To receive a presentation from Jean O’Callaghan, Chief Executive of the Royal Berkshire NHS Foundation Trust, to include the Trust’s performance and role as landlord of the Bracknell Urgent Care Centre
Minutes:
The Chairman welcomed Jean O’Callaghan, Chief Executive of the Royal Berkshire NHS Foundation Trust to the meeting to speak about the performance of the Trust and the Bracknell Urgent Care Centre.
It was reported that the Trust’s governance structures had been reviewed and a new risk management framework developed. The Board was now working to develop a long term strategy for the Trust.
Generally the Trust’s performance was improving and mortality rates were below the national average. However, it had been found that the Eighteen Week Pathway Rules for monitoring waiting times were not being applied correctly and people were waiting for longer that they ought to have been. An error that had resulted in the review of over 40,000 cases to ensure that patients were correctly placed on the pathway. The correct reporting methodology was now being used and the Trust was compliant with two out of the three pathways monitored. Compliance with the third pathway was expected by the end of July.
With 94.89% of the patients attending accident and emergency during quarter 2 receiving treatment within the target times set, the Trust was one of the best performing in the Thames Valley for accident and emergency waiting times. However the target had been set at 95% and had consequently been missed. The size of the Accident and Emergency unit was such that it was currently not able to cope with the demands placed on it and the target had also been missed in Quarter 3 and was expected to be missed again in Quarter 4. To address this the Trust was exploring ways of expanding the footprint of their urgent care provision.
Other positive areas of note included:
· The opening of a new £10million surgical facility
· Positive returns from the staff survey particularly when compared to the staff survey out-turns from other Trusts
· The Royal Berkshire Trust was considered to be one of the best heart attack treatment centres in the Country
· Work was taking place with Reading University to develop a Physician’s Assistant Role. This was a common role in North America where assistants provided a service that was approximately halfway between that of a nurse and a doctor
· Work was also taking place to address capacity issues in the provision of maternity and ophthalmology services.
The Trust’s current financial position was considered to be challenging and it was expected that there would be a budget deficit of between £6.7 and £8million by the end of the current financial year. Further savings would have to be made in the next financial year and the situation would remain challenging. To address this the Board was working to identify where savings might be made through improving processes and service efficiencies as well as exploring alternative ways of delivering services and improved partnership working.
There had been an increase in the number of incidents being reported. This was not seen to be a negative because it meant that people were willing to report incidents and the data being collected was now more accurate. Feedback was finding that where incidents were reported they were well investigated and patient feedback on the outcomes was positive. To assist the reporting process a new electronic system had been introduced and staff were being trained to use it correctly.
Staff behaviour had been a known problem in previous years and the Trust was still getting too many complaints about staff attitude and rudeness. The Trust’s Board monitored complaints and had a zero tolerance approach to dealing with unsatisfactory behaviour. Following staff feedback that the appraisal process was not as good as it might have been the process had been reviewed and updated and work to further improve the process was ongoing. Staff training had also been increased and the target to achieve an 85% participation rate had been met and subsequently increased to 90%.
The Care Quality Commission (CQC) and the Clinical Commissioning Group were monitoring action plans that had been put in place to ensure the Trust’s compliance with identified problem areas. Performance against these action plans was regularly monitored by the Board and the latest overview progress report would be forwarded for information.
It was acknowledged that although the work of those within the Dementia Unit was praised by those using the service there had been complaints about the knowledge and awareness of staff who worked outside the unit particularly in relation to awareness of the Mental Capacity Act and Deprivation of Liberty Safeguards. Staff training had been put in place to address this however the high turnover of staff meant that this was currently an ongoing concern.
Whilst the calculation of mortality rates was a complex process, the data had indicated a higher mortality rate at weekends and the Board had moved to improve out of hours consultant cover and work was taking place to examine how the hospital could be fully serviced seven days a week. In the Accident and Emergency Department a consultant was available twenty four hours a day seven days a week and there was senior coverage on the unit twenty four hours a day.
The volume of administrative tasks that staff had to do had increased over time and the Trust did work to ensure that staff were doing the right jobs.
It was acknowledged that the Working Time Directive had impacted on staff availability however working too many hours was not considered good practice when it came to patient care and the directive had reduced this.
Bracknell Urgent Care Centre, Brants Bridge
The Trust was committed to providing more services in the wider community and was working with the Clinical Commissioning Group to explore ways to further develop the offer available at the Bracknell Urgent Care Centre and to occupy the second floor of the building for example through the provision of an endoscopy service or a fracture clinic. However it was stressed that the Trust did have to cover its costs and a range of options would be considered when planning new services at the Centre.
The Panel expressed concern that when the service was re-commissioned in April there would be a significant rent increase. It was thought that an automatic rent increase had been incorporated into the contract for Brants Bridge however it was agreed that the matter would be clarified.
It was noted that there were anecdotal reports that the atrium at the Brants Bridge building suffered from temperature extremes. It was agreed that the matter would be explored and a solution developed. Garage lighting and the availability of refreshments were also raised as issues requiring attention.
The Panel thanked Jean O’Callaghan for her update.