To receive an update from Royal Berkshire NHS Foundation Trust.
Minutes:
The Committee received an update on the Royal Berkshire NHS Foundation Trust from Raghuv Bhasin, Director of Systems Partnerships.
During the discussion of this item, the following points were made:
· Raghuv Bhasin outlined current key areas of focus for the Trust:
Ø Pressure on the Emergency Department – a 20% increase in attendances had been seen compared to the same period in 2019/20, the second highest increase in the South East. This had put pressure on staff and capacity within the Department. Safety and quality was prioritised, with patients being seen within the first 15 minutes for an initial assessment. A campaign was being launched around winter pressures which would focus on three principle themes; being prepared for winter; knowing which service to choose; and engaging with primary care in multiple different ways.
Ø Elective recovery – there was a significant backlog due to Covid. The Trust was one of few Trusts in the country that had maintained its referrals throughout the pandemic. However, there were less referrals as fewer patients had visited their GP during the pandemic. The Trust was trying to deliver elective activity over and above levels delivered in 2019/20.
Ø Safety and quality – ensuring that patients with an urgent need, such as having cancer, received rapid access to treatment. All patients on waiting lists were risk assessed, ensuring that capacity was maximised.
Ø Impact of Covid – case rates were rising. A slight increase in hospitalisations were being seen. There were about 40 patients at any one time with Covid, some in intensive care. Covid had had a big impact on staff resilience. Staff in intensive care and respiratory wards had found it particularly challenging to take annual leave. Continuing to operate at such a high level during the pandemic had had a big psychological impact. The Trust was focusing on staff resilience and wellbeing. Precautions such as social distancing and mask wearing, to minimise Covid infections were continuing.
Ø Partnership working – the Chief Executive had visited a large number of primary care practices to understand how the Trust could improve the interface between the Trust and Primary Care. The Trust was working more closely with Berkshire Healthcare to deliver more joined up services, such as the Long Covid clinic, which was jointly provided. Work was being undertaken with Berkshire West Integrated Partnership regarding priorities for the next year.
Ø Health inequalities – an analysis had been carried out of patients who did not attend out patient appointments. There was a disproportionate amount in the lower income decile. The Trust was working to engage more and to provide improved access to outpatient appointments, to minimise health inequalities. Four Public Health priorities had been developed.
Ø Development and growing the organisation – a five-year partnership had been signed with the University of Reading (Health Innovation Partnership). In addition, the Trust continued to invest in its Digital Hospital, developing new patient portals, electronic models of consent and a digital approach to outpatient appointments. Members were also reminded of the Building Berkshire Together programme which focused on the redevelopment of the hospital. There were two upcoming engagement events.
· Members sought an update on the Building Berkshire Together programme. A Strategic Outline case had been submitted to the Department of Health which contained a range of options for consideration, including redevelopment of the current site and relocation. Feedback had not yet been received from the Department of Health or the Treasury regarding these options or the amount of funding provisionally allocated. Engagement work with the community continued. Redevelopment on the site was continuing where necessary.
· A Member questioned how long it was likely to before backlogs in wait lists had been cleared. Raghuv Bhasin commented that the backlogs were particularly in elective care, which was a national issue for the NHS. More elective care was being delivered at present than in 2019/20, which was helping to reduce backlogs. This varied across specialities, some of which had had challenges in recruitment and retention prior to the pandemic. The level of referrals was not yet at expected levels and were likely to increase. In addition, wait lists and long waiters was expected to increase and then decrease over 2022/23. It was difficult to provide a definitive date as to when backlogs would be cleared due to uncertainty around referral levels. Raghuv Bhasin indicated he was happy to provide the Committee with greater clarity when available.
· Members asked a number of questions regarding staffing. A Member questioned the level of staff vacancies and how the Trust was looking to retain and recruit new staff. Raghuv Bhasin indicated that the level of vacancies varied across the Trust and largely mirrored the national picture. For example, there had been a national shortage of radiographers to conduct and interpret scans. The Trust was working with the University of Reading to develop a training programme to grow its own staff. There was a huge focus on retention. Raghuv Bhasin emphasised the development and investment in staff and the focus on staff wellbeing. Additional people management support had been invested into. Members were also informed of a recent recruitment campaign by the Maternity Services which had focused on student nurses.
