Questions at BHRUT board tomorrow
I will be asking five questions at the Barking, Havering and Redbridge University Hospitals NHS Trust board meeting this Wednesday 2nd May. The board reserve 15... minutes for questions. So not all of my questions may be allowed. After the question I explain in brackets the purpose for the question, there will not be time for my reasons to be read out at the meeting. Given the importance of what the board does, 15 minutes seems too little time for the board to be held to effective account for their decisions by the public.
Questions
1) To Trust Chair: in light of Redbridge Council claiming a North East London population increase of 470,000 from 2011 to 2027 will this board consider expanding emergency beds on the King George Site rather than selling off land? (this seems the obvious thing for the board to do. The stat comes from page 102 of the Redbridge Council Emergency Department Scrutiny Working Group of February 2018).
2) To Trust Chair, is there not a conflict of interest between being Chief Executive of BHRUT and NELFT? (MPs cannot represent two consistencies as there would be a clear conflict of interest about whether they where representing Ilford South or Ilford North for example. Joe Fielder is Chair of both BHRUT and North East London Foundation Trust (NELFT). My concern is that at some stage there may be a conflict between what BHRUT want for the site per the plan below and what NELFT want. NELFT own the where Goodmayes Hospital is situated and BHRUT own the land at King George. I would like to see Joe choose which organisation he wishes to represent and resign from one of his posts.)
3) To Matthew Hopkins, is BHRUT supporting all13 recommendations of the Redbridge Council BHRUT Department Scrutiny Working Group and if so, can you point to examples of changed practice in the board papers? (I understand BHRUT has accepted all 13 recommendations, but evidence is required that they are being implemented)
4 Mr Bailey, (GLA member)
Do you agree that the plan to closing acute beds (by this I mean beds for emergency admissions) and replace them using self care and polyclinics (page 73 of Decision Making Case at https://healthemergency.org.uk/…/NE%20London%20Decision%20M…) has been a disaster leading to BHRUT having some of the worst A&E performance in England?
http://www.bbc.co.uk/news/health-41483322
states Barking, Havering & Redbridge University Hospitals NHS Trust ranked 116 out of 133 trusts in England for four hour A&E waits at 73.9%
& should you agree do you support the call of Redbridge Council for two wards to opened to cope with Emergency Admissions?
5 To Chair: Redbridge CCG is refusing to to supply tenders to me for the £55M contract for the KGH day centre unit made by BHRUT and Care UK Ltd? Do you agree that these tenders should be disclosed in full to maintain public confidence in the procurement process?
End of Questions
13 Recommendations below from Redbridge Council
Improving A&E performance and patient/user outcomes and experiences
Recommendation 1
We heard of efforts being made by local NHS organisations to improve performance against the four hour A&E waiting time standard and recommend that BHRUT and Barts Health NHS Trusts consider the findings of the published Care Quality Commission resource: Meeting the quality challenge – sharing examples of best practice from clinical leaders in Emergency Department (CQC December 2017) and reports progress to the Health Scrutiny Committee within 6 months of the date of this report.
(BHRUT/Barts Health)
Recommendation 2
We heard that a high proportion (approximately 30 per cent) of A&E attendances are for non-urgent conditions and we acknowledge that the four hour waiting time standard, set out within the NHS Constitution, whilst being a commitment to maintaining and delivering timely treatment to patients requiring NHS services, had limitations in that it did not differentiate between the most or least vulnerable patients, however it is currently the best way of assessing performance. Despite BHRUT's explanation that the Trust website adheres to accessibility guidelines and that work is ongoing to enhance the website, we understand that the issue of accessible performance indicators has been put before the Council and the Health Scrutiny Committee on a number of occasions and that the Committee has in the past worked collaboratively with the trust to develop an infographic for publication on the BHRUT website, however this does not appear to be regularly updated. We therefore recommend that report be to the Health Scrutiny Committee within 6 months of the date of this report regarding progress to enable the monthly publication of the following key performance indicators, in an accessible format for each hospital site:
Performance against the 95% per cent four hour waiting time target for admitted, non-admitted and total patients.
