Agenda item

UPDATE FROM KING'S COLLEGE HOSPITAL NHS FOUNDATION TRUST

To include an update on the London Ambulance Service (LAS)

 

To follow

Minutes:

Jonathan Lofthouse, Site Chief Executive – PRUH and South Sites (“Site Chief Executive”) provided an update on the King’s College Hospital NHS Foundation Trust.

 

The Site Chief Executive noted that, speaking as a subject matter expert through his role as Gold Command rather than LAS representative, he was aware that, across London, the LAS had experienced recent challenges relating to the physical handover of patients to Emergency Departments (ED). Within the South East London region, the PRUH had been particularly challenged. There were six hospital sites across London which were identified as being the most challenged, one of which was the PRUH, and an additional £1m of direct funding had been received before Christmas to implement improvements. This included the improvements relating to the speed of offloading patients brought in by ambulance, and co-ordination and flow. This funding had been used to create a larger handover environment at the PRUH, allowing space for 10 ambulances to offload patients at any point in time – this  was a threefold increase from the previous capacity. The Site Chief Executive emphasised that, despite this being a difficult issue, the interaction with the LAS had been good and they had worked with the PRUH to implement as much improvement as possible.

 

Members were advised that a wider piece of work, affecting all 23 EDs across London, had also been undertaken to refine procedures for handover. It was noted that handover times at the PRUH had improved rapidly over recent weeks. The two category markers were the number patients which took more than 30 minutes to handover, and the number taking over 60 minutes to handover – these markers were now back down to single digits over a 24-hour period. In response to a question, the Site Chief Executive advised that these handover markers related to the patient being brought into the hospital building, taken off an ambulance trolley and the ambulance crew being available for release. It was noted that the ambulance crew were responsible for indicating to LAS control that they were available for their next 999 call. The Site Chief Executive said the PRUH was able to support the rapid offloading of patients. There was a protocol in place for the immediate release of ambulance vehicles, if required, and they were confident that this could continue to be managed.

 

In response to questions, the Site Chief Executive advised that a number of changes had been made throughout the hospital, and with partners, in relation to improvements in offloading patients – a larger offloading space had been established but steps had also been taken to create ‘positive flow’. For example, if an inpatient ward had 20 beds, which were full, hospitals had been moving one further patient to the ward approximately 4 hours ahead of another patient being discharged. This was known as ‘plus 1-ing’ and was used to create an earlier flow out of the ED.

 

The Chairman enquired if there was any guidance for residents in terms of safely parking and off-loading patients at the hospital, if they were taking someone to the ED themselves. The Site Chief Executive advised that the triage point was adjacent to the Urgent Care Centre (UCC), which had a vehicle drop off space immediately outside. For those in extreme risk, patients should present directly to the UCC, where trained doctors and nurses could undertake rapid assessments. It was highlighted that if patients presented at the ambulance bay, the doors to the ambulance bays were locked, and therefore there was limited opportunities to receive attention. The Chairman said that this information was extremely useful, and suggested that it be captured in a note that could be circulated to Members.

 

With regards to the strike action being undertaken by the LAS, and a number ambulance services across the country, the Site Chief Executive said that on each strike day around 75% of vehicles were not on the roads of London. On recent strike days there had been a significant reduction in the number of 999 calls and therefore the PRUH had not experienced particular issues relating to ambulance presentations, ambulances being released rapidly, and no evidence of patient harm associated with the LAS strikes had been identified. What had been seen was more patients presenting on the day before each of the strikes and more patients making their own way to the hospital and presenting through the UCC.

 

The Site Chief Executive advised Members that over the next couple of days the Royal College of Nursing (RCN) would be undertaking strike action at the PRUH, Orpington Hospital and the Denmark Hill site. It was noted that a robust range of plans were in place. The hospitals had worked with the RCN over recent days and a staffing ratio had been calibrated for each area across the Trust, and they had applied for derogation of strike action – for example the ED was not subject to strike action and would be fully staffed. The strike would commence from 7.30am the following morning and there would be designated picket lines outside the PRUH and Denmark Hill, and no ill-behaviour was anticipated. Members were reassured that full services would be provided where derogation had been applied, or a night duty service.

