To receive a general update on performance, patient satisfaction and any issues identified in the CQC inspection (March 2014) of the Royal Berkshire Hospital. (30 mins)
Minutes:
The Committee received an update on the Royal Berkshire Hospital from Caroline Ainslie, Director of Nursing RBH.
Royal Berkshire NHS Foundation Trust had been placed in Band 1, trusts that were the highest priority for inspection, following intelligent monitoring undertaken by the CQC in October 2013.
4 elevated risks:
o whistleblowing alerts;
o neonatal readmissions;
o In-hospital mortality - Gastroenterological and hepatological conditions and procedures;
o Dr. Foster: Composite of Hospital Standardised Mortality Ratio indicators)
and 5 Risk indicators:
o 'never event' incidence;
o deaths from respiratory conditions and procedures;
o the number of health workers who had had a flu vaccine;
o staff receiving health and safety training in the last 12 months and;
o governance)
had been identified.
A two day inspection had been carried out in March 2014 and the report published in June 2014. The Trust had been rated ‘Good’ for ‘Effective’ and ‘Caring’ and ‘Requires Improvement’ for being ‘Safe’, ‘Well lead’ and ‘Responsive.’
During the discussion of this item the following points were made:
· Seven compliance actions had been received. A CQC post-inspection action plan in respect of the compliance actions to address all issues identified had been developed. This was monitored via the Trust’s governance system. The Action Plan was reviewed at a departmental level and at the governance groups of the difference Care Groups before being considered by the Trust’s Governance Board.
· The Requires Improvement rating and compliance notices would remain in place at least until the Trust was next inspected by the CQC.
· Maternity Services had been rated ‘Inadequate’ for safety. The Trust had acted quickly to address some of the concerns identified. An issue relating to hoists had been resolved within 24 hours.
· The Committee was provided with information on where the Trust was a year on from the inspection. Some of the actions such as reviewing the critical care capacity and ensuring that the A&E was fit for purpose were not quick fixes. The A&E had been built to take 60,000 patients per year but currently saw approximately 105,000 patients. The Trust was working to improve patient experience in A&E and the introduction of an observation bay had had a positive impact. Work was being undertaken across the health system to reduce demand on A&E and the A&E wait target had been achieved the first two months of the financial year.
· The Trust had linked up with Bournemouth and Christchurch NHS Foundation Trust to establish an internal peer review system to provide assurance to the CQC and patients that actions being taken were delivering the desired outcomes.
· Quarterly meetings were held with the CQC and monthly quality meetings were held with the CCGs.
· In April the CQC had produced three additional essential standards. A gap analysis action plan was capturing any outstanding actions from the inspection and actions required to also achieve the new standards.
· RBH was in the top 20% for NHS Foundation Trusts for Friends and Family Test results and the Staff Satisfaction Survey results.
· Councillor Richards questioned how long the CQC had given the Trust to make improvements and was informed that this varied according to the issue. The CQC had signed off the action plan and the deadlines.
· With regards to points raised in relation to staff shortages, Members were informed that the inspection report had commented that at the time of the inspection there were staff shortages and an over reliance on agency staff. This was an issue faced by many other Trusts. There had been issues regarding staffing in the maternity unit which had had to close six times during August 2014 due to staff shortages. Additional capacity had been invested in since the CQC inspection.
· In response to Members’ questions regarding maternity service capacity, the Committee was advised that the birth rate fluctuated. Last August there had been a need to divert a number of mothers but this year the pressure was much less. Throughout 2014/15 the midwife to birth ratio at the hospital had fluctuated between 1:31 – 1:36. Other providers had reported ratios of between 1:30 – 1:35. Staff sickness had an impact on capacity but the midwives at the hospital were flexible and responded to service demands. A phased business case had been put forward to employ six additional midwives and an additional seven the following year.
· Members heard that although the Trust used more agency staff then it would like, it was a lower user of agency staff, particularly nursing staff. Efforts were being made to further reduce the number of agency staff used.
· Councillor Clark commented that the Minister for Health had recently announced a cap on agency staff and asked what impact this would have. Members were advised that the Trust was financially constrained and tight controls regarding agency staff were in place. A high level of authorisation was required.
· In response to a question regarding staff numbers, the Committee was advised that the Trust were actively recruiting and had looked to Ireland, Spain and Portugal to recruit nurses. A challenge faced was staff moving on to areas such as London once they had gained training and experience. Members heard that nurses recruited internationally took a language test and were provided with additional support if required.
· Councillor Clark queried whether increased key worker housing would lessen retention and recruitment issues.
· Many Trusts across the South of England were experiencing problems recruiting and retaining staff. Reading was an expensive area to live. Councillor Shepherd-DuBey questioned if the Trust could pay London waiting and was advised that the Trust was already very financially challenged.
· Councillor Blumenthal asked what other factors had an impact on staff retention. Members heard that retention was more of a problem in harder to recruit to areas such as elderly care and orthopaedic trauma.
· With regards to A&E Councillor Holton asked what was being done to expand facilities. Caroline Ainslie commented that the Trust was working with health and social care to develop long and short term strategies to address the needs of the local population. There was a need to do things differently. The number of younger people accessing A&E and the severity of cases had increased.
· Councillor Miall questioned whether the GP in admissions pilot would be continuing. It was suggested that a senior manager or physician provide an update.
RESOLVED: That the update on the Royal Berkshire Hospital be noted.