Agenda item

Steve Russell, Improvement Director of Barking Havering and Redbridge University Trust (BHRUT), presented a report on the Care Quality Commission (CQC) Inspection of the BHRUT Hospitals in October 2013 and the CQC report which was published in December 2013.  As a result of the Inspection, the CQC had recommended that the BHRUT be placed into special measures and that significant improvements were required; particularly around the emergency care pathways, governance, organisation / structures and processes to drive improvements in the quality of services. 

The Board were apprised of the Improvement Plan which BHRUT had drawn up and the five key areas of ensuring the services are safe, effective, caring, responsive and well lead and the progress that had been made and work that was ongoing.  Mr Russell made particular comment in regards to:

·  Consultants would now be part of the patient process much earlier in emergency treatment.

·  600 people had been trained / retrained in sepsis management and treatments.

·  The ethos of the organisation is being changed to be more outward facing and staff are realising the need for joined up working with partner organisations and services.

Mr Russell stressed that special measures had allowed extra support and expertise to be levered-in to progress the required improvements.  There was now strong clinical and managerial leadership and changes were being made organisationally for success.  The most potent factor was that the attitude of staff had changed and they were now much more open and receptive to innovation and the development of the Action / Improvement Plan with the wider health sector.

Matthew Cole, Director of Public Health LBBD, said that the Improvement Plan seemed to be very medical based and asked if were BHRUT satisfied that the organisation had enough support and services for mental health issues.  Mr Russell responded that the BHRUT is keen to develop mental health provision and with NELFT, and would welcome input from partners.

Helen Jenner, Corporate Director of Children’s Services LBBD, said that the work that was being undertaken on the Improvement Plan was to fix the problems found by the CQC inspection at that time, however, there would be a massive change in demographics in the next few years and she asked if the improvement plan would be the only way of moving things forward or if emerging issues could also be given resources.  Mr Russell indicated that they were more aware of such pressures and would work on these issues as well as the response to the Inspection.

Councillor Carpenter, Cabinet Member for Education and Schools LBBD, indicated that she felt that the Improvement Plan was better presented but was still concerned that in the past organisational culture issues had caused blockages to improvement at BHRUT and asked Mr Russell why it would be different this time.

Mr Russell responded that the clinical directors, senior clinicians, operational managers and matrons were now talking about the Improvement Plan as their Plan.  The Plan had been compiled in a different way, with much more ground up consultation and suggestions.  There was still work to do in rolling out the changes, but cultures and attitudes were beginning to change.

The Chair commented that budgets had been top sliced by NHS London but the benefits had not seemed to materialise in the east of London.  John Atherton, NHS England, said that he felt broadly the Improvement Plan was right, it was linked with the right partners and there was a good timescale for change and pace for improvement, bearing in mind the Government agenda and funding issues.

The Chair said felt there were two bits missing, the problems with the building itself at Queen’s Hospital and how we would change the behaviour of the public choosing to go to Accident and Emergency (A&E) because other services are not easily available.

Mr Russell accepted that the building was not optimal at present and that they will be looking at the redesign of A&E in the future.  Work also needed to be done in regards to transporting people to hospitals, and the mindset of being within hospital walls to get treatment when a paramedic /mobile doctor ‘in home’ service could reduce the number of people taken to hospital. 

Dr Steven Burgess, Interim Medical Director BHRUT, stressed that they know they have much more to do but the development of the plan had been at the shop floor and there was a definite culture change taking place following the introduction of the ‘PRIDE’ Programme. 

Frances Carroll, Healthwatch, commented that the over use of A&E at both Queen’s and King George Hospitals clearly indicated that there was a need to look at the primary care sector first and GP services and appointment availability, as well as provision at weekends when GP surgeries were not open.  Steve Russell advised that even if the primary care was better it would still not solve all the issues as there was still a need to change the public’s perceptions and expectations.

Sharon Morrow, Chief Operating Officer B&D CCG, said that it was important that the various partners were aligning plans so that they were all working towards common goals and service provision and this had begun to happen.

The Board

(i)  Noted the Improvement Plan; and,

(ii)  Requested BHRUT to report back to the 28 October on the progress being made against the Improvement Plan and any further actions being taken.