Agenda item

Steve Russell, Deputy Chief Executive, BHRUT presented the report and presentation and informed the Board that following publication of the Improvement Plan in June 2014 there had been significant changes to the leading personnel and some of the roles in the organisation.  For the last four months the Trust had published and circulating its monthly progress report, which included details of key achievements and changes made.

Steven Russell went on to outline some of those changes:

·  Work Streams and Organisational Development

New Chief Executive and the rest of the senior management team had been appointed, with the exception of one post for which the interviews would be held on 29 October.  It was expected that all senior Executive staff would be in place by January 2015.  The reorganisation of the clinical management and middle tier would begin shortly

Five new non executive directors were now in post.  Steve Russell said that the new BHRUT Board would, in his view, hold the Chief Executive and senior Executive staff to account.  The Executive staff were being challenged, and were “stepping-up their game” to meet the expectations and demands from the non executive BHRUT Board members.

·  Outpatients

The management were now actively listening to the staff and feedback from patients.  As a result there had been some significant patient interface improvements.  For example,

-  Now achieving 97% of calls are being answered (up from 40%).

-  Short-term clinic cancellations had now been reduced by 87%.

-  Clinics details /specialism had been reviewed to improve correct referrals by GPs, reducing second referrals and delays for patients.

-  Customer Service Improvements had been made and a listening event had been held, as a result the number of concerns made through PALS had reduced, which indicated the actions taken were having a positive effect.  In addition, stock letters were being re-written to make them more easily understood and patient-friendly clinic timetables were being looked at.

·  Patient Care

Over 3,000 staff had been trained in recognising and managing sepsis.

Audits were now being undertaken on how many patients are treated within 1 hour.

Nursing Documentation was also being improved to increase record efficiency and reduce staff time needed to complete the paperwork.

·  Patient Flow

Ambulatory Care Unit and the Medical Receiving Units were now both open

The number of discharges before noon had substantially improved, and this had also improved bed occupancy rates.  This had been achieved by some new simple procedures, which had resulted in priority testing of blood and other tests and faster dispensing of medications for those due to be discharged, as well as carers / relatives being arranged to receive patients at home.

The Assessment Units were now being reviewed.

·  Ward of the Week

Every Friday there is a thank you visit by senior managers for good discharge rates.  These visits had improved feedback and engagement of the staff and improved staff’s attitude to being a valued part of the organisation.

Steve Russell stressed that they had still not “cracked it” but felt that the new team and staff were on the right path and were moving forward and added that governance in the organisation now felt much stronger and more robust and the culture was starting to change.

In response to a question from Councillor Turner, Steve Russell explained that Nursing Documents covered a wide range of care plans and ways of monitoring care on the wards.  Nurses were saying the records systems were not the same across the organisation and it was time consuming working out what was where in the patient folders etc.  As a result the Nursing Documents and patient folder layouts were being reassessed to simplify them and where possible provide some conformity across all the wards / disciplines.

Steve Russell then received and responded to a number of further questions from the Board and Public:

·  Public Transport Difficulties – TfL had approached BHRUT about a seminar on transport access and this should occur in the near future.  Transport difficulties had been raised on a number of occasions and the point would be taken back for discussion with BHRUT colleagues and noted that the Council could also raise the issue of transportation links with TfL if it would assist.

·  Listening Events – As some people could not attend in the day and some preferred not to attend in the evening, BHRUT will be looking at spreading the events over several times of the day and different venues as a way of increasing participation

·  Spend on Locum Staff – The spend on bank and agency staff was about £20m per year.  The priority was to get the spend converted to permanent staff as this would have a quality and care benefit and in addition would improve costs.

·  CQC Systems – CQC had indicated oversight was less strong for mortality information and some areas appeared to be higher than should be expected, but this information may not have be accurate and collection needed review.  The clinical lead for Mortality was now in place and improved governance and other actions would be progressed as necessary.

·  Learning Disability Partnership Board – Steve Russell said he or a Trust Representative would attend the LDPB to improve relations between the LDPB and BHRUT and to obtain their feedback on issues of concern and would be sent dates of the LDPB meetings.

·  Staff Recognition – The BHRUT Executive team now undertook weekly visits to various wards / departments. There appeared to be an improvement in the moral of staff as they now felt their concerns were being listened to.  Steve Russell added that some improvements had started as suggestions from staff.

Mark Tyson advised that a live ‘Twitter’ comment had been posted to the Board in regards to why a member of the public had been told by 999 that ‘babies are not important’.  Steve Russell responded that he was not sure who had made that comment and if the call had been to 999 it may have been a response by LAS to that particular incident, however, he stressed that at Queens all infants are triaged by a specialist paediatrician.

The Chair commented that she felt that there was a level of honesty in the responses from BHRUT that was truly refreshing and some signs of practical improvements, although there was still significant improvement to come.  Conor Burke, Chief Officer, CCG, supported this comment and said he felt that is some palpable change and the honest relationship and work with NELFT and the Joint Assessment and Discharge Service was also part of the solution.

The Board:

(i)  Received the presentation and noted the response of the Deputy Chief Executive of the BHRUT to questions raised by the Board and Public and the progress of the BHRUT Improvement Plan; and

(ii)  Were encouraged by the genuine and positive level of honesty from the BHRUT and felt that whilst there was still some way to go there were clearly some tangible and practical actions being taken and improvements were beginning to be achieved.