Issue - items at meetings - Emergency Care Update- Brighton & Sussex University Hospitals Trust

Presentation by Matthew Kershaw, Chief Executive – Brighton & Sussex University Hospitals Trust (copy attached).

14.1    The Committee received a presentation from Matthew Kershaw,  Chief Executive of Brighton & Sussex University Hospitals Trust (BSUH) in relation to an update on emergency care, focussing on the hospital’s current performance, achievements and challenges.

14.2    Mr Kershaw explained in more detail the areas that needed improving, highlighting that the quality of care given to patients, including waiting times, and their experience was essential. The Trust’s performance against the four hour national standard had fallen; there had been a number of incidents of 12-hour trolley breaches, ambulance handover delays and very high demands for unscheduled care. There have also been concerns raised by the coroner in relation to the Acute Medical Unit.

            Mr Kershaw said that there were a number of reasons for this and that the hospital remained at very high capacity. Independent consultants had assessed the hospital as needing 127 more beds in order to meet the demand effectively.

            The focus on the next six months would be on patient flow and patient experience, capacity and process.

14.3    Matthew Kershaw and Dr Mark Smith, Chief Operating Officer, BSUH, explained to the Committee that departments were particularly under pressure due to the hospital design and the types of patients that they attracted due to their position as a trauma centre. The 3T development will be progressed over the next few years.

14.4    Dr Smith explained that once the hospital expanded, and had additional capacity, the intention was to employ more specialists to treat significant injuries and illnesses. He explained that usually patients would travel to the hospital where there was greater specialism in their specific area of care, rather than simply go to the closest hospital. Dr Smith believed this would help improve the waiting time for patients.

14.5    In response to Councillor Allen’s question about the number of Care Quality Commission inspections, Mr Kershaw said that there had been an announced inspection in May 2014, with 45 inspectors looking at 64 performance areas. They have recently had an unannounced inspection, with ten inspectors focussing on Emergency Care and AMU. BSUH was still waiting for the formal assessment results.

14.6    Ms Fagge said that she was responsible for delivering the action plan brought into place following the May 2014 inspection. Unfortunately the actions for the Emergency Care department had not moved forward as much as had been hoped.

14.7    In response to Councillor Wares, Mr Kershaw answered queries regarding the ambulance turnaround time by explaining that the paramedics were now assessing the patients before bringing them to hospital or taking them to an alternative provider. This was improving the turnaround time, but ongoing work was needed to progress this upward trend further.

14.8    In response to Councillor Peltzer Dunn, Mr Kershaw clarified that the target for 999 emergency telephone pick up times was within one minute; however, approximately 93% had an average of being answered in 33 seconds. Mr Kershaw recognised the concerns of the Committee that there was still further work to be undertaken to improve in this area.

14.9    In response to Councillor Cattell, Ms Fagge clarified that the “dump the junk” programme was in place to dispose of items that were broken or not of any use. This helped with infection control. Ms Fagge went on to explain that the remaining “clutter” was predominately equipment that was used regularly, but needed to be more productively organised.

14.10  In response to a further query from Councillor Cattell, Mr Kershaw outlined that a proportion of the staff in the hospital, such as caterers and cleaners, were external agency but the service was being brought inhouse. This should be completed by the beginning of September 2015. Mr Kershaw was confident that this would show improvements, as staff would feel part of the same team with the rest of the hospital staff. They would have to decide the long term plan for the service in due course.

14.11  Ms Polanski asked whether the hospital had noticed any increases in attendance due to the closure of Eaton Place practice. Mr Kershaw said that they had not noticed any dramatic increase thanks to the work of the CCG and NHS England to transfer the patient lists.

14.12  In response to a query from Councillor Page about the Risk Summit that had recently taken place, Mr Kershaw said that the Summit had discussed similar issues about unannounced care. The Trust would be returning to the Summit in October to check progress against the actions that have been agreed.

14.13  Ms Cambridge stated that Healthwatch had visited the Accident & Emergency department last week and had agreed to undertake more Enter and View visits in the future to monitor the situation. She also commented on how friendly and engaging the staff were, and reminded the Committee that the main causes for concern were in relation to patients’ basic care which needed further improvement.

14.14  Ms Cambridge said that she was aware that the independent Ombudsman was leaving the Trust; what was the proposal to cover her role as independent advocate? Mr Kershaw said that there was a national drive for ‘Freedom to Speak’ champions in healthcare and they would be replacing the Ombudsman’s post. In the interim, the Safety and Quality Team would be picking up issues raised.

14.15  In response to the Youth Council representative about international recruitment, Ms Fagge explained that there was local advertising to recruit nurses and GPs as well as on going work with local universities in this area but that it was necessary to recruit internationally to meet the demand.

14.16  In response to a query from Councillor Moonan about the link between BSUH and Adult Social Care, Mr Kershaw said that the two organisations worked very closely together with positive results, particularly in Brighton and Hove.

14.17  The Committee agreed a further progress update to the November meeting of the Committee.

14.18  RESOLVED – That the Committee note the contents of the presentation and the response to their questions.