A scatter diagram of A&E performance showing the present and previous years*
The number of patients waiting more than 1 hour for transfer from the ambulance to the A&E (ie “black breaches”)
The number of beds on each hospital site by bed occupancy category (KH03) (ie including beds allocated to other providers such as NELFT).
(*optional, where available)
(BHRUT/Barts Health)
In view of the complexity of NHS data such as bed methodology, we recommend briefings between the Council and the NHS, including Public Health, to challenge the assumptions and narratives behind data which supports any revised proposals for King George Hospital. (BHRUT /Barts Health/ ELHCP / BHR CCGs / LBR Public Health)
Recommendation 4
In view of the feedback shared by Healthwatch Redbridge regarding public perceptions of urgent and emergency care services, and in view of the mitigation plan outlined for communication within the Revised Clinical Strategy for King George Hospital (PwC / ELHCP, November 2017), we recommend that NHS communication strategies be revised to ensure greater clarity for the public in terms of where they should go to access care for different needs and that the benefitsof the urgent care redirection initiatives are clearly communicated so that the public can make well informed choices.
(BHR CCGs/ BHRUT/ Barts Health, ELHCP)
Recommendation 5
In considering the outcomes of the Healthwatch review of urgent and emergency care services in Barking Havering and Redbridge, we recommend further work byBHR CCGs and ELHCP using these findings to improve public perception, confidence and health outcomes, and we request a future progress report to the Health Scrutiny Committee.
(BHR CCG/ ELCHP / Healthwatch)
Recommendation 6
In relation to the availability of information for patients on the BHRUT website regarding urgent and emergency care services, we note that the Trust adheres to accessibility guidelines and is enhancing its website and we recommend that information about urgent and emergency care services is made available to patients in a range of accessible formats such as large print, easy read, audio and Braille, as appropriate.
(BHRUT)
Recommendation 7
In seeking to effectively communicate the Working Group's findings with local residents, we recommend the production of two short films on social media: i) produced by the Council to outline the facts behind our findings and ii) co-produced by ELHCP and BHRUT to highlight public health campaigns such as the importance of influenza (flu) vaccinations.
(LBR Scrutiny and Public Health/ BHRUT / ELHCP)
Recommendation 8
We welcome the offer by BHRUT and ELCHP in their joint press stakeholder letter (dated 11 December 2017) to engage with key stakeholders, including the Council, regarding
more options for the way urgent and emergency care is delivered, and in particular the services provided at King George and Queen's hospitals and we recommend that NHS organisations agree a sufficient period of time with stakeholders, including the Council, to comment on any revised approach or options for King George Hospital, in order to ensure that the Council can play an active role in promoting consultation or engagement activities via social media or the Council website.
(BHR CCGs/ BHRUT/ ELHCP/ LBR/ Healthwatch)
Reviewing existing proposals for King George Hospital
Recommendation 9
On the basis of the evidence gathered by the Working Group, and in the light of the Revised Clinical Strategy for King George Hospital published by ELHCP in November 2017, which outlined that "A binary approach to decision-making that concludes either to; 'close; or 'not close' theKGH A&E is unlikely to be satisfactory for patients, commissioners and other stakeholders", we welcome the report's recommendation that "the original decision now needs a changed approach", and we recommend that any revised plan includes the provision of an A&E service at King GeorgeHospital.
(BHRUT/ ELHCP /BHR CCGs)
Recommendation 1O
In view of the ongoing need to consider transport arrangements as part of any revised plans for King George Hospital we recommend that BHRUT and ELHCP liaises with Transport for London (TfL) to consider patient flows and reviews the provision of direct bus routes between Redbridge and Queen's Hospital (based in Havering).
