Agenda item

1.1.        The Committee considered a report on the Care Quality Commission’s (CQC) follow-up inspection of East Sussex Healthcare NHS Trust (ESHT).

1.2.        Catherine Ashton, Director of Strategy, and Alice Webster, Director of Nursing, answered questions from the Committee.

Performance of A&E Department

1.3.        Alice Webster explained that shortages of available clinical staff, including consultants, are a major reason for the performance of the A&E Department. The difficulty in recruiting and retaining staff is a nationwide issue and is the result of a shortage of available candidates not lack of resources. Alice Webster added that the CQC had inspected the emergency departments at a particularly busy period when there were a large number of patients and flow issues throughout the Trust that were causing delays in A&E.

1.4.        Alice Webster outlined some of the ways that the Trust is working to improve A&E performance:

·         increasing consultant cover at both A&E departments, and recently recruiting an additional emergency consultant;

·         strengthening clinical management by employing a clinical lead to manage the whole department whilst retaining a clinical lead for both A&E departments at Eastbourne District General Hospital (EDGH) and Conquest Hospital who are present at all times;

·         put in place an extra nurse on each shift to see patients who are waiting but are not in a cubicle, e.g., waiting in an ambulance, or ‘off loaded’ onto the department;

·         monitoring the number of patients in A&E four times a day to improve patient flow and ensure patients are safe; and

·         entering discussions with NHS Improvement about the physical appearance of both A&E Departments.

1.5.        Alice Webster said that it was important to make clear that A&E Departments do not work in isolation of the rest of the Trust. Staff will try to identify patients that can move out of A&E to elsewhere in the hospital or could go home, and implement this with immediate effect, to manage the throughput of patients in A&E. ESHT also works closely with South East Coast Ambulance NHS Foundation Trust (SECAmb) to manage hospital handover; the A&E department has an action plan that encompasses hospital handover.

1.6.        Alice Webster confirmed that there has been change in staffing at the Ambulatory Care Unit at Conquest Hospital but people continue to receive care at the Unit.

1.7.        Amanda Philpott, Chief Officer, Eastbourne, Hailsham and Seaford Clinical Commissioning Group (EH CCG) and Hastings and Rother CCG (HR CCG) said that urgent care is a system-wide service that hospital A&E departments play a major part in. Every health system is required to have a local A&E delivery board to oversee urgent care and the East Sussex A&E Delivery Board is working on five workstreams to improve urgent care, including:

·         improving the minor injuries discharge rate within 4 hours from 95-98% to 100%;

·         developing protocols for ensuring consistency in seeing, diagnosing and treating patients;

·         establishing equal clinical leadership on both hospital sites;

·         improving discharge planning to begin when a patient is first admitted to hospital to reduce instances of delayed transfer of care;

·         improving the rate of recruitment and retention of consultants and GPs. 

Performance of Children and Young People services

1.8.        Alice Webster said that one of the CQC’s ‘must do’ actions was for the Trust to develop play services in line with national guidance. The CQC has since elaborated with ESHT that its inspectors had concerns with the number of beds in a particular paediatrics room, and the lack of a paediatric nurse in A&E 7 days per week. Inspectors required evidence that both were being introduced in a sustainable way, and the Trust has now carried this out.

End of Life Care and rapid discharge process

1.9.        Alice Webster explained that the discrepancy in the rating of End of Life Care (EoLC) between both hospitals was due to the responsiveness of the EoLC team in EDGH, for example, it was less aware of ESHT’s pathways that allow for the discharge of patients from the A&E directly into the community. Since the CQC inspection, a training programme is being undertaken around EoLC and the preferred place of death for patients, i.e., ensuring that they are taken to their preferred place of death and not automatically put into a bed. In addition, a piece of work is being undertaken at the Conquest Hospital to develop ‘peace plans’ for the last 12-18 months of a patient’s life that involves patients and their family.

Organisational culture

1.10.      Alice Webster explained that the annual NHS Staff Survey is managed independently and the company that runs the survey said that the progress ESHT has made has been phenomenal. All measures of staff satisfaction have improved (including staff morale) or stayed the same, and a number are now at the national average. Furthermore, ESHT is showing a marked improvement in areas such as communication between management and staff, communication between staff, and staff being able to identify and report if they are being bullied or harassed.

1.11.      Alice Webster assured HOSC that ESHT will continue to build on innovations such as the independent ‘speak up’ guardian, staff engagement sessions, training on the essentials of management for junior staff, and managing the manager training for more senior staff, which have started to improve the culture at the trust at all levels.

1.12.      Alice Webster said that patient and service users are reporting an improved service. This is based on triangulating the results of the Friends and Family Test (FFT) (which have always been positive but have now seen a 15% increase in the number of patients filling them out), patient complaints (which have not increased or shown any emerging patterns), plaudits from patients, and feedback from Healthwatch engagement events.

Leadership and Board monitoring ESHT progress

1.13.      Alice Webster said that there had been a number of changes to the ESHT Board. The Board receives reports of departmental performance in public meetings and it will continue to monitor the progress of the trust’s action plans through board papers and committees, such as its audit and finance committees. The Board and Chief Executive are also doing ‘quality walks’ through the departments and ‘in your shoes’ visits to understand the patient and staff experience of the Trust and see whether what is in the board reports is accurate. The expectation is that these visits are several hours long and involve following patient journeys and pathways through the hospital, not just walking around a ward.  Catherine Ashton confirmed that in the last 6 weeks there have been over 20 quality walks throughout the Trust in both the daytime and evenings, and both on frontline wards and in back office areas.

Infection control rates

1.14.      Alice Webster said that infection control rates are overseen effectively by a Director of Prevention Infection and Control who is a qualified microbiologist. There are set objectives around MRSA, C-Difficile, and winter flu rates (amongst other diseases) and these are monitored by the CCGs on a regular basis – with clear evidence of improvements being seen. 

Maintenance backlog

1.15.      Alice Webster clarified that there is a maintenance programme, monitored by the estates team, and there is an ongoing discussion about backlog priorities.  The figure of £26m backlog of maintenance works is for the whole trust and is indicative of the age of the building stock. Catherine Ashton said there is a maintenance backlog issue at ESHT but added that one of the workstreams of ESBT is to look at the shared estate of all partner organisations and how it can be used differently and more effectively.

Backlog of unreported x-rays

1.16.      Alice Webster confirmed that the backlog of x-rays have all been reviewed and reported on, which was a considerable piece of work. The Trust has a new x-ray reporting system so is not expecting a re-occurrence of the issue.

1.17.      The Committee RESOLVED to:

1) note the report; and

2) request a report on the progress of the end of life care, and urgent care and patient flow projects in more detail at a future committee meeting; and

3) request that ESHT provide by email the NHS Staff Survey results and a breakdown of maintenance costs for each building in ESHT’s estate.