (“Director of Operations”) and Debbie Hutchinson, Director of Nursing – PRUH and South Sites (“Director of Nursing”) provided an update on the King’s College Hospital NHS Foundation Trust.

 

The Director of Operations noted the request made by the Sub-Committee for an update on the endoscopy backlog to be provided to the meeting. There was a capacity gap within the Princess Royal University Hospital (PRUH) endoscopy service, which had resulted in a significant backlog of patients on the activity diagnostic (DM01) waiting list, as well as surveillance patients. A comprehensive recovery plan of immediate and medium term solutions was underway, with a focus on bringing waiting times in line with national standards. Capacity was being increased in a number of ways, including:

 

-  using 30 weekend appointments at King’s College Hospital, Denmark Hill, providing patient transport if required;

-  outsourcing of between 30 and 40 appointments per week to BMI Healthcare, Croydon;

-  support from an 18-week insourcing team to deliver twilight and weekend services at the PRUH;

-  since September 2019, Day Surgery Units had been providing weekend sessions at Orpington Hospital, supported by Vanguard decontamination units.

 

The Director of Operations advised Members that throughout the recovery programme there had been a continued reduction in the number of patients waiting over six weeks. There had been an issue in regards to outsourcing, with the provider being unable to deliver the 50 appointments initially offered, but overall the position was much improved. In respect of longer term solutions, a business case was being developed for the expansion of the current endoscopy unit, in line with demand and capacity analysis. To maintain standards, a group had been established to explore longer term solutions.

 

From May 2019, harm reviews were being undertaken for all patients that had been on the diagnostic waiting list longer than six weeks, and all patients on surveillance waiting list with a past ‘due by date’. The current status of this process was that following harm reviews being completed for patients with cancer diagnoses, work was underway validating the cohort of patients whose pathways were delayed and had a diagnosis other than cancer. In response to a question, the Director of Operations noted that this was a huge piece of work, involving around 8,000 patients. It would be difficult to pin-point exactly if patients had come to harm as a result of these delays and they would therefore be looking at the whole clinical procedure.

 

A Member enquired if a specific “pinch-point” had been identified which had contributed to the delays. The Director of Operations advised that room availability was a key factor. There were currently two endoscopy rooms at the PRUH. However with 14,000 patients per year, plus a 6.5% growth in the number of patients per year, five endoscopy rooms were needed. In response to a question, the Director of Operations said that patients on all pathways were vetted by the clinical team, but they had seen an increased trend in the number of requests.

 

The Director of Operations informed Members that the Trust had identified two cohorts of ‘Lost to Follow Up’ patients in the Outpatients Dermatology service at Beckenham Beacon. These were patients that had been asked to return to the service, but had not been given an appointment or had not been formally discharged. A comprehensive review was underway, and an oversight group had been established to progress the necessary actions. There were two cohorts of patients, both of which related to a shortfall in consultants to cover the service. The harm reviews for the first cohort, which related to the locum consultant service provision, were nearly complete. Three cases of moderate harm, and one more serious, had been identified. The second cohort related to the 18-week wait pathway via insourcing, and harm reviews were ongoing. Three cases of moderate harm had already been identified, but there may be more. A harm review summit had been put in place, and the Director of Operations agreed that the Governance Action Plan could be shared with the Sub-Committee.

 

A Member asked for further information relating to how many patients had been affected in each cohort. The Director of Operations said that there had been 637 patients in the first cohort that had been clinically triaged and discharged. There were 668 patients in the second cohort, however following clinical triage, this number had reduced by half.

 

Actions that had been initiated to make the service more resilient included: two consultants, plus an additional consultant; a GP with special interest in dermatology joining the bank staff for the service; and nurse led surgery had recently commenced. A Member noted that tele-medicine could be ideal for this service, as it was quick and reliable. The Director of Operations advised that a number or virtual reviews were undertaken, and acknowledged that tele-medicine had a number of benefits. It was noted that there had been an increase in referrals, a number of which had not be appropriate and could have been seen in a primary care setting.

 

The Sub-Committee were provided with figures relating to the PRUH Emergency Department (ED) and Urgent Care Centre (UCC) performance from October 2019 to date. The Director of Operations noted that there had been an increase in attendances at both the ED and UCC in October and November 2019, and there had been a drop in performance. The hospital had struggled during December and January, and there had been a high number of patients presenting with influenza and Norovirus. There had been a significant increase in requests for side rooms and monitored rooms, which impacted on patient flow through the hospital. Hospital staff were seeing sicker, more complex patients, a higher number of whom were required to stay on site.

 

In response to a question, the Director of Operations said that the ‘Type 3’ performance was the four-hour wait time, which should be at 95%. Members asked for information relating to the number of ED attendees having waiting times of over 8 and 11 hours. The Director of Operations confirmed that these figures could be provided to the Sub-Committee following the meeting.

 

The Director of Operations informed Members that a floor co-ordinator role to support patient flow at the PRUH was now in place, with cover provided seven days a week where possible. This role was covered by a nurse, although not in uniform, as this was felt to be safer in relation to carrying out assessments. A Member noted that there had previously been an offer from the Trust to deliver a presentation in relation to ‘Patient Flow’. It was suggested that a post-winter follow up on patient flow / discharge could be scheduled and delivered jointly with the Bromley Clinical Commissioning Group (CCG).

