Agenda item

(Director of Governance) To undertake further external scrutiny of Barts Health NHS Trust, with regard to the continued improvement of inpatient, outpatient and other medical and emergency services at Whipps Cross University Hospital.

The Chairman welcomed officers from Barts Health NHS Trust, who were attending to update Members on their improvement plan from their last visit to this meeting on 23 February 2016. In attendance were Alan Gurney, Managing Director and Dr Heather Noble, Medical Director both from Whipps Cross Hospital.

Mr Gurney advised that the Care Quality Commission (CQC) undertook a focused unannounced inspection in May 2017 of three of the core services at Whipps Cross Hospital, these were surgery, end of life care and outpatients and diagnostic imaging. This visit was a follow up to the CQC’s previous inspection of Whipps Cross Hospital in July 2016, which at that time, rated Whipps Cross Hospital as inadequate overall. In September 2017 the CQC published their report and the inadequate overall rating for the hospital had improved and the status had moved from inadequate to required improvement, although some areas such as surgery still remained inadequate.

The problems that remain with surgery are due to the age of the building and the state of repair, the theatres are old and needed major investment to repair and update them. Mr Gurney reported that Barts Health Trust were reinvesting £1.4 million in the current financial year to completely overhaul and refurbish two of the operating theatres that the CQC were concerned about and this refurbishment should be completed by Spring 2018.

In 2015 the CQC documented that they were concerned with the culture within the hospital and bullying and harassment was sited as a real problem. In the 2017 CQC reported it had been noted, that whilst there were still pockets of concern, a significant improvement had been noticed within the Hospital concerning culture, good relationships between management and staff and staff engagement with patients and colleagues.

Whipps Cross Hospital continued to focus their efforts on improvement including:

·        Taking immediate action to improve surgical services by improving the environment and governance within the service;

·        Recruit more permanent staff;

·        To improve the flow through the hospital so that patients do not have to wait too long for treatment and cancellations are kept to a minimum;

·        Identify and learn from incidents which occur; and

·        To ensure all staff are aware of infection and control guidelines and policies.

Mr Gurney stated that the Whipps Cross Hospital site needed redeveloping the site was a 100 years old and needed a major overhaul, 43% of the site pre-dated the NHS, 70% of the site was more that 30 years old and the layout was confusing, making it difficult to deliver the best possible care. There was increasing pressure on services for example the Accident and Emergency department saw over 450 patients a day, making it one of the busiest departments in the country. There were also over 500,000 outpatients a year and the maternity unit delivered 5,000 babies a year.

There was a need to invest in the future of Whipps Cross and redevelopment was greatly needed. A strategic outline case was with the Trust’s regulators for approval. Once approved the next level would be to outline a business case and then options would be looked at for the  redevelopment of the site and how the Trust would be able to acquire the funding for this major project.

The meeting was then opened up to questions from members.

Q.        Members expressed concerns regarding the diagnostics department, staff and patients could have been in contact with high levels of radiation which wasn’t detected at the time. Why did this happen, why wasn’t this detected at the time.

A.        Each member of staff working in the diagnostics department had their own radiation monitor which would alert them if the levels were high. There was a problem with the system that was used to monitor and process the data that read the levels of radiation. The system failed as the monitors were not flagging when staff were near to the high levels. It had now been remedied the system was now working and the exposure to staff, at that time, was within the acceptable limit.

Q.        It had been noted that Whipps Cross Hospital were looking build a new hospital has the Trust looked at any sites for redevelopment or would the new hospital be built on the same site.

A.        The site that Whipps Cross Hospital sits on was18 hectares of land, therefore the redevelopment of the hospital would be on that land. The Trust would be looking to reduce the footprint of the hospital as a nurse would leave the ward to go to the pharmacy and would be gone from the ward for 30-40 minutes due to the distance that they had to go.

Q.        Have Whipps Cross lost much capacity from bed blocking, as the government have put emphasis on care in the community and have reduced the number of beds nationally in hospitals from 183,000 in 2002 to 136,000 now. have Whipps lost any bed capacity and what are you doing to facilitate the movement of patients through the hospital.

A.        Firstly I would like to say we don’t use the term bed blocking no longer exists its called delayed discharge. As of today we have 11 beds occupied by delayed transfer of care. We recognise as the winter approaches that this will become more challenging and we are working with our partners to see how we can keep the system flowing over the winter months. We have not closed any beds this year apart from some escalated winter beds that we opened last year and we are not looking to reduce any bed stock in the hospital.

Q.        In your report it talks about the problems Whipps Cross have had with bullying, favouritism and unfair treatment causing a lack of confidence. What steps have you taken to alleviate these issues.

