Agenda item

(Maximum of 60 minutes allocated)

The Panel considered the latest position regarding the Action Plan at Heatherwood and Wexham Park Hospitals NHS Foundation Trust to address warning notices issued by the Care Quality Commission (CQC) and Monitor.  Grant MacDonald, Deputy Chief Executive of the Trust, was in attendance and introduced the schedule of completed, ongoing and new actions being pursued by the Trust’s Executive Team.  He confirmed that after publication of the second CQC report in January 2014, a follow up inspection had been made in February which would result in a further inspection report being issued around late April/early May.

The following points arose from answers to questions put by members:

• Approximately 220 qualified nurses had been recruited in the last year, but with a 14% turnover of staff this was the number needed to ‘stand still’.  The additional bed spaces provided had increased the staffing requirement it was anticipated that a further 290 nurses would need to be recruited in the year ahead to reduce the vacancy rate to about 10% (which was manageable).
• With regard to cleanliness, a second independent deep clean had been carried out and the recently appointed Facilities Director would have responsibility to oversee improved arrangements for a thorough ongoing routine cleaning programme.  A comprehensive replacement programme for ward-based equipment had been carried out and a rolling programme for future replacements put in place.
• Examples of good practice from other hospitals trusts had been taken up, particularly in relation to customer care.  A set of basic “Always” themes had been adopted and the Frimley Park customer care training model had been introduced.
• It was acknowledged that work on implementing improvements was resource intensive and required a big commitment from staff.  However, the additional funding available in the last two years had enabled a continuing investment in the training and development of staff, and additional people had been brought in to assist the permanent staff.
• Improvements had been made to the discharge process and the liaison with colleagues in Social Care services was good.  Results remained patchy because although the procedures were sound, they were not always followed.  It was recognised that if a patient was discharged before adequate home arrangements were in place, then this could put a life at risk or lead to an early re-admission.
• The role of ward matrons had been strengthened to give them greater authority to act and to be effective advocates for the patients in their care.  Nurse leaders were charged with embedding and monitoring agreed care standards.
• A lot of work had been done to enable the Trust Board to be kept fully informed of what was happening on each ward and to closely monitor key indicators.  The compliance team put in place carried out monitoring of patient experience on a daily basis.

Sarah Bellars, Nurse Governor from Slough CCG, confirmed for the Panel that the Trust had shared information on the improvements taking place and progress was considered monthly by the Clinical Quality Review Group.  There were also a number of other meetings at which progress was reviewed as well as physical inspections and receipt of patient feedback.  A recent tour of wards with the Director of Nursing had shown a very different picture from that seen a year ago when the hospital was struggling to cope with capacity issues.

Colin Pill reported on behalf of Healthwatch on a community engagement visit at Wexham Park during in August 2013, when patients and visitors had been advised of the role of Healthwatch and a survey carried out to obtain views for the patients and public.  Survey results confirmed that the majority of patients considered they had been treated with dignity, given privacy and treated with respect.  Some had raised concerns about issues such as not being kept informed, long waiting times at Inpatients and A&E, lack of hygiene as well as the ongoing issue of lack of car parking.  A start on a proposed piece of work relating to patient discharge was outstanding.

Resolved –

(a)  That Grant MacDonald be thanked for attending to report and answer questions on quality and improvement work at Wexham Park.

(b)  Further information be considered in due course on progress regarding discharge procedures, including separate data for Slough and South Bucks residents, and results from the Healthwatch project to look at this.