Agenda item

To consider the Trust’s draft Quality Account for 2017/18 including the position on progress made, continuing priorities and the plans set out to deliver them.

Shona Maxwell, Professor Julien Redhead and Mick Fisher were welcomed to the meeting.  Councillor Richardson briefly explained that the Committee had unfortunately missed the opportunity to scrutinise the Draft Quality Accounts for 2017/18 due to the timetable imposed by the Care Quality Commission and because of local borough elections purdah.

Professor Redhead acknowledged that areas for improvement had been identified.  The Trust was currently placed in the top five nationally with strong performance on cancer, achieving the 60-day standard.  However, they had continued to struggle with Accident and Emergency (A&E).  The Trust aimed to continue engagement with residents and key priorities had been channelled into the draft strategy.  Key performance indicators were to be monitored through the Trusts own governance structure.

Mr Naylor asked how Imperial were specifically addressing the concerns of older people who must navigate complex silos and site pathways.  Professor Redhead responded that this was a local and national concern and that they were working to improve things like signage around the Trust’s sites.

Councillors Caleb-Landy and Kwon highlighted concerns about the Trusts plans for Charing Cross and the uncertainty around these.  There was no mention of the future of Charing Cross in the Trusts Annual Report but there was a reference to further investment for site improvements.  Professor Redhead confirmed that that there were no plans to close the Charing Cross for the foreseeable future and that the Trust would continue to invest in the site, including A&E.  Councillor Kwon pointed out that the end of the current comprehensive spending review 2021 was only three years away and that the promise of investment did not offer reassurance given that there were no plans beyond this. Professor Redhead confirmed that the Trust continued to work with the CCG to provide the best plans for patients and the future configuration of services.

Recruitment and retention of nurses across the NHS workforce was highlighted as a concern by Councillor Lloyd-Harris. The Trust recognised that nursing was in crisis and welcomed any suggestions that might address this.

Merrill Hammer (Save Our Hospitals) raised concerns about the way in which the NHS consulted, particularly about consultation on changes to A&E.  Professor Redhead explained that this was a cost issue and under review.  There were difficulties in redeveloping a site and wider input would be welcomed.

Following a discussion around Delayed Transfer of Care (DTOC), Professor Redhead recognised that there were delays in moving on care and social service referrals, particularly with patients over 7 and 21 days stay. Although this had compared well nationally, a third of patients remained hospitalised for longer than required, and who did not necessarily need to be there. 

Councillor Coleman asked about Charing Cross, the Trusts consideration of SaHF (Shaping a Healthier Future) and the CCG’s views on plans to downgrade Charing Cross.  Professor Redhead said that while the substance of SaHF was referenced, it was the CCG that was largely responsible for its implementation. 

Councillor Coleman referenced page 112 of the Agenda and the Quality Report and staff satisfaction, and the how the Trust addressed staff reports about poor behaviour and performance. Ms Maxwell explained that the Trust had introduced measures to improve the management of performance and encourage greater openness to report incidents. There were staff ward and departmental meetings, standards agendas to ensure staff were on message and consideration about the culture of the working environment. Safeguarding training was offered to staff (adults and children) and the Trust was actively listening to staff. Significant work had been undertaken that could now be translated into tangible outcomes. 

Jim Grealy referenced page 102 of the Agenda, waiting list improvement programme, and asked what key factors might impact on a patient’s wait time and cause this to exceed 52 weeks.  Professor Redhead said that the impact of emergency cases affected routine patient care and delayed elective procedures.  Additional factors included the use of patient data sharing and accuracy of information.  The issue was not about the number of beds.

Patient discharge and readmission impacted on patients between the hospital and the introduction of a medical and social packages in the community.  Lisa Redfern observed that there was little mention of social care.  Professor Redhead explained that they were working closely with the CCG and colleagues in social care to ensure that care packages were in place, but that there could be miscommunications about the start dates for care packages.  There were also certain ambulatory discharges that were included in the figures provided. 

Councillor Coleman commented that there was a joint responsibility between the Council, CCG and the Community Independence Service.  He observed that there was often a lack of information and insufficient co-ordination.  The Trust was under great pressure to discharge early and there was a significant concern that this would adversely affect vulnerable people. Professor Redhead said that cost was not a factor in decisions to discharge and that a fine balance was maintained in the allocation of resources.

RESOLVED

That the report be noted.