Agenda item

BHRUT reminded the Board of the background to how the poor performance had occurred and gave a presentation on the work that had been undertaken on their 18 week Right to Treatment (RTT) Recovery and Improvement Plan and the work streams within it.  In addition, they had now completed a major validation exercise on the data and now had accurate information on the patients waiting to be seen

BHRUT advised that good progress had been made to reduce the backlogs on both admitted and non-admitted patients.  BHRUT had developed a trajectory to clear the longest waiting patients and by 3 April 2016 had made, better than expected progress against that target, with a 34.8% reduction in those patients waiting.  The total number of patients on the Trust waiting list had now been reduced from 114,000 to 54,000.  The Trust was also undertaking a review of the RTT administration roles for booking and managing patient pathways.  However, even with material demand management, outsourcing, additional recruitment, improved theatre productivity and administration the size of the backlog meant that it would take until 2017 to clear. 

BHRUT advised that they were also developing detailed demand and capacity plans for the specialities.  These plans would allow staff to quantify weekly any capacity gaps and assist with future planning to match resources with patients’ needs.

BHRUT reiterated that they had a communications strategy in place.

CCG advised that their role was to hold the BHRUT to contractual delivery and ensure that the Trust adhered to the Improvement Plan.  Havering CCG, as the lead on contracting body for BHRUT, had been issued with legal directions in June by NHS England.  The CCG also had a role in averting 30,000 GP Outpatient referrals in high demand sections out of BHRUT.  The Board’s attention was also drawn to the work which was being undertaken to design new clinical pathways for 10 key areas. 

The escalated position had provided extra support to focus on the RTT problems.  A robust, overarching recovery plan from the Trust with a CCG Demand Management Plan would need to be signed off and reported to NHS England in September 2016.

Cllr Carpenter asked for clarification in regard to the backlog taking till 2017 to clear and what affect that would have on new patient referrals.  BHRUT responded that both current backlog and new patients were being taken into consideration and assessed to determine clinical priority and any problems were also being resolved in regards to incorrect pathway data. 

Cllr Butt indicated that despite raising this issue with the BHRUT Chief Executive at his recent attendance at the Board, she was dismayed to see individuals were still being referred to by BHRUT as ‘waiters’, rather than people or patients.  BHRUT apologised for this and gave an undertaking that this would not happen again.

Cllrs also raised concern about the value of the additional leadership and administrative roles and if the cost of this would be taking resources away from treatment.  BHRUT responded that this area had been under resourced for some time, and it was felt that the lack of overview was probably a contributory factor as to why the situation had occurred.  The structure would be needed to deliver the Plan, in addition some of the leadership roles also had clinical functions.

Cllr Turner reminded BHRUT that their Chief Executive had given a commitment to provide details on the number of patients in each specialist area and how many of those patients were LBBD residents.  Cllr Turner repeated the request for those details and the current number of LBBD residents still on the waiting lists.  BHRUT apologised and said they could provide locality data, down to a General Practice level, and would do so by the next meeting.

Councillor Bright raised concern on the communication strategy as a number of people had spoken to her about being referred to Queens and nearly two years later they were being sent back to their GP.  In that time they had either not heard anything from Queens or were now being told they could go private; but many could not afford to do so.  The Chair commented that this meant that either the BHRUT communication was not getting to the correct people, there was a lack of good quality communication or it was not being explained well, which meant that patients had not understood what the options were.  The Chair suggested that as the Council regularly communicated on mass with residents, that expertise could have been useful in making the letters and other communications easier to understand, for example when there was mention of the private ‘Roding’ hospital patients would have assumed they would need to pay, when it would in fact have been funded fully by BHRUT.  Anne Bristow, Strategic Director of Service Development and Integration, raised the issue of Stakeholder communication and consultation and said it was no good telling Partners after the event and this must be undertaken earlier in order that partners input could be given, so the message would get across to the public.

BHRUT advised that they would be looking at communicating with GPs to make sure that they understand that the alternative providers would be free to the patients and would take the issue of consulting earlier with Partners back to their colleagues.

BHRUT gave an assurance that Clinical reviews were undertaken of each individual on the waiting list to ensure they suffered no additional clinical harm. 

In response to a question from Cllr Oluwole, BHRUT advised that any private / independent providers used would be checked to ensure that they meet the clinical and other governance capacities required by the NHS.

Anne commented on the 780 extra operations expected to be undertaken by the end of September as this was not a huge number considering the 54,000 people on the waiting list and the historic recruitment issues in many specialisms.  Anne asked BHRUT how many of the new approved posts were actually filled.  BHRUT advised they were ahead of the trajectory target for treatment and recruitment was ongoing but where there were gaps locums and the independent sector were being used.

Sean Wilson asked if the individual patient’s issues were becoming more complex and also if direct employees could not be recruited was the outsourcing more expensive.  Dr Moghal advised that patient issues were increasingly more complex often needing input from a number of specialist areas.  The costs of outsourcing all or some parts of more cases was not necessarily any more expensive than dealing with all aspects of treatment within BHRUT facilities.

Conor Burke, Accountable Officer, Barking and Dagenham, Havering and Redbridge Clinical Commissioning Groups, suggested setting up a sub-group to consider the issues in more detail.

The Board

(i)  Noted that the number of people waiting for their appointment had now been reviewed and BHRUT confirmed that this now stood at 54,000 patients;

(ii)  Noted that BHRUT had not yet recommenced reporting its Referral to Treatment performance to NHS England;

(iii)  Requested BHRUT to provide an update on patients’ Referral to Treatment waiting times to every Board meeting until the NHS Constitution standard, which gives Patients a legal right to start non-emergency NHS consultant-led treatment within a maximum of 18 weeks following a GP Referral, was achieved and embedded at BHRUT.

(iv)  Suggested that consultation with the Council would have been helpful in drafting the communications with the patients waiting for appointments.  Particular concern was raised in regards to the lack of understanding by patients that alternative treatment provided outside of Queens and King George hospitals would still be paid for via the NHS and that there would be no charge to patients for accessing these services at private facilities

(v)  Reminded BHRUT that the Board was still awaiting details of:

(a)  The numbers of patients in each specialist area and how many of those patients were Barking and Dagenham residents. 

  The Board also now required details of the current number of LBBD residents that were included in the outstanding 54,000: and

(b)  Evidence to substantiate the previous anecdotal claim by BHRUT that patients were prepared to wait longer to be seen within BHRUT rather than being treated by other providers. 

  The Board now also required details of the number of LBBD residents that had already been referred to independent / private providers or non BHRUT hospitals.

(vi)  Reminded BHRUT of the previous request made by the Board for them not use the term ‘waiters’ in their future reports and that ‘patients’ or ‘people’ was more appropriate.