Agenda item

Diana Hamilton-Fairley (Medical Director, Medway NHS Foundation Trust) and Shena Winning (Chairman, Medway NHS Foundation Trust) were in attendance for this item.

(1)       The Chairman welcomed the guests to the Committee. Ms Winning began by explaining that the Trust last visited the Committee in March 2016 following the CQC inspection in August 2015.  She stated that the Trust was currently preparing for a further inspection taking place in November 2016. She introduced Dr Hamilton-Fairley who was the interim Medical Director, as part of the Trust’s buddying agreement with Guy’s and St Thomas’ NHS Foundation Trust (GSTT).

(2)       Dr Hamilton-Fairley stated a further CQC inspection would take place on 29 & 30 November 2016. The CQC had undertaken a fieldwork visit in March 2016 and the CQC had reported that the hospital was safer for patients and the leadership & staff engagement at the Trust had improved. She highlighted a number of improvements which had been made in the last six months:

§  65% of ambulance patients were seen within 15 minutes of arrival; the A&E was now the highest performing Trust in the region;

§  The refurbishment of the new 24 bed majors unit had begun and was expected to be completed by December 2017;

§  The Trust was regularly performing above 80% for patient being seen and treated within four hours; the Trust had moved from 127th to 86th in the performance tables;

§  Patients requiring a KMPT acute inpatient bed were being admitted within 24 hours.

(3)       Dr Hamilton-Fairley noted that the Trust had introduced a new Medical Model in March 2016. Following the introduction of the model 60% of patients were now discharged within 48 hours and overall length of stay had reduced. She reported that the Friends and Family test had risen above 80% for the first time in 18 months and the number of consultants seen by the patients was reducing. She stated as part of the new ambulatory care unit, GPs were able to directly refer patients to the unit and bypass the Emergency Department.

(4)       Dr Hamilton-Fairley noted that staffing and finance were two areas of challenge. The Trust had been unable to recruit English trained staff and 75 Skype interviews had been scheduled with foreign staffing. She stated that nursing vacancies in the Emergency Department had reduced from 60% to 25%. She reported that the Trust had forecast a deficit of £40 million for 2016/17 and was aiming to make saving of £12.8 million through procurement and estate efficiencies.

(5)       Dr Hamilton-Fairley highlighted that two CT scanners and a MRI scanner located in the car park would be installed by the end of the year to reduce waiting times. She noted that the hospital would become smoke free from 17 October with onsite support for staff and patients by Medway Council’s Stop Smoking Service. She reported that the Trust was working closely with partners, including KMPT and Maidstone & Tunbridge Wells NHS Trust, as part of the Sustainability and Transformation Plan for Kent and Medway.  She stated that she was confident that the Trust would come out of quality special measures following the CQC inspection in November. 

(6)       Members of the Committee then proceeded to ask a series of questions and make a number of comments. A Member enquired about the impact of 4% efficiency savings on the Trust’s recovery plan. Dr Hamilton-Fairley explained that the recovery plan was under review and the savings targets were on track. She stated that in addition to procurement efficiencies, the Trust was changing the way it delivered services which included the closure of some acute beds. The Trust currently had 50-60 patients who were fit for discharge but were not able to do due to external factors; once those beds become free the Trust would be able to close them and redistribute staff to areas of staffing shortages which would create efficiencies. To help support discharge and improve flow, the Trust had implemented a Hospital at Home service which put in place support for patients within two hours of discharge; 35 patients a week used the service.

(7)       Local Members shared the views of their constituents: a Member stated that their constituents had begun to notice improvements whilst another Member stated their constituents still had major concerns. A Member asked for reassurance that the Trust was improving.  Dr Hamilton-Fairley stated that when the CQC visited the Trust in March 2016 they found it to be safer for patients and was providing better care. She noted that the number of deaths in the hospital had decreased from 118.3 to 100.9 which were within the average mortality band for a District General Hospital; the Trust had not been within the average band for the last three years. She stated that the Trust had data to demonstrate significant improvement; the Trust had received feedback from a variety of stakeholders about the improvements made following the last full CQC inspection in August 2015. She noted that there were areas of good and outstanding practice in the maternity, paediatric and neonatal wards.

(8)       A number of comments were made about staffing. Dr Hamilton-Fairley explained that the Trust was losing as many staff as it gained; however the Trust currently had 30-40 more staff than it had lost this year. She stated that the most challenging wards to recruit to were the general and elderly care wards. The Trust was looking to develop nursing support roles as part of career progression. She noted that the Trust carried out regular exit interviews and organised a full induction programme for overseas staffing including English language lessons, social events and staff accommodation for the first three months. She reported that the Trust was trying a number of different methods to recruit and retain staff including an educational package for nurses which was being developed for medical staffing too. 

(9)       In response to specific questions about collaboration with other hospitals and ambulance handover delays, Dr Hamilton-Fairley explained that the Trust worked as part of a complex matrix with partners and the Trust delivered some services on behalf of another provider to enable patients to receive high quality services closer to home. She stated that the Trust received 110 – 120 ambulances a day and 65% of ambulance patients were seen within 15 minutes of arrival making the Trust the best in Kent.

(10)     RESOLVED that:

(a)       the report be noted

(b)       Medway NHS Foundation Trust be requested to provide an update to the Committee following the publication of the CQC inspection report;

(c)        Medway NHS Foundation Trust be requested to provide the Committee with a series of graphs to demonstrate progress since the original CQC inspection in 2014.