 

Members were advised that, following a lengthy and robust debate, the Council’s Development Control Committee had voted in favour of allowing planning permission for the £20m endoscopy unit development at its meeting on 10th January 2023. It was anticipated that ground would be broken on the build in early summer 2023 and, following a 13 month build programme, the unit would open in summer 2024 – progress reports would be provided throughout the year.

 

In terms of performance, the Site Chief Executive advised that King’s was making great inroads. In relation to core diagnostics, such as MRIs, King’s was one of the highest performing units in the country and, with regards to elective recovery, was the highest performing major unit in London.

 

The Site Chief Executive informed Members that the car park deck, providing 197 additional spaces on the PRUH site, had opened on time and under budget and was being fully utilised. It was noted that 41 electric vehicle charging points would be available later in the summer, and a further 41 next year. In response to questions, the Site Chief Executive said that the park and ride scheme had ended in mid-December 2022, when the car deck opened, however this may be revisited at a later stage. The scheme had worked well, but it was provided at a cost to the Trust. The 197 spaces provided on the elevated car deck were all for staff, with the ground floor available for use by patients. With regards to parking charges, the Site Chief Executive informed Members that there was a scaling system in place – the price paid was dependent on the skillset of staff and their hours of duty. It was agreed that information relating to the exact number of car parking spaces, and parking charges, could be provided to Members following the meeting. The Site Chief Executive said that the hospital considered that it had made the best endeavours to improve car parking, and it was felt that the £4m investment into the car park deck was the right thing to do. There was now a shared responsibility to explore other potential schemes, if they were felt to be required.

 

In response to a question from the Director of Adult Social Care, the Site Chief Executive advised that the Care Quality Commission (CQC) had undertaken a range of visits toward the end of last year, including an inspection of the Maternity Services at the PRUH and Denmark Hill. The formal outcome of the CQC assessment had now been received, and published on their website. There had been a broad reduction to the ‘Requires Improvement’ level status for Maternity Services and a range of action plans were created in response to the CQC findings. It was noted that the findings were mainly environmental and process related, rather than staffing, and a number of these had been addressed prior to the report publication. The Site Chief Executive informed Members that the Maternity Services based at the PRUH were managed by colleagues at the Denmark Hill Site, and Julie Lowe (Site Chief Executive – King's College Hospital) would continue to manage the local improvement plans. In response to a question from a Co-opted Member, the Site Chief Executive advised that, in relation to the services at Denmark Hill, there were 39 points for improvement. The majority of these (around 25) had already been fully executed, and the remainder were in progress – for example a large volume of staff members were undertaking refresher training. It was anticipated that all points would be addressed before the end of the financial year. The Chairman requested that a further update on the CQC inspection of Maternity Services be provided to Members at the Health Scrutiny Sub-Committee meeting in April 2023.

 

In response to questions from a Member, the Site Chief Executive advised that during the COVID-19 pandemic, the CQC had ceased its inspection regime. When inspections recommenced, the regime had changed – the CQC no longer undertook large scale inspections of entire hospitals, and instead focussed on single, specialist areas. The inspections were often driven by outputs from the CQC’s “insight tool” and could prompt an inspection of a site. The Trust was experiencing the new CQC inspection approach, against a backlog of issues and a back drop of staff and services that had not been exposed to this level of onsite inspections for a number of years. In terms of staffing levels and recruitment, the Site Chief Executive said that there was a routine report which provided a breakdown of the workforce. It was agreed that this could be provided to the clerk for circulation to Members following the meeting.

 

The Chairman thanked the Site Chief Executive for his presentation to the Sub-Committee.

 

RESOLVED that the update be noted.

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