To consider the preparation of the Committee’s commentaries on health bodies in Herefordshire as part of the Healthcare Commission’s Annual Health Check process.  

The Committee considered the preparation of its commentaries on health bodies in Herefordshire as part of the Healthcare Commission’s annual health check process.

 

Representatives from the West Midlands Ambulance Service NHS Trust, the Primary Care Trust (PCT) and Hereford Hospitals NHS Trust attended the meeting to comment on their performance during the year and answer the Committee’s questions.

West Midlands Ambulance Service NHS Trust

 

Sue Green, Regional Head of Risk and Planning Guidance, and Lee Hutchinson, Station Manager at Hereford Ambulance Station, referred to the written submission to the Committee included in the agenda papers and informed the Committee that the Trust expected to meet all its targets this year.

 

Performance statistics for Herefordshire, the Hereford, Shropshire and Worcester Division and the Trust as a whole had been circulated separately to the Committee.

 

In the ensuing discussion the following principal points were made:

 

·         In relation to the target of responding to 75% of category A calls within 8 minutes a question was asked about the implications of this for response times to the remaining 25%.  The Herefordshire performance over the year stood at 78%.  In reply it was stated that the Service was always seeking to improve response times.  The deployment of paramedic response units was enabling calls to be answered more quickly.

 

·         A question was asked about the number of complaints received.  It was stated that the Trust received some 4-5 complaints a month across the Region.  The Trust was required to respond to complaints within 25 days but set its own target of 20 days.

 

·         It was noted that the effect on performance of the reconfiguration of the Trust’s call centres would be something to consider in a few months time.

 

·         That it would be useful for the Committee to receive information at its next meeting showing a breakdown of response times across the County.  It would be helpful if Mr Hutchinson as Station Manager could attend to answer any questions.

 

·         It was noted that, in the more rural areas of the County, Community First Responders would play an important role in helping the Trust to meet the required standards.  It was agreed to reiterate the Committee’s comment in its response to the consultation on the reconfiguration of call centres that the Committee would want to see some reinvestment into the County of any resources realised through reorganisation.  Providing direct funding for equipment for Community First Responders would be a good place to start to seek to improve the provision of service to rural areas. 

 

·         Members welcomed the Trust’s success in winning the Ambulance Service of the Year Award from the Ambulance Service Institute.

 

The Chairman thanked representatives of the Trust for their attendance.

 

Herefordshire Primary Care Trust

 

Mr Chris Bull, Chief Executive Herefordshire Council/Herefordshire Primary Care Trust, and Mr Paul Edwards, Director of Commissioning and Strategy were present to answer the Committee’s questions together with Greg Barriscale, Performance Manager.

Greg Barriscale gave a presentation, supplementing the report in the agenda papers, summarising the health check process and drawing attention to new requirements for 2007/08.  He noted in particular the change to the way in the Commission would assess compliance with the Standards.  He noted that the reporting frequency on compliance to the PCT Board and Sub-Committees was to be increased to monitor compliance and identify any issues of non-compliance.  He considered this would strengthen the PCT’s position.

In the ensuing discussion the following principal points were made:

·         It was noted that the lateness of the guidance issued by the Commission and the frequently changing targets complicated the task of all three Trusts in seeking to fulfil the requirements of the health check.  It was noted that the PCT did have the opportunity at meetings with the Commission to make representations about this issue.

·         It was noted that there was only one standard where the PCT considered there was insufficient assurance to demonstrate compliance: core standard 7(e) health care organisations challenge discrimination, promote equality and respect human rights.  The action being taken to address this point was noted.

·         Members noted some of the technicalities relating to compliance with the Standards and acknowledged comments on behalf of the PCT that it was important to recognise that the health check was only part of the assessment framework to which the PCT was subject.  It was emphasised to the Committee that the PCT was not simply target driven.  Its key focus was to improve service delivery.  The Committee readily acknowledged this point recognising the PCT’s commitment to improving services, noting that there were many initiatives underway as demonstrated in the presentation of the Local Delivery Plan to the Committee in March 2008.

·         A question was asked about the development of a closer working relationship between the Council and the PCT and the scope for efficiencies from joint data collection and the sharing of such information to demonstrate compliance with performance targets.  The Chief Executive Herefordshire Council/Herefordshire PCT said that the potential for efficiency savings in this area was recognised and as services were integrated performance management systems would also need to be combined.