(BHRUT / ELHCP/ Transport for London)
Recommendation 11
We note from the PwC/ ELHCP Report (November 2017) that the review had "not undertaken any further scrutiny of the clinical risk profile or the workforce",and the report recommended "a changed approach be based on a redesigned clinical model, maximizing opportunity from existing estate and allowing for thegreatest workforce flexibilities", and we recommend that BHRUT and STP leads undertake a thorough examination of workforce plans to support afuture model.
Furthermore, we recommend an east London-wide recruitment and retention strategy which incorporates a skill-mix of carers/ services within the community including pharmacy, currently an underused resource.
(BHRUT / ELHCP)
Recommendation 12
In light of the Revised Clinical Strategy for King George Hospital (PwC / ELHC, November 2017), which outlined that: "It is apparent that the factors influencing this decision have changed significantly since the original Health for North East London (H4NEL) decision was made [in December 201O]", we recommend that:
i) Plans always include a ten year "horizon".
ii) Plans which involve major decisions should always be subject to an independent evaluation particularly if they involve highly technical work.
iii) Plans should always include an appropriate measure of equity.
iv) Plans should always include any major
delopments which could impact on the outcomes.
v) Where plans have not achieved their
objectives, an appropriate review should be undertaken.
vi) Non-executives are given adequate time and relevant briefings in order to make informed decisions on proposed changes.
vii) There is transparency for all partners, including Public Health. (NHSE / NHSI / ELHCP)
Seeking the provision of resources to support the delivery of safe A&E services
Recommendation 13
Given the requirement within the Revised Clinical Strategy for King George Hospital (PwC/ELHC, November 2017, that: “Business cases for each of the partner organisations will consider the impact on operational finances by incorporating appropriate activity and financing assumptions. The current context in NEL must be framed in light of the existing financial envelope with alignment to prioritised developments for the STP, the Naylor Report (7) (On NHS property and estates) as well as other existing plans in NEL (for example the Whipps Cross redevelopment Strategic Outline Case) and in considering the need for adequate resources to support health and social care, we recommend that:
a) The Council consider ways in which it can support requests for additional central funding to improve recruitment, which could impact positively on patient outcomes and experiences and avoid the the over-reliance on agency staffing.
b) In the event that NHS estates are sold on any local hospital site to finance transformation developments, any surplus capital stock is reinvested into local health care services.
(BHRUT/Barts Health/BHR CCGs/NHSE/NHSI/ELHCP)
See more1) To Trust Chair: in light of Redbridge Council claiming a North East London population increase of 470,000 from 2011 to 2027 will this board consider expanding emergency beds on the King George Site rather than selling off land? (this seems the obvious thing for the board to do. The stat comes from page 102 of the Redbridge Council Emergency Department Scrutiny Working Group of February 2018).
2) To Trust Chair, is there not a conflict of interest between being Chief Executive of BHRUT and NELFT? (MPs cannot represent two consistencies as there would be a clear conflict of interest about whether they where representing Ilford South or Ilford North for example. Joe Fielder is Chair of both BHRUT and North East London Foundation Trust (NELFT). My concern is that at some stage there may be a conflict between what BHRUT want for the site per the plan below and what NELFT want. NELFT own the where Goodmayes Hospital is situated and BHRUT own the land at King George. I would like to see Joe choose which organisation he wishes to represent and resign from one of his posts.)
3) To Matthew Hopkins, is BHRUT supporting all13 recommendations of the Redbridge Council BHRUT Department Scrutiny Working Group and if so, can you point to examples of changed practice in the board papers? (I understand BHRUT has accepted all 13 recommendations, but evidence is required that they are being implemented)
4 Mr Bailey, (GLA member)
Do you agree that the plan to closing acute beds (by this I mean beds for emergency admissions) and replace them using self care and polyclinics (page 73 of Decision Making Case at https://healthemergency.org.uk/…/NE%20London%20Decision%20M…) has been a disaster leading to BHRUT having some of the worst A&E performance in England?
http://www.bbc.co.uk/news/health-41483322
states Barking, Havering & Redbridge University Hospitals NHS Trust ranked 116 out of 133 trusts in England for four hour A&E waits at 73.9%
& should you agree do you support the call of Redbridge Council for two wards to opened to cope with Emergency Admissions?
