Agenda item

Patricia Davies (Accountable Officer, NHS Dartford, Gravesham and Swanley CCG & NHS Swale CCG), Lesley Dwyer (Chief Executive, Medway NHS Foundation Trust), Shena Winning (Chair, Medway NHS Foundation Trust) andMorag Jackson (Chief Operating Officer, Medway NHS Foundation Trust were in attendance for this item.

(1)       The Chairman stated that the Trust’s report for this item was not published with the papers as the report was not available. He stated that he had decided to take the report as urgent due to the number of substantive items on the agenda for the next meeting in July which would prevent it from being rescheduled.

(2)       Ms Winning began by explaining that the Trust had commenced an 18 month recovery plan in November 2014 which aimed to have the Trust in a stable position by April 2016. The Trust was now eight months into the plan and there had been substantial changes including the appointment of a new substantive executive team.

(3)       Ms Dwyer stated that it was her third week at the Trust; she had been involved in the decision making at the Trust since her appointment in February 2015. She noted that she had arrived at the Trust at an interesting time and was pleased to be taking on the challenge. She reported that the recovery plan was solid and would improve the Trust and the quality of care delivered to its community.  She stated that the Trust would be reinspected by the CQC in August 2015; the Trust was looking forward to validate progress and improve on the recovery plan.

(4)       Ms Jackson reported significant improvement to the Emergency Department. The Trust had moved from being one of the worst performing Emergency Departments to being within the top 50% on the four hour target. The Trust had introduced a new frailty pathway to ensure frail and elderly patients were on the most appropriate pathway. The length of stay for a frail patient had reduced from 17 days to 5-6 days. The Trust had also opened up two wards for patients awaiting discharge which had released inpatient beds and improved patient flow. The Trust had recently appointed Dr Patricia Bain, Chief Quality Officer, who had led safety and quality initiatives for the Department of Health and other NHS Trusts. Dr Bain worked closely with the Chief Nurse and Medical Director to monitor performance daily. The Trust had a large number of Band 5 nursing vacancies who made up a large proportion of the nursing workforce.  A Director of Workforce had been appointed and was looking to stabilise retention in order to increase recruitment. The Trust was looking at new models of care including paramedics in the Emergency Department and Anaesthetic Practitioners. She noted that the Trust had made improvements but acknowledged that there was still a significant way to go.

(5)       Members of the Committee then proceeded to ask a series of questions and make a number of comments. A Member enquired about the diverting of patients to Maidstone Hospital’s Emergency Department and data quality. Ms Davies explained that the CQC issued a Section 31 Warning Notice on Medway’s Emergency Department in September 2014. In response to the Notice, commissioners and providers of NHS services in Kent and Medway looked at options to reduce pressure on the Trust including diverting patients to Maidstone Hospital and Darent Valley Hospital. This option was not enacted instead NHS Swale CCG, as the second associate commissioner of the Trust’s services, encouraged Swale patients to be seen at Maidstone and Tunbridge Wells NHS Trust for their elective outpatient appointments for cardiology and care of the elderly from November 2014. She noted that referrals to Maidstone and Tunbridge Wells NHS Trust had increased but there had not been much take up of care of the elderly appointments due to transportation issues. NHS Swale CCG was looking into local outpatient clinics provided by the Trust in community hospitals. Ms Davies reported that whilst NHS Swale CCG welcomed the improvements to Accident & Emergency performance, the CCG was concerned with the deterioration of waiting time performance for cancer, upper & lower gastrointestinal and dermatology.

(6)       Ms Jackson stated that the Trust had not seen a significant shift of patients move away from the Trust. She explained that a new Patient Administration System was introduced in February 2015. The Trust had employed 20 additional full time staff to transfer patient records onto the new electronic system.  In preparation for the transfer to the electronic system, a number of data quality issues were highlighted including the incorrect coding of patients. The Trust had introduced a training programme on data quality to ensure data was correctly entered onto the system. The Trust was in the process of  data quality validation and had identified significant pressures on cancer waiting times in April – May. The Trust was meeting the two week urgent GP referral target; all patients who were waiting for their first cancer appointment had been booked in. The Trust had introduced 30 - 40 additional clinics to achieve this. Ms Jackson acknowledged that improvements were required for 31 and 62 day cancer treatment pathways. She noted that patients arriving into the Emergency Department were routinely seen within 15 minutes of arriving at the hospital by a nurse practitioner; 27% of patients were then referred to the 24/7 Primary Care unscheduled care service through MedOCC at Medway Hospital.

(7)       A number of comments were made about workforce including Band 5 Nurses, apprenticeships, morale and language barriers. Ms Jackson explained that Band 5 Nurses were newly qualified with one or two years of experience. The Trust had 15 Band 5 Nurses on each ward. Ms Jackson noted that at her previous Trust in Birmingham, apprentices were used in every area of the hospital. Medway NHS Foundation Trust was looking at every vacant post which did not require a specific qualification to see if it was an appropriate role for an apprentice. She stated that apprenticeships at the Trust would provide opportunities for young people who had previously not thought about a career in health and social care to come into the Trust. The Trust was looking at a number of workforce initiatives including overseas recruitment and improving staffing accommodation.

(8)       Ms Dwyer explained that she had spent a significant amount of time speaking with the staff since starting. She noted that despite the negative press coverage, the staff wanted to improve the hospital for their local community. She reported that the Trust had lacked stability and leadership, the recovery plan was binding staff with a common purpose.  She stated that negative press coverage and London pay weighting were a challenge for recruitment and retention at the Trust. She explained that she had met with the press to provide a balanced view of the Trust. The Trust needed to understand why people left the organisation and provide flexible opportunities to enable them to return. Ms Jackson stated that the Trust had learnt from previous mistakes and staff recruited must be able to communicate with patients.

(9)       A Member thanked Dr Phil Barnes for his contribution as acting Chief Executive. Ms Winning also thanked Dr Barnes for stepping up to a difficult task and providing value and continuity to the Trust. Ms Winning acknowledged that the Committee had heard presentations from the Trust over many years about delivering change but stated that the current executive team would deliver a stable organisation through its recovery plan.

(10)     RESOLVED that the reports be noted and Medway NHS Foundation Trust and NHS Swale CCG be invited to submit an update to the Committee once the CQC inspection report is published.