· Members were assured that critical areas were not facing shortages in staffing.
· Raghuv Bhasin confirmed that critical departments were covered at all times, although this could involve high agency costs, which the Trust was looking to reduce through the development of its own staff and permanent recruitment.
· In response to a question regarding communication with the community, Raghuv Bhasin commented that there was a big focus on communication. The website had recently been relaunched and the Trust was growing its presence on social media, and were also engaging more with Healthwatch and other voluntary and community groups. The vaccination campaign had built good relations which the Trust was looking to build upon to ensure that particular groups who found it difficult to access services, were engaged with. It was noted that there were over 3500 Trust members who acted as amplifiers of the Trust’s message across a range of medial channels.
· Staff resilience and wellbeing was one of the biggest challenges going forwards. A recent Safe Staffing review had confirmed that staffing levels were safe going into the winter. However, staff were fatigued and under pressure and needed continued support.
· Members questioned how parking at the hospital could be improved and was informed that travel and transport were vital to the development of the hospital. The Trust was looking at expanding its parking footprint particularly for staff, and had increased its presence at the Queen’s Road car park. A cycle village with spaces for over a hundred bicycles had been opened, to encourage more cycle use. Members were informed that there was a programme in place which looked at future parking modelling.
· A dedicated pick and drop off point for 30 minutes would be introduced shortly, and the Trust was working with the voluntary sector to ensure the volunteer drivers were aware of this. The impact of the drop off/pick up point would be monitored.
· A Member questioned whether a shuttlebus could be introduced and was informed that there was one in place for staff which ran from Reading Station via Queen’s Road. The Trust was working with Reading Buses to encourage more bus routes to the site.
· In response to a question regarding staff trends Raghuv Bhasin commented that staff numbers were generally increasing. The Trust was rated ‘Good’ by the CQC and had a good reputation for research and training.
· With the increased focus on digital communication, a Member queried whether additional staff were being used to manage communication, and how it was ensured that those who were less IT literate did not miss communication. It was noted that a Digital Hospital Programme had been in place since 2017 which had changed the organisation into very paper lite. The Trust had continued to invest in digital during the pandemic, in areas such as maternity and theatres. Staff training and retraining had been crucial to the success of this. A lot of the administration team now worked largely through digital means. Artificial intelligence was used for some process automation tasks, freeing up staff time to focus more on quality provided and helping those that may require more assistance.
· The Trust was working with independent sector colleagues to maximise staff capacity.
· Members asked about Covid vaccinations for staff and the Trust’s approach to those who were not vaccinated. Raghuv Bhasin stated that there a number of staff who were medically exempt and individual risk assessments as to the duties that they could undertake would be carried out. These were signed off by the Director of Nursing. High levels of PPE were worn throughout the hospital. The number of unvaccinated staff was small with the Trust having one of the highest levels of staff vaccinations in the country. The booster and flu vaccination programmes were going well.
· The Committee discussed the use of Artificial Intelligence. Raghuv Bhasin referred to the use of Brainomix by the Stroke Service to speed up the diagnostic process. Artificial Intelligence could also be used to go through waiting list and identify those in need of targeted support.
· Members referred to the survey undertaken by Healthwatch regarding services during the pandemic and commented that maternity services in particular had received quite negative feedback. Raghuv Bhasin stated that maternity was a key area of focus for many Trusts, particularly following the Ockenden Review. There had been challenges with recruitment and retention in this area with 14% vacancies and a 10% turnover. However, over twenty midwives had recently been appointed, and a Maternity Summit had been held with the Executive and Maternity in the last six weeks to agree actions to improve and support this area. Work was being undertaken with patient leaders to improve the services provided. The Chairman commented that the Committee hoped to look specifically at maternity services at a future meeting.
· Members questioned how they as Councillors could assist the Trust. Raghuv Bhasin indicated that it would be helpful if the Members could publicise the winter pressures campaign. The Winter Plan would be circulated to the Committee.
· Raghuv Bhasin thanked Council officers in Adult Social Care for their support.
RESOLVED: That
1) the update from the Royal Berkshire NHS Foundation Trust be noted and Raghuv Bhasin, thanked for his presentation;
2) an update on the implementation of the Winter Plan be requested.