Agenda item

1.1.        The Committee considered a report by the Assistant Chief Executive which included a response from ESHT to HOSC’s report on the Trust’s Quality Improvement Plan (QIP).

1.2.        Julie Fitzgerald, Chief Executive, Healthwatch, provided a summary of Healthwatch’s work with ESHT in relation to the QIP. HOSC thanked Healthwatch for their involvement in the process.

1.3.        HOSC asked further questions in relation to specific areas identified as a concern in the Care Quality Commission (CQC) report.

Patient records

1.4.        HOSC asked for an update on funding for the digital tagging system for patient records, and the progress of the records storage site at Apex Way.

1.5.        Dr Adrian Bull, Chief Executive, confirmed that the digital tagging system was in place and as a consequence the number of missing patient records at outpatient appointments had fallen significantly. The move to Apex Way had begun following extensive consultation with affected staff and the performance of the new system was being carefully tracked. A formal opening of Apex Way was due to take place on 12 July 2016.

Patient involvement

1.6.        HOSC asked what ESHT was doing to ensure patients were involved in the quality improvement process.

1.7.        Dr Bull said that ESHT involved patients in service design well in an ad-hoc manner but agreed that the Trust needed to do more to ensure patient involvement in its service design at all levels as a matter of course. He said that ESHT will develop a well thought through plan to achieve this. He used the example of the work ESHT had undertaken with Healthwatch, including a recent mock inspection in preparation for the next CQC visit, that was very helpful to illustrate effective patient involvement. 

Maternity services

1.8.        HOSC asked for an update on the capital works proposed as part of the reconfiguration of maternity services in 2014, and asked whether it would affect the decision to single-site consultant-led services at the Conquest Hospital.

1.9.        Dr Bull said that the capital improvement spend in 2013/14 for maternity services was just over £100,000 at Eastbourne District General Hospital (EDGH). In the 2017/18 capital programme there is a further £130,000 planned to improve the environmental surroundings of the midwife-led unit. ESHT has limited capital funds and there is a list of proposed capital projects which total greater than the £45m annual capital budget. Included in this list is the significant and substantial rebuilding of the maternity unit at EDGH, but this cannot be accommodated in the current capital programme because of other urgent works which take priority. ESHT is planning to create a business case for further external capital funding to enable the Trust to carry out more of its proposed capital projects.

1.10.      Dr Bull clarified that ESHT has no plans at present to bring consultant-led maternity services to back to EDGH, but the Trust would continue to listen to the concerns of the residents it serves.

Seven day working

1.11.      HOSC asked ESHT to clarify its seven day working plans, including how it planned to work with other hospitals and whether the Trust was planning to hire more non-clinical staff.

1.12.      Dr Bull said that ESHT works as part of a wider network to deliver some specialist services, for example, the provision of immediate response for people with heart attacks. This does not mean ESHT will rely on other Trusts to provide core services on a seven day basis. He agreed that the NHS should work towards a full seven day service but the stated objective of the NHS at the moment is to ensure that there are a certain number of standards which apply seven days a week, for example consultant-led reviews of admitted patients and access to diagnostic tests. ESHT must reach these standards by 2020 with certain milestones in between. A senior consultant –led group has been set-up to ensure that ESHT complies with these milestones. A consultant-led medical round is a cornerstone of good medical care in hospital, and at the moment ESHT is not comprehensively achieving this. Dr Bull has set a challenge to his senior medical staff to achieve this.

1.13.      Dr Bull said that there is real value in introducing non-clinical staff because it enables clinicians to reduce time spent on non-clinical tasks, for example, freeing up ward matrons to lead nurses by providing administrative support for documentation.

Patient satisfaction and performance

1.14.      HOSC asked about the value of patient satisfaction as a measure of a trust’s performance.

1.15.      Julie Fitzgerald said that patient surveys formed a very important part of a wider understanding of a trust’s performance, but should be triangulated with other sources of information, such as the findings of independent inspectors with the ability to gather evidence and present it to the correct authorities. For example, Healthwatch East Sussex performed joint enter and view visits with Healthwatch Brighton at Brighton and Sussex University Hospitals NHS Trust and sent this information to the CQC and the local Quality Surveillance Group.

1.16.      Dr Bull said that ESHT was not providing perfect care to all patients across its services. He said he will sign the majority of complaint response letters and compliment response letters in the future. This was because it was important for senior leaders to understand the experience of patients. Dr Bull said ESHT needs to continually measure its performance by looking at patient feedback, waiting times, infection rates, staff morale – which is currently a mixed picture – and patients’ individual experiences. He suggested that it was important to avoid a cycle of self-reinforcing bad news at the Trust – he will continue to promote the good things that happen in the organisation so that staff recognise achievements and are encouraged to flag good and bad events without a fear of reprisal. 

1.17.      Julie Fitzgerald said that Healthwatch commissions the Independent Complaints Advocacy Service. There had been more referrals recently but when Healthwatch drilled down into these figures it was found that more staff were referring patients to the Service. This indicated that staff were recognising that learning from complaints was a useful tool for improving performance. 

Stroke standards and consultant referrals

1.18.      HOSC asked for clarification with regard to stroke standards and the process for consultant to consultant referrals

1.19.      Dr Bull said that, as far as he was aware, the standards at the hyper acute stroke unit were being met. He acknowledged an issue with consultant to consultant referrals which ESHT is currently discussing with Clinical Commissioning Groups.

Infection control

1.20.      HOSC asked whether there were sufficient infection control measures in place at the hospital entrances.

1.21.      Dr Adrian Bull said that the entrances of both EDGH and Conquest Hospital were due to be redesigned to be more accessible, efficient, and pleasant to patients and the public.

Medical bed capacity

1.22.      HOSC queried the Trust’s strategy to increase medical bed capacity in order to reduce the use of surgical beds for medical cases.

1.23.      Dr Bull said that ESHT’s strategy was being vetted by NHS Elect. The strategy set out the allocation of bed space between medicine, surgery, planned and urgent care. NHS Elect has indicated that the balance is wrong and a reallocation will be necessary. ESHT will need to protect the elective bed space at the same time as providing space for urgent admissions – this includes active work with Adult Social Care to manage patient discharge. There is a specific action plan both in terms of re-designation of areas of the hospital and much more focus on the flow of patients through the hospital and into the wider system.

1.24.      The Committee RESOLVED to:

1)    request a further report providing an update on the performance and development of the Trust’s maternity services.