Members received their annual update from the South Tees NHS Foundation Trust which covered 4 main areas, Care Quality Commission (CQC) ratings update, Health Care Associated Infections, the current financial position and parking issues.
The Director of Quality and Risk took the panel through the CQC inspection and the Healthcare Associated Infections section.
The CQC had inspected the Trust in December 2014. The inspection covered 5 domains of quality against a set of standards at the James Cook University Hospital, the Friarage Hospital in Northallerton and community provision. There were 4 possible ratings, inadequate, requires improvement, good, and outstanding. The Trust had received an overall rating of 'requires improvement' and the panel had received information on the improvement actions that had been put in place to at their meeting in August 2015.
Since the inspection in December 2014 the Trust had received regular reviews by the CQC about their improvement plan. The Trust was then revisited by inspectors in June 2016 and then received an overall rating as 'good, improvements had been made in areas rated as inadequate or required improvement and no areas received those ratings. The Trust were pleased to have been rated as 'good but their aim was to be 'outstanding. In a national comparison of trusts Members were told that 68% of trusts were rated as inadequate or that required improvement. 28% were good and 4% outstanding.
The Trust had a number of areas that had been rated as outstanding and that included: improvements in patient flow and admission avoidance; and improving advance decision making in End of Life Care.
The Trust were asked to undertake a number of 'should dos which were: increased pharmacist support to wards; checking of controlled drugs and improvements in medicines reconciliation; and developing their End of Life Care strategy. There were no sanctions placed on Trusts if they didnt complete their 'should dos but as the Trust wanted to move to 'outstanding those issues were classed as the top priority for the organisation regardless of the CQC judgement.
The Chair asked if the developments with the BHP and the STP were stopping the Trust from doing things. In response the Trust replied that in the proposals the JCUH was still going to be designated as a specialist centre and that key services would still exist in the patch. The STP had not changed their thinking but that it offered the opportunity to work collaboratively in certain areas.
In discussing staff recruitment and retention, Members questioned the turnover of staff. In response the Trust stated that they had a slightly lower turnover than most trusts, many of their staff had worked for the Trust for a long time. Clinically there are some hot spots where it was difficult to fill vacancies. There were some nursing vacancies that included specialist nursing vacancies in neuro critical care. The Trust outlined how they juggled the workforce on a daily basis. They had to make roles attractive to current staff in order to keep them, they had been involved in specific marketing campaigns to target national recruitment, however that was not the first port of call to attact nurses. The Trust operate a bank system of nurses which ensures that they dont have to use agency nurses that would incur greater costs to the Trust.
Work was being undertaken to look at the options of recruitment and retention, national work was being taking place around the role of apprentices and the creation of a new band 4 role of a Healthcare Associate which would operate between the band 2/3 role of a Healthcare Assistant and a Band 5 Registered Nurse role.
As part of the Health Scrutiny Panels work programme Members received the annual update on healthcare associated infections. Statistics were presented on the number of Clostridium Difficile (C-difficile) cases. C-difficile can kill and was transferred in hospitals by patients and staff. Between March 2015 and March 2016 the Trust had 61 cases, higher than the target of 50. There had been 2 Trust apportioned cases of C-difficile in October bringing the total to the end of October to 24 cases however there had been no linked cases since January 2016, which showed that the hospitals preventative measures were working.
The statistical graph presented showed how C-diff could never be completely eradicated. The Trust monitored the statistics on a monthly basis and a weekly report was produced where every case was reviewed by a panel which looked at the care, hand hygiene, staff training, how sick were isolated etc. Checks were made to establish if cases were linked as this causes the greatest concern as it shows a breakdown in the systematic process, for example poor hand hygiene.
There had been 1 case of MRSA bacteraemia in September which brought the total to the end of October to 5 cases. All areas had met their required standards, however it was noted that Teesside was a high prescriber area for the use of antibiotics. The overuse of antibiotics lowered peoples immune systems and their resistance to those bugs. The Trust was working closely with Primary Care colleagues on trying to reduce the over reliance on antibiotics be people in Middlesbrough.
Given the importance of the issue, and the recommendations contained within the Francis Report that highlighted the importance of health scrutiny panels in being kept abreast of issues within the local health economy, the Chair and the panel agreed to have updates on healthcare associated infections a 6 monthly basis.
The Director of Finance for the Trust took the panel through the organisations financial position. In explaining the EBITDA (Earnings before interest, taxation, depreciation and amortisation) rate and how it reflected the health of an organisation, Year to Date figures showed the Trust were £4.0m behind plan. The Trusts overall budget was £300m and the underlying run-rate was behind what was planned. There was an unidentified gap of c.£7.0m. Recovery plan savings of £6.1m (17%) had been achieved to date for month 6 against a plan of £10.7m.
The Trust outlined the problem with debtor balances, notably funding from NHS England at £4.9m and contractual over-performance with South Tees and Hartlepool and Stockton CCGs which were £4.5m and £2.3 million respectively. The cash flow pressures faced by the Trust meant that the Trust had borrowed money from the NHS at various rates of about 2.5% depending on the product.
At the time of the panel meeting the Trusts 18 week waiting times target had been met. The panel discussed sanctions that were placed on trusts for the non-compliance of targets. Fines would be levied on the Trust should they fail to meet that target. It was noted that the Trust had an excellent relationship with the CCG and as commissioners the CCG would re-invest any fines back into the Trust to help improve services and prevent future penalties. However new penalties were now paid at a national level and there was no local discretion to return those funds back into services.
Members were keen to receive an update to clarify the position with the new car park, Members were informed that the Brackenhoe car park that had 700 spaces closed on Friday 28 October 2016 and the Prissick Base car park (1100 spaces) opened to staff on Monday 24 October 2016.
On the whole the new Prissick car park has been welcomed had received positive feedback. The Trust was to conduct a wider review of car parking across the James Cook site which was to be concluded by the end of March 2017. The strategy would consider who parks where and would also consider which entrance people would use to help avoid the Marton Road exit and also help ease traffic flow in that area.
Members discussed the cost of public parking, during those discussions Members agreed that the 15 minutes free parking was not sufficient time in order to be able to drop people/items off at the hospital given the large nature of the site. It was agreed that it would be prudent to write to the Trust and seek their consideration to extending the free parking from 15 to 20 minutes to assist those people who only visited the site for very short periods.
AGREED - That the Democratic Services Officer drafts a letter to be sent on behalf of the Chair and the Health Scrutiny Panel to the South Tees Hospitals NHS Foundation Trust which asks the Trust to consider extending the 15 minutes free visitor parking to 20 minutes.