A.        There was still a problem but on a much less scale, we have taken steps to put structures in place so that matters can get resolved in the right way. We have supported staff with information on how to deal with bullying and who to report it to. All areas of the hospital are working together and talking to each other we are implementing a culture change. A set of values and behaviours have been introduced throughout the trust and all staff are expected to follow these guidelines.

Q.        Were all staff aware of who they should go to for any concerns they felt they had or if they felt procedures were not being followed.

A.        Yes, they could go through their line managers or there was a confidential anonymous hotline.

Q.        In regard to winter planning measures can you extend on any measures you have in place this winter for the A&E department.

A.        We have a very robust winter plan that we have put into place, not just internally with the Barts Health Trust but also with our external partners. Additional resilience has been put in around the A&E department in terms of how we stream patients, as they come through the front door. £500,000 has been invested internally within Whipps Cross Hospital, geared around the weekend resilience to keep the department moving. On the 6 November 2017 a brand new ambulatory care unit will open, £700,000 of capital was given to Whipps Cross Hospital by the Department of Health during the summer and building work has been going on for the last 6 weeks. At present 20-25 people a day are put through the ambulatory unit and new unit will allow 50 people a day to be put through the unit. Additional investment had also been put into the rapid response team.

Q.        In your report it states under the heading ‘Safe’, ‘Feedback was not shared consistently with staff, as monthly ward meetings did not always take place.’ Has this issue been addressed.

A.        This was within the surgical wards, when the CQC came out of the 6 surgical wards only two of them were able to produce consecutive minutes for the previous months. I can categorically say that this has been one of the improvements put into place and that these ward meetings are now taking place regularly and the minutes are available for every ward.

Q.        When visiting the hospital it was noted the dilapidation of the old nurses living quarters, it was very expensive for nurses to live in London and maybe with having living accommodation you would be able to retain nurses. Are there any plans to bring back living quarters for nurses or could the accommodation be used for the delayed discharge patients

A.        From September 2016 to September 2017 we have employed 60 new members to the nursing staff. As of today there are 96 further nurses in the process of being employed. We are looking into bringing living accommodation back on site for single and family affordable living accommodation.

Q.        What is the purpose of the Strategic Outline Case (SOC) and when do you hope to take it to the Outline Business Case.

A.        The SOC was prepared to outline the case for change, in terms of investing into the Whipps Cross Hospital site. That was with our regulators NHS Improvement and we are awaiting approval from them to agree that we can take it forward to Outline Business Case. This will probably take another 12 months as this would be where the detailed planning around options for the site would take place.

Q.        How can we as a District Council support you.

A.        The District Council could help by spreading the word particularly with the redevelopment and the problems with the current site. Need people to know that the building was very old and needs to be rebuilt in the hope that the support of the people will add weight of opinion when we take our funding bid to the Government.

Q.        There have been press reports that the NHS was taking on more managerial staff than they are front line staff.

A.        I don’t believe this to be true but the NHS do need to employ managerial staff otherwise more of the paperwork and administrative side of the hospital would fall to the front line staff and therefore they would not be able to use the skills they trained for effectively.

Q.        A presentation was received from your team at the Joint Health Overview and Scrutiny meeting a few weeks ago, there was some statistics discussed regarding inappropriate discharge into the community, particularly where people needed re-enablement services and were placed into care homes and they weren’t given the adequate level of care to support their needs. What is the trust doing now to safeguard future discharges from hospital and the appropriate care package put into place.

A.        We know that when elderly people are admitted into hospital they get deconditioned. Their life space was reduced from a house or a flat to a bed and a chair. We need to get them back into their home as quickly as possible so their mobility doesn’t deteriorate. We have a good service in the Forest Assessment Unit and that is where our care of the elderly team will put an appropriate care package into place to get them back into their own homes as soon as possible.

Q.        In terms of recruitment what kind of relationship do you have with schools, colleges and universities and how do you foresee younger people wanting to join the medical profession and do you do any work around that.

A.        Regarding schools and colleges, Whipps Cross Hospital do need to develop relationships with schools and colleges. We have work going on in other districts of Barts Health, for example, Newham they have a scheme which draws people from disadvantaged backgrounds that haven’t made the grade to get into medical school and they are given some experience to help them to get into medical school the next time around.

Q.        What have you done on the Dementia Care Service that has been put in place.

A.        Dementia care is a priority for the Trust, we have more patients at Whipps Cross Hospital with dementia than at any of our other sites. Dementia was now part of the mandatory training for all staff and all new staff it was part of their induction. We have dementia champions who go out and educate staff. Our clinical areas are dementia friendly. We recognise that we haven’t always got dementia care right but it was critical that we continue to work on our processes to dementia care.

The Chairman stated that what came out of the report positively was the caring and compassionate attitude of staff to patients and their relatives.

The Chairman thanked Mr Gurney and Dr Noble for coming to this meeting, presenting their report and answering all the questions.