To receive an updated report on progress at the County Hospital following the intervention by the Care Quality Commission.

The Committee received a presentation from The Chief Executive, Wye Valley NHS Trust, on progress at the County Hospital following the intervention from the Care Quality Commission (CQC).  As part of his presentation, the Chief Executive highlighted the following areas:

·           That the CQC had highlighted good practice in both the Acute and the Community Services in the Hospital and had emphasised the caring and empathy shown by staff to families that was exemplary.

·           The Emergency Care Intensive Support Team (ECIST) had shown a volatile performance, but there that there was a planned expansion of the medical team in acute care, in line with an agreed recovery plan.  Recruitment in Herefordshire was an issues, and it was proving difficult to recruit to parts of the organisation. 

·           Stroke Services were subject to recruitment problems, but the transient ischaemic attack (TIA) service was improving and the hospital had exceeded national targets in this area and did not want to lose this impetuous. 

·           Patient safety had improved, as there had been a 38% increase in reported incidents with no concomitant increase in patient harm.  The hospital had also been free of MRSA for over 850 days. 

·           Bed occupancy and demand remained challenging as it was the smallest district hospital in the country and the highest bed occupancy rate. 

·           Diagnostic targets would be met with the addition of a second CT scanner by the end of the calendar year and a mobile unit by the end of the summer.

·           That there was a deficit plan in place for 2015/16 to address the deficit of £19.1m.  This was against the deficit from the previous year of £12.7m.  Changes to services would be considered in order to improve the position but reduction in costs would not be straightforward, as the largest cost centre was that of staff.

·           That exacting national standards and a reducing financial envelope were issues for the hospital.  There was a strong case for the future of the hospital, but work would need to be done to invest in and change the community provision of healthcare.

In reply to a series of questions from a Member the following points were made:

That staff turnover was currently at 13%, with a target of 10%.  Recruitment and retention was benchmarked against other organisations, and that 40 additional nursing staff had been recruited from residents within the County. 

That attendance in June and July had been around 160 a day.  The Chief Executive’s personal view was that this situation arose as a result of the inability of a poorly understood and fragmented health service to admit acutely unwell patients in a timely fashion.  The urgent care system needed to be simplified, and work was in hand with the HCCG to address this.

That there was a good working relationship with the Powys Teaching Health Board.

In reply to a comment regarding delay at patient discharge, he said that the main issues were not associated with the pharmacy, but with the limited time available to junior doctors, who were focussed on the unwell.  This mean that they tended to have to leave the sign off of prescriptions to the end of their shifts.  Priority was now being given to electronic discharge in order to allow the pharmacy to process order more quickly.  A Focus on Flow week had just been held to look at processes within the hospital, and any sustainable and affordable changes that could be made would be taken forward. 

The Chief Executive agreed with a Member’s concern about the number of senior staff available as part of the maternity triage.   There was now a full establishment in the maternity service, and the hospital had seen a reduction in caesarean section rates as a result.

That there would not be a reconfiguration of services as had happened in Worcestershire, as the county did not have the luxury of another hospital.  Work would be undertaken with clinical staff in order to provide a reconfigured service across seven day working.  Resilience in this area would be planned and addressed by working closely with both commissioners and partners.

In reply to a further question, the Chief Executive said that he would look at greater involvement from the voluntary sector in the future as part of the reconfiguration of services, but that whilst the hospital was in special measures there was no spare managerial team to address new initiatives of this nature. 

That sixteen additional beds would be in commission before the winter this year, and a business case was in hand to secure funding for the second phase of the capital building with the estate.

In reply to a question, the Director of Adults Wellbeing said that consultation on the proposed cuts to public health funding had not been finalised, and the Council had made representations stating that cuts should not be made.  It was unclear as to whether these representation would be successful, and plans were being made around a 7% reduction in the public health grant.  These plans were being driven by the Management Board within the Council, together with partner organisations. The Department view the county as overfunded from the point of view of public health, but this was because they did not take into consideration issues associate with rurality.  A detailed report would be provided to the meeting in September.

The Chairman thanked the Chief Executive, Wye Valley NHS Trust, for his presentation.

Resolved:

That

a)    the report be noted; and;

b)    an updated report on Public Health funding be bought to the next meeting.