5 To Chair: Redbridge CCG is refusing to to supply tenders to me for the £55M contract for the KGH day centre unit made by BHRUT and Care UK Ltd? Do you agree that these tenders should be disclosed in full to maintain public confidence in the procurement process?
End of Questions
13 Recommendations below from Redbridge Council
Improving A&E performance and patient/user outcomes and experiences
Recommendation 1
We heard of efforts being made by local NHS organisations to improve performance against the four hour A&E waiting time standard and recommend that BHRUT and Barts Health NHS Trusts consider the findings of the published Care Quality Commission resource: Meeting the quality challenge – sharing examples of best practice from clinical leaders in Emergency Department (CQC December 2017) and reports progress to the Health Scrutiny Committee within 6 months of the date of this report.
(BHRUT/Barts Health)
Recommendation 2
We heard that a high proportion (approximately 30 per cent) of A&E attendances are for non-urgent conditions and we acknowledge that the four hour waiting time standard, set out within the NHS Constitution, whilst being a commitment to maintaining and delivering timely treatment to patients requiring NHS services, had limitations in that it did not differentiate between the most or least vulnerable patients, however it is currently the best way of assessing performance. Despite BHRUT's explanation that the Trust website adheres to accessibility guidelines and that work is ongoing to enhance the website, we understand that the issue of accessible performance indicators has been put before the Council and the Health Scrutiny Committee on a number of occasions and that the Committee has in the past worked collaboratively with the trust to develop an infographic for publication on the BHRUT website, however this does not appear to be regularly updated. We therefore recommend that report be to the Health Scrutiny Committee within 6 months of the date of this report regarding progress to enable the monthly publication of the following key performance indicators, in an accessible format for each hospital site:
Performance against the 95% per cent four hour waiting time target for admitted, non-admitted and total patients.
A scatter diagram of A&E performance showing the present and previous years*
The number of patients waiting more than 1 hour for transfer from the ambulance to the A&E (ie “black breaches”)
The number of beds on each hospital site by bed occupancy category (KH03) (ie including beds allocated to other providers such as NELFT).
(*optional, where available)
(BHRUT/Barts Health)
In view of the complexity of NHS data such as bed methodology, we recommend briefings between the Council and the NHS, including Public Health, to challenge the assumptions and narratives behind data which supports any revised proposals for King George Hospital. (BHRUT /Barts Health/ ELHCP / BHR CCGs / LBR Public Health)
Recommendation 4
In view of the feedback shared by Healthwatch Redbridge regarding public perceptions of urgent and emergency care services, and in view of the mitigation plan outlined for communication within the Revised Clinical Strategy for King George Hospital (PwC / ELHCP, November 2017), we recommend that NHS communication strategies be revised to ensure greater clarity for the public in terms of where they should go to access care for different needs and that the benefitsof the urgent care redirection initiatives are clearly communicated so that the public can make well informed choices.
(BHR CCGs/ BHRUT/ Barts Health, ELHCP)
Recommendation 5
In considering the outcomes of the Healthwatch review of urgent and emergency care services in Barking Havering and Redbridge, we recommend further work byBHR CCGs and ELHCP using these findings to improve public perception, confidence and health outcomes, and we request a future progress report to the Health Scrutiny Committee.
(BHR CCG/ ELCHP / Healthwatch)
Recommendation 6
In relation to the availability of information for patients on the BHRUT website regarding urgent and emergency care services, we note that the Trust adheres to accessibility guidelines and is enhancing its website and we recommend that information about urgent and emergency care services is made available to patients in a range of accessible formats such as large print, easy read, audio and Braille, as appropriate.