·         In response to a question about core standard C6 regarding co-operation between health care organisations and social care organisations the Committee was assured that the evidence to demonstrate compliance was available.  However, it was an area where further improvement was required not least because this was expected to be an area of national focus with initiatives emerging from Lord Darzi’s review of the health service.  A number of examples of co-operation were given of the PCT working with social care, the Ambulance Trust and the Hospitals Trust.  These included work on unscheduled care to reduce the pressure on the Accident and Emergency unit and the work of the Children’s Trust Board. 

·         In response to a question about Standard C8a Paul Edwards agreed to circulate information on instances of staff raising issues in confidence.

·         The issue of ensuring confidentiality of data when it was shared between the Council and the PCT was raised.  It was noted that this was a national issue but work was ongoing within both the Council and the PCT to build in safeguards.

·         The issue of the need for an equitable sharing of financial resources between the Council and the PCT as integration of services progressed was raised.  The existing Section 75 arrangements for pooling budgets were noted.  The Chief Executive HC/PCT added that steps would be taken to ensure that financial arrangements between the two organisations were transparent.  He noted the need for the growth in demand for social care to be reflected in the national funding settlement and commented on the tension created by the higher growth in funding for the health service in recent years compared with funding for social care.

The Chairman thanked Mr Barriscale and Mr Edwards and expressed the hope that the development of a closer working relationship between health and social care would continue to progress over the coming year.

Hereford Hospitals NHS Trust

Mr Martin Woodford, Chief Executive of the Trust, gave a presentation.  He referred briefly to the heath check process noting that this had already been outlined to the Committee in the PCT’s presentation. 

On the use of Resources he noted that the Trust was on track for a £1.1 million surplus for 2007/08 and would repay its current loan.  The cash limit had been achieved.  £2.7 million of the planned £3 million of cash savings had been achieved.  The underlying deficit had been eliminated.  It was probable that the Audit Commission’s Local Evaluation assessment on the use of Resources would be “fair”.

He noted that the following national targets had been achieved or were likely to be achieved:

•98% patients to be seen in 4 hours in A&E             Achieved (98.2%)

•2 week/31 day/62 day cancer treatment target       Achieved (99%)

•2 week rapid access chest pain clinics                    Achieved (99%)

•60 minute thrombolysis – pain to needle time          Likely achieve

 (68% patients)

 

The one target it was thought would not be achieved was cancelled operations (< 0.8% of the total).  The current cancellation level was 1.5%-2% and was a consequence of pressure on the availability of beds, made worse by the recent outbreak of norovirus which had temporarily closed wards to new admissions.

In terms of the new national targets the position was as follows:

•MRSA Bacteraemia<baseline 2003/04         13 cases only 07/08

  (4 cases)                                                       compared to 19 06/07

                                                                        but target failed

•C-Diff infections                                            43% reduction

25% reduction >48 hours from 06/07            >48 hours at end of Feb

                                                                        Likely achieve

•18 week target – 85%                                   Estimated out-turn 78%

 (admitted patients)                                         Likely underachieve

•18 week target – 90%                                               Estimated out-turn 93%

  (non admitted patients)                                 Likely achieve

 

•5% reduction in emergency bed days          Likely achieve

  from 2003/04

 

In relation to MRSA he noted that the baseline against which the hospital’s performance was judged had been set in 2003/04 when the hospital had one of the lowest numbers of cases nationally.  There had been 13 cases in 2007/08 down from 19 in 2006/07 with no cases since January 11 and no hospital acquired (>48 hours) cases since August 2007..  Whilst the target would not be met there had been huge progress.  The majority of patients were now screened before being admitted.

The target for C diff 25% reduction > 48 hours from 2006/07 was a more realistic one and was likely to be achieved.

The target of 85% of admitted patients to be treated within 18 weeks of referral by a GP was not likely to be achieved, the estimated outturn being 78%. 

The good news was that the target of treating 90% of non-admitted patients within 18 weeks was likely to be achieved the estimated turn out being 93%.

The target of a 5% reduction in emergency bed days from 2003/04 was likely to be achieved.

