Issue - meetings

1.1.        The Committee considered a report on the findings of a recent Care Quality Commission (CQC) inspection of Brighton & Sussex University Hospitals NHS Trust (BSUH) and the Trust’s response.

1.2.        Lois Howell, Director of Clinical Governance, BSUH, provided an update and answered a number of questions from HOSC in relation to the CQC report and BSUH’s quality improvement programme.

A&E Department waiting times

1.3.        HOSC asked whether the improvements to the A&E Department made since the CQC’s warning notice was issued in April had made any difference.

1.4.        Lois Howell said that improvement in the A&E Department had been significant. BSUH has reduced the number of 12 hour waiting time breaches from 12 during April 2016 to five in total between May and the end of September 2016. The longest a patient had to wait since April had been more than 26 hours, but this had been for patient safety reasons and was now the subject of a serious incident review. BSUH had also improved 4 hour waiting times to 86% compliance, although the 95% target is unlikely to be met until after this financial year when building works at the Royal Sussex County Hospital (RSCH) – designed to improve patient flow and capacity in other wards – are completed.

1.5.        Lois Howell said that the improvements to the A&E Department included:

·         changing staffing rotas at both hospital sites, in particular altering staffing levels at the Princes Royal Hospital (PRH) to match the increased attendance levels during the evenings;  

·         requiring staff to use a checklist to monitor patients’ welfare and a checklist to monitor signs of patient’s deterioration, based on the National Early Warning Scores. There is currently a 100% compliance with both checklists;

·         carrying out audits of patients’ notes to ensure that they are being treated properly and that staff are using checklists.

Patients in corridor area at A&E Department

1.6.        HOSC asked whether it was acceptable to allow patients to wait in corridors, and what BSUH was doing to reduce or eliminate the need for this practice.

1.7.        Lois Howell explained that a corridor area is used when there are no available cubicles for patients who have entered the A&E Department on ambulance trollies, or who are too sick to go into the waiting room; it is safer to have them in the corridor area where a nurse is allocated to them than to put them in the waiting area. She said that putting a patient in the corridor is a difficult judgement call based on what is the safest place for the patient within the circumstances. It is not a situation that the Trust is happy with and is one that the Chief Executive has apologised for.

1.8.        Lois Howell said that if more than five patients are in the corridor a trust wide escalation policy is initiated. Less than 10% of patients now have to spend any time in the corridor, these patients have to wait in the corridor for  ...  view the full minutes text for item 16

1.1.        The Committee considered a report by the Assistant Chief Executive which provided an update on recent CQC activity in relation to Brighton & Sussex University Hospitals NHS Trust (BSUH).

1.2.        Dr Steve Holmberg, Medical Director, provided HOSC with a presentation.

1.3.        HOSC agreed that it was clear there were significant issues with BSUH, but until the full CQC inspection report had been released, the Committee did not know enough to comment fully. It was particularly important that HOSC understood the details as BSUH was both a regional referral centre and a teaching hospital.

1.4.         HOSC asked whether the waiting times for outpatient appointments at BSUH, in particular neurology, had improved.

1.5.        Dr Holmberg said that BSUH has a real problem with the timeliness of offering treatments, which includes outpatient appointments, and that is highlighted in the CQC notice to the Trust. BSUH had not understood the scale of the problem but a lot of work has been done over recent months to analyse this and measures will be put in place to improve the issue over time. He said that BSUH is working with its Clinical Commissioning Groups (CCGs) to access additional capacity where there are insufficient staff or facilities to enable a rapid enough improvement by the Trust alone.

1.6.        Dr Holmberg also referred to ongoing operational difficulties with the Trust’s booking hub. BSUH was beginning to deliver significant improvements in performance but it was a journey that was not yet completed.

1.7.        With regard to neurology, Dr Holmberg said that there was triage in place early on in the patient referral process which aims to mitigate risk to patients. To some extent, neurology is a victim of its own success due to a number of referrals to the service outside of its natural catchment area because it is seen as a good service. This meant that not all patients could be seen in a timely manner.

1.8.        The Committee RESOLVED to:

1)    Agree to co-ordinate ongoing scrutiny of BSUH’s CQC report with neighbouring Health Overview and Scrutiny Committees;

2)    Request a report on the outcome of BSUH’s CQC inspection on 29 September; and

3)    Circulate the CQC report electronically as soon as it is published.