To receive a report from the Chief Executive of the Wye Valley NHS Trust on the recent CQC Inspection and report.

The Committee received a presentation on the recent Care Quality Commission report of its Inspection of the County Hospital by Mr R Beeken, Chief Executive and Mr M Takolia, Interim Chairman of the Trust. The following points were raised:

·           That there were significant service challenges around the Urgent Care Pathway. There was a lack of depth of leadership across A&E, and that the Trust as a whole was an immature organisation which did not learn from its mistakes.

·           That whilst demand had exceeded supply for some time, the County Hospital had not made itself more efficient in order to meet the needs of the patients. There had been a 7% increase in admissions to A&E over the year, and a concomitant 23% increase in emergency admission to the hospital.  Recruitment of consultant staff was a problem for the Trust, and the working hours of existing staff had been extended in order to ensure that a consultant would be present in A&E. New ways of working were being looked at, including introducing advanced care practitioners and advanced nursing staff.

·           Patient length of stay in hospital was good compared to other hospitals, but bed occupancy was higher than the hospitals peers.  This meant that here was a huge problem when there was a surge in demand.

·           The concerns raised by the Care Quality Commission were being taken seriously and had been addressed in an overarching improvement plan, attached to the Agenda.

·           The Urgent Care System was being improved by the introduction of the ambulatory care system, was a patient focused service where some conditions could be delivered on an outpatient basis. Ambulatory emergency care cases were averaging 11 a day.

·           Work was in hand with external partners on the System Resilience Plan.  Mobile day surgery units were in place in order to ensure that elective routine surgery could be continued.  There were insufficient specialist staff to be able to offer a seven day a week discharge, and the Trust would need to be creative in order to be able to offer this service

·           That there would be improved capacity in outpatient units through a capacity planning process of human resources and the available physical space.  Work had been undertaken with the HCCG to reduce demand on secondary care.

·           That the Executive Board would develop twelve key outcomes against which the Hospital would deliver in order to ensure that the process had been successful.

In the ensuing discussion, the following points were made:

·           That non-recurrent funding from central government was not helpful in this situation, as it did not allow for long term planning and it was not possible to build resilience with such funding.

·           That the Hospital had worked with the Council regarding the plans for economic and population growth within the city and the County.

·           That the role and membership of the Trust’s Board had been strengthened in order to ensure that they would have better oversight of the operation of the Trust.  New members included Richard Humphreys from the Kings Fund and Andrew Cotton, previously the Chief Executive of the Powys Teaching Health Board who would bring a greater understanding of cross border issues.  The Board do ward rounds, and had regular contact with patients.

In reply to a question, the Clinical Lead, HCCG said that there was a problem recruiting GPs in Herefordshire, and alternative clinical models were being looked at such as employing Physicians Assistants in practices.

·           That a series of activities were in hand to improve the discharge process.  These included short, high intensity ward rounds by consultants.  AS well as increasing the Trust’s own transport capacity, discussions were in hand with the St John’s Ambulance Service in order to facilitate transport following discharge.  Electronic record keeping would also speed up the discharge process by allowing for medication to be provided in a more timely fashion.

·           That every patient had a named nurse and consultant when admitted to hospital.  There were matrons on the wards, and it was ensured that they were not numbered amongst the working nurses on that ward in order to allow them to liaise with families and deal with discharges.

·           That no staff posts had been held back for financial reasons.  As the Hospital was small and geographically isolated, it was struggling to recruit specialist staff. Teaching hospitals were more of a draw for staff.

·           That delayed transfer of care was usually blamed for bed blocking, but some patients at the Acute or Community Hospitals should be moved to alternative accommodation.  There was a belief that there were periods when there was a disproportionate influx of patients from the Powys Health Board area, but whilst there were times when more patients were admitted, this was not a chronic problem.

·           That patient notes were held electronically by GPs, with the exception of some patients with long medical histories.  The availability of patient’s notes did not delay appointments, but it could reduce the quality of the decisions made the physician.  Funds had been received for the introduction of electronic patient records at the Trust.  This was not just an IT project but also a cultural change for the organisation.

·           That the Hospital was spending a lot of time being scrutinised at the moment by various part of the NHS structure.  University Hospitals Birmingham NHS Foundation Trust had provided a diagnostic for the hospital in order to ensure that they were in a position to provide the appropriate support during this period. They were proving to be very helpful, but there was a need to accelerate the help they were given to ensure that targets would be met.

·           That, with regard to both adults and children’s safeguarding, the contracts to an agency for nursing staff were let to a set standard of training that staff were expected to meet.  Individual policies and procedures did differ for every organisation.  The nursing establishment was improving, so it was possible to release staff for additional training when required.

Resolved:

That

a)    the report be noted; and;

b)    That the Trust be invited to provide an update to the Committee at their meeting in March 2015.