Agenda item

Dr Phil Barnes (Acting Chief Executive, Medway NHS Foundation Trust), Morag Jackson (Chief Operating Officer, Medway NHS Foundation Trust), Patricia Davies (Accountable Officer, NHS Swale CCG), Dr Fiona Armstrong (Chair, NHS Swale CCG) and Elliot Howard-Jones (Interim Area Director, NHS England (Kent and Medway)) were in attendance for this item.

(1)       The Chairman welcomed the guests to the Committee. Dr Barnes began by giving an update on three key developments at the Trust: leadership, CQC inspection and recovery plan. He stated that there had been a high turnover of the executive team. He reported there was now a strong executive team following the appointment of a Chief Operating Officer, Interim Chief Nurse, Director of Health Informatics and Director of Workforce. He noted that, following a second wave of recruitment, there would be interviews in mid-February for a substantive Chief Executive.

(2)       Dr Barnes reported a further unannounced CQC inspection on 9 December 2014 which looked at the emergency department and surgical theatre services. The final inspection report was due to be published shortly.  Initial feedback given to the Trust indicated that there was some progress within the emergency department: improved clinical leadership and better partnership working between the nursing and medical staff. He stated that there was a need to improve internal and external patient flow particularly in trauma. 

(3)       Dr Barnes explained that on 29 January 2015 the Trust’s Board had agreed a comprehensive recovery plan with 30,000 separate actions. He stated that previous plans were reactive and poorly co-ordinated; the new plan had been developed over four months and incorporated previous plans into a single logical plan. He stated the aim of the recovery plan was to stabilise the Trust by April 2016 in order to deliver targets and be removed from special measures.

(4)       Further to the three key developments, Dr Barnes noted that there had been no improvement to the 4 hour wait. He stated that South East Coast Ambulance Service NHS Foundation Trust (SECAmb) was concerned about their ability to admit patients by ambulance due to stacking at the hospital. Dr Barnes reported that a number of process and safety measures had been implemented to improve ambulance handover times.

(5)       Morag Jackson reported that previous plans had been poorly managed and tracked. She stated that the new recovery plan would be different as it would be appropriately managed, controlled and reported by an experienced team of staff. She noted that the plan needed complete buy-in by the new executive team including the new Chief Executive in order to be successfully implemented.

(6)       Patricia Davies updated the Committee on NHS Swale CCG’s plans to support the Trust. She reported that patients in Swale were now able to choose and encouraged to use Maidstone and Tunbridge Wells NHS Trust for their cardiology and care of the elderly outpatient appointments. A small number of Swale patients were using this new patient pathway; there was an increasing amount of activity. The CCG was looking to develop plans with Maidstone and Tunbridge Wells NHS Trust to provide further services in the future. She stated the CCG was disappointed that the four hour access target was not being adhered too. She acknowledged that there had been some recent improvement in A&E and handover performance but it was still far short of the target. She stated that the CCG would continue to support the Trust.

(7)       Members of the Committee then proceeded to ask a series of questions and make a number of comments. A Member enquired about signposting to primary care services. Dr Armstrong explained that signposting would be a key part of the North Kent Urgent and Emergency Care Review. The CCG was looking to create integrated primary care teams – a network of health professionals, aligned to GP practices, delivering care in the community. She stated that local practices in Sittingbourne and Sheppey were bidding to become access pilots in the second wave of the Prime Minister’s Challenge Fund. Ms Davies explained that improving GP access was part of the CCG’s commissioning plans and would be funded by the CCG if the bid to the Challenge Fund was not successful. Ms Jackson stated that currently  25% of the Trust’s A&E attendances were diverted to the onsite primary care facility.

(8)       A number of comments were made about hospital discharge. Ms Davies explained that an Integrated Discharge Team (IDT) had been set up at the Trust. It was based on the IDT at Dartford and Gravesham NHS Trust which had been in operation for twelve months. The IDT at Dartford and Gravesham NHS Trust was led by the acute trust and fully integrated with Kent County Council, Kent and Medway NHS and Social Care Partnership Trust (KMPT), Kent Community Health NHS Trust and the voluntary sector. She stated that IDT at Medway NHS Foundation Trust was not fully integrated and led by NHS Swale CCG. Dr Barnes explained that the IDT at the Trust had not been as successful as Dartford and Gravesham NHS Trust because the Trust had no control or ownership of the IDT. He stated this needed to be reviewed urgently to improve discharges. Mr Howard-Jones explained that IDTs’ were critical to improving discharge but stressed the importance of alternative provision such as out of hospital care which may be more appropriate for some patients.

(9)       A Member enquired about staff morale. Mr Howard-Jones explained that the NHS England (Kent and Medway) area was the first area where all acute trusts had been fully inspected by the CQC. He stated that a CQC inspection provided an opportunity to develop an action plan on areas for improvements which caused an immediate dip in morale. He believed that in the long term, the acute trusts would be able to build on their successes and increase morale. Ms Jackson explained that a lack of executive leadership and framework had caused low staff morale; overall sickness in the Trust was only 3.4% despite the low morale. She stated that the new stable executive leadership team would be able to turn around the Trust including morale within 18 months.

(10)     A number of Members commended Ms Jackson for her honesty and determination to turn the Trust around. A Member enquired about how long the Trust would remain in special measures. Mr Howard-Jones explained that the Trust needed to move out of special measures as soon as possible. NHS England, Monitor and CQC were committed to improving the Trust through the recovery plan.

(11)     In response to a specific question about system capacity, Mr Howard-Jones noted that the Five Year Forward View looked at the capacity required in the system over the next five years. The View promoted increased investment in health; identified efficiencies and ensured people were treated in the correct setting. 

(12)     A number of comments were made about the expansion of hospital, the four hour access target, the working patterns of interim executives and alternative providers. Dr Barnes explained that work was planned to improve the hospital’s environment as there was no possibility of the relocating the hospital. Dr Barnes stated that he had no control over the four hour access target. He believed it to be a reasonable target for emergency departments. Ms Jackson noted that the Trust had received funding to expand the A&E which would include medical and surgical assessment units to enable patients to move through the emergency department as quickly as possible and improve the four hour access target. Dr Barnes noted that many interim executives chose to work a four day week as part of their work life balance. Ms Davies explained that the NHS Swale CCG had considered other providers; the CCG had discussions with a variety of providers to ensure the best service for its local population.

(13)     The Chairman invited a local Member, Mr Bowles, to speak. Mr Bowles expressed concern that there had been no sign of progress over the last 18 months.

(14)     RESOLVED that the reports be noted and that Medway NHS Foundation Trust and NHS Swale CCG be invited to attend the June meeting of the Committee.