 

The Co-opted Member representing Healthwatch Bromley highlighted that feedback from residents indicated that there was often confusion in relation to signage, and patients were unsure who they had been triaged by. The Director of Operations agreed that signage was something that could be worked on, and that confusion often arose from the ED and UCC being located in the same part of the PRUH. It was noted that when considering changes to signage it was good to have a “fresh pair of eyes”, and an invitation was extended for Healthwatch Bromley to do a walk-through and provide specific feedback.

 

In response to a question in relation to the number of 52-week waiters, the Director of Operations said that there were 260 patients to be seen between now and the end of March 2020. A plan was in place to treat these patients, with a number of weekend and twilight sessions being scheduled. Meetings were taking place on a daily basis to look at the trajectory, allowing for a 5% tolerance. The Director of Operations confirmed that the attendance and performance figures for the PRUH’s ED and UCC could be provided on a regular basis to the clerk, for circulation to Members of the Sub-Committee.

 

The Director of Nursing informed Members that in respect of the Care Quality Commission (CQC) update, the CQC follow up engagement event had taken place on 20th November 2019. On the 26th and 27th November 2019, the CQC had carried out an unannounced inspection at the ED’s of the PRUH and Denmark Hill. The inspection at the PRUH had been undertaken by three inspectors, including the National ED Consultant Lead. The inspection had taken place on a busy day at the PRUH’s ED, with 24 patients awaiting admission and some doubled up in cubicles. Feedback on the day was that the improvements in care were noted on both sites, but there were some areas that still required improvement. This included the management of safe storage of medicines, where a lot of work had been done in relation to auditing, however consistency needed to be embedded. Following issues identified during the first inspection, some work had been carried out on the mental health room at the PRUH. Work to complete the room would be starting the following week. It was noted that the Trust were currently awaiting the draft CQC report from this visit.

 

The Director of Nursing advised Members that work streams had been established to progress action steps in the ED, Outpatients, End of Life Care and Surgery. These Departments were reporting the work that was being undertaken to regular meetings chaired by the Director of Nursing, and this was also being formally presented to the Trust’s Board.

 

Members noted the comments made in the initial CQC Inspection Report relating to the attitude of staff towards patients and staff morale, and asked if there had been improvements. The Director of Nursing agreed that these had been the most saddening comments to read. Immediately after the initial CQC visit, morale had been incredibly low, as staff had been disappointed with the report. The Director of Nursing said that she felt some progress had been made in respect of cultures and behaviours in the ED, however more needed to be done in terms of how staff were perceived by patients.

 

A Member highlighted that the Severe Heart Failure End of Life Pathway had won a number of awards. It provided a huge benefit to patients, and reduced the number of ED admissions. It was suggested that a presentation on the Pathway could be presented to a future meeting of the Sub-Committee.

 

The Director of Nursing was pleased to inform the Sub-Committee that the nursing vacancy figures had reduced at the PRUH and South Sites, and currently stood at 7.18%. It was noted that there were no vacancies at Matron or Ward Manager level. In addition to recruitment, there would be a focus on the retention of nursing and non-qualified nursing staff as one of the main reason for these staff leaving was lack of career progression. In response to a question, the Director of Nursing said that the UK’s imminent departure from the European Union (EU) did not appear to have had an effect on staffing at the PRUH.

 

The Trust had its most successful year yet in relation to staff uptake of the flu vaccination. Staff at the PRUH, Orpington Hospital and Beckenham Beacon had the highest vaccination rates across the whole Trust at 85.4%. The overall Trust vaccination rate was 71.2%, against a target of 80%, which had surpassed the previous year’s rate of 69.6%. In respect of the Norovirus, the Director of Nursing said that there had been ten cases during December 2019. However, the number of cases often peaked in February, and therefore policies and algorithms were in place if the number of cases started to increase. Members were advised that last year it had been highlighted how the difficult layout of the PRUH had impacted on infection control, and funding had been received from NHS Improvement to address this. Additional doors had been installed and on-site testing for the Norovirus was now available, which allowed better management of cases and quicker treatment.

 

In response to a question, the Director of Nursing said that plans were currently being put in place in relation to the Coronavirus. Staff in the ED were being fit-tested for face masks, and policies were being put in place to make sure they recognised patients presenting with symptoms of the virus. To date, two patients had been tested for the Coronavirus at the PRUH, and both had returned negative results.

 

Members were advised of the Trust’s proposal to develop a single storey car deck at the PRUH to alleviate parking pressures on the site. There would be a loss of 20 spaces at ground level, but an increase of 90 spaces overall. These proposals had been shared with staff, stakeholders and over 500 local residents in November 2019, and no negative comments had been received. The Trust had submitted the application for planning permission, and was currently awaiting the decision. If approved, it was noted that there would be disruption to the site during the car park build, but information could be shared with the Sub-Committee prior to any work commencing.

 

In response to a question, the Director of Operations confirmed that money had been identified to pay for the construction of the car deck. If planning permission was approved and the car deck was built, a review of staff parking permits would be formally undertaken. Allocation would be based on the distance staff travelled from home to the PRUH, and it was noted that the cost of staff parking permits was proportionate to their banding.

 

The Director of Nursing informed Members that there had been a number of winners across the PRUH at the ‘King’s Stars’ annual staff awards. A special mention was given to the Patient Records Library (South Sites), Overall Winners of the quarterly award, and Dr Dennis Grigoratos (Paediatrics), winner of the Patient’s Choice Award.

 

The Chairman extended her thanks to Meredith Deane and Debbie Hutchinson for attending the meeting of the Health Scrutiny Sub-Committee, and providing an update in relation to the PRUH and South Sites.