Turning to performance against the Standards for Better Health totalling 44 standards across 7 governance domains the predicted Trust performance for 2007/08 was that 36 standards would be achieved.  There were 6 standards where there was insufficient assurance: waste management, workforce planning, corporate clinical governance (2) (attributed to staffing changes), complaints responses and patient information (improvements had been made but there was some inconsistency).  Two standards would not be met: infection control in respect of the MRSA target, as referred to above, and cleanliness. 

In respect of cleanliness the Trust had declared compliance with the standard in May 2007 but the standard had been raised.  The Chief Executive confirmed that the Trust had also completed its “Deep Clean” ahead of the target date for completion. The Healthcare Commission had made an unannounced cleanliness visit in 2008 and had expressed concerns primarily about the cleanliness and environment of the hutted wards.  Significant improvements had been made and the Trust had developed a new cleaning strategy with rapid response cleaning, the immediate refurbishment of the hutted wards and a decision taken to close and replace the hutted wards by 2009.

Challenges for 2008/09 included: reducing bed pressures by tackling delayed discharges, continued reduction in healthcare associated infections, progressing hutted wards refurbishment and replacement plan,  planning for the new cancer unit (2009 build), increasing surgical activity to meet the 18 week target (100% December 2008) and delivering £1.1m planned surplus though increased income.

 

The Chairman thanked Mr Woodford for his candid presentation.

In the ensuing discussion the following principal points were made:

·         It was suggested that the Trust should be congratulated on its success in achieving  the ambitious 18 week target for treating non-admitted patients.  Mr Woodford noted how the hospital had improved the planning of treatment to achieve the target.  It remained challenging to meet the target for elective patients because of the pressure on beds.  The hospital was trying to increase capacity by exploring options for additional day surgery capacity.  It was requested that a copy of the Healthcare Commission’s cleanliness report should be made available to the Council when finalised. 

·         It was asked whether the welcome replacement of the hutted wards would lead to increased capacity.  Mr Woodford said it was possible that the current provision of 67 beds in the three hutted wards would be replaced by up to 75 beds.  However, that remained to be determined and depended on how successful other strategies were in reducing demand for beds.

·         Asked to clarify what was meant by the word “seen”, in relation to the target that 98% of patients were to be seen in 4 Hours in A&E,  Mr Woodford confirmed that this meant assessed by a Doctor.  He assured the Committee that the hospital did not seek to manipulate this statistic as it was reported some Trusts allegedly did.  He added that the position on ambulance turnaround times was a separate issue and that was being monitored.

·         A number of questions were asked about the hospital’s cleaning contract.  Mr Woodford confirmed that this was operated under the Private Finance Initiative.  He assured the Committee that the contract was flexible and if standards were raised these could be delivered under the contract.  The contractor had co-operated with the Trust and joint monitoring arrangements were in place.  It was suggested that the Local Involvement Network should be recommended to review Hereford Hospital NHS Trust’s progress in meeting the cleanliness standard.

In conclusion the Chairman noted that the effective working relationship the Committee was developing with the three Trusts and the regular updates it had received had enabled it to address issues of concern and monitor progress satisfactorily throughout the year.  This had helped to make the debate on the health check shorter than it might otherwise have needed to be.

RESOLVED:

 

That    (a)        a breakdown of ambulance service response times across the County be presented to the next meeting;

 

            (b)       it be reiterated to the West Midlands Ambulance Service NHS Trust that the Committee would want to see some reinvestment into the County of any resources realised through reorganisation following the Trust’s reconfiguration of call centres.  Providing direct funding for equipment for Community First Responders would be a good place to start to seek to improve the provision of service to rural areas. 

 

 

            (c)        the West Midlands Ambulance Service NHS Trust’s success in winning the Ambulance Service of the Year Award from the Ambulance Service Institute be welcomed;

 

            (d)       the continuing efforts of the PCT to improve service delivery and     the extent to which it was exceeding expectations be recognised;

 

            (e)       the Hereford Hospital NHS Trust should be congratulated on its achievement of the ambitious 18 week target for treating non-admitted patients;

 

(f)           the Local Involvement Network should be recommended to review Hereford Hospital NHS Trust’s progress in meeting the cleanliness standard; and

 

(g)       the Director of Adult and Community Services be authorised to finalise the annual health check commentaries for transmission to the three Trusts taking account of the Committee’s comments, following consultation with the Chairman of the Committee.