Agenda item

James Devine (Deputy Chief Executive, Medway NHS Foundation Trust), Glynis Alexander (Director of Communications and Engagement, Medway NHS Foundation Trust) and James Lowell, Director of Planning and Partnerships, Medway NHS Foundation Trust) were in attendance for this item.

(1)      The Chair welcomed the guests to the Committee.  Mr Devine began by stating that following a planned inspection in April and May and the resulting CQC Report published in July, the Trust was rated once again as ‘requires improvement’ with no significant change being recorded overall.  Areas of outstanding practice had been recorded in the ‘caring’ domain within surgery.  The new CQC inspection regime, rated the Trust as ‘requires improvement’ in the ‘well led’ domain and ‘use of resources’ rated as ‘inadequate’, primarily due to the financial deficit.  The supplementary paper identified ‘must dos’ and ‘should dos’ with a number of those actions now closed and tackled quickly with continuous improvements being made on core topics. He drew attention to consultant cover in the Emergency Department which requires 16.5-hour cover per day, explaining that was s significant challenge nationally but that the Trust had recruited two emergency consultants, taking the average cover to 14.5 hours

(2)      Mr Devine explained that wider progress had been made on NHS constitutional targets and that a number were ahead of trajectory; caution was expressed given the impending winter period.  In relation to the broader transformation agenda, the Trust was addressing the financial deficit and were reviewing unwarranted variation and redesigning referral pathways across the system.  He also explained that transition arrangements were in place for forthcoming Executive changes within the Trust, including the Chief Executive and Finance Director.

(3)      A Member asked about length of stay and risk of harm.  Mr Devine stated that patients were not at risk and the review was on areas within the hospital that showed that some patients were staying longer within the Trust – 2 days longer – compared to the national average.  Clinically led transformation teams were actively working on this through the Transformation Programme – Better, Best, Brilliant - but emphasised that the Trust requires partner organisations to help support the process for cohorts of patients. He confirmed he was happy to provide further information to the Committee on the action being taken by the Trust on length of stay and flow.

(4)      Members asked about finances and payments by results.  Mr Devine reported that the Trust was reporting favourable to plan but challenges would come in the second part of the year.  Differences in opinion on payment by results nationally had been reported. The Trust had a longstanding financial deficit and that work was being completed on the drivers of the deficit; one being coding and accounting and that this year the Trust has entered in to a Concordat arrangement to ensure a fixed income with Commissioners to plan for 2019/20. 

(5)      In response to a specific question about the Kent and Medway Stroke Review, Mr Devine expressed that the Trust was disappointed not to be selected as the preferred option but that 3 hyper acute stroke units across the area was the correct number for patients.

(6)      Members enquired about capital spend and staffing expenditure.  Mr Devine said that work was being undertaken on system wide solutions through the transforming strategy meaning that services were being accessed in the community as well as co-located.  Staff expenditure was higher than some other trusts as benchmarked against ‘the model hospital’ tool.  The CQC had reported on a reduction on agency spend -  23/24% historically, now 9% - the redesign of the workforce was continuing to aid that reduction and on insufficient skill mix. 

(7)      The Chair elaborated on this point by enquiring if the workforce deficit was causing difficulties in achieving what the Trust wanted to achieve and financially recover.  Mr Devine confirmed that recruitment was a challenge and that pay spend was a driver of the deficit; impacting constitutional standards but that multi-faceted system redesign would lead to efficiencies.  The Chair confirmed that workforce was an issue that the Committee would be considering in due course.

(8)      RESOLVED that:

(a)  the report be noted and Medway NHS Foundation Trust provide a written update on the workplan including additional information on length of stay and patient flow;

(b)  Medway NHS Foundation Trust be requested to provide an update at the appropriate time;

(c)  Medway NHS Foundation Trust, with relevant partners, provide an update on the Single Pathology Service for Kent and Medway in January 2019 following completion of the full business case.