(BHRUT)
Recommendation 7
In seeking to effectively communicate the Working Group's findings with local residents, we recommend the production of two short films on social media: i) produced by the Council to outline the facts behind our findings and ii) co-produced by ELHCP and BHRUT to highlight public health campaigns such as the importance of influenza (flu) vaccinations.
(LBR Scrutiny and Public Health/ BHRUT / ELHCP)
Recommendation 8
We welcome the offer by BHRUT and ELCHP in their joint press stakeholder letter (dated 11 December 2017) to engage with key stakeholders, including the Council, regarding
more options for the way urgent and emergency care is delivered, and in particular the services provided at King George and Queen's hospitals and we recommend that NHS organisations agree a sufficient period of time with stakeholders, including the Council, to comment on any revised approach or options for King George Hospital, in order to ensure that the Council can play an active role in promoting consultation or engagement activities via social media or the Council website.
(BHR CCGs/ BHRUT/ ELHCP/ LBR/ Healthwatch)
Reviewing existing proposals for King George Hospital
Recommendation 9
On the basis of the evidence gathered by the Working Group, and in the light of the Revised Clinical Strategy for King George Hospital published by ELHCP in November 2017, which outlined that "A binary approach to decision-making that concludes either to; 'close; or 'not close' theKGH A&E is unlikely to be satisfactory for patients, commissioners and other stakeholders", we welcome the report's recommendation that "the original decision now needs a changed approach", and we recommend that any revised plan includes the provision of an A&E service at King GeorgeHospital.
(BHRUT/ ELHCP /BHR CCGs)
Recommendation 1O
In view of the ongoing need to consider transport arrangements as part of any revised plans for King George Hospital we recommend that BHRUT and ELHCP liaises with Transport for London (TfL) to consider patient flows and reviews the provision of direct bus routes between Redbridge and Queen's Hospital (based in Havering).
(BHRUT / ELHCP/ Transport for London)
Recommendation 11
We note from the PwC/ ELHCP Report (November 2017) that the review had "not undertaken any further scrutiny of the clinical risk profile or the workforce",and the report recommended "a changed approach be based on a redesigned clinical model, maximizing opportunity from existing estate and allowing for thegreatest workforce flexibilities", and we recommend that BHRUT and STP leads undertake a thorough examination of workforce plans to support afuture model.
Furthermore, we recommend an east London-wide recruitment and retention strategy which incorporates a skill-mix of carers/ services within the community including pharmacy, currently an underused resource.
(BHRUT / ELHCP)
Recommendation 12
In light of the Revised Clinical Strategy for King George Hospital (PwC / ELHC, November 2017), which outlined that: "It is apparent that the factors influencing this decision have changed significantly since the original Health for North East London (H4NEL) decision was made [in December 201O]", we recommend that:
i) Plans always include a ten year "horizon".
ii) Plans which involve major decisions should always be subject to an independent evaluation particularly if they involve highly technical work.
iii) Plans should always include an appropriate measure of equity.
iv) Plans should always include any major
delopments which could impact on the outcomes.
v) Where plans have not achieved their
objectives, an appropriate review should be undertaken.
vi) Non-executives are given adequate time and relevant briefings in order to make informed decisions on proposed changes.
vii) There is transparency for all partners, including Public Health. (NHSE / NHSI / ELHCP)
Seeking the provision of resources to support the delivery of safe A&E services
Recommendation 13
Given the requirement within the Revised Clinical Strategy for King George Hospital (PwC/ELHC, November 2017, that: “Business cases for each of the partner organisations will consider the impact on operational finances by incorporating appropriate activity and financing assumptions. The current context in NEL must be framed in light of the existing financial envelope with alignment to prioritised developments for the STP, the Naylor Report (7) (On NHS property and estates) as well as other existing plans in NEL (for example the Whipps Cross redevelopment Strategic Outline Case) and in considering the need for adequate resources to support health and social care, we recommend that:
a) The Council consider ways in which it can support requests for additional central funding to improve recruitment, which could impact positively on patient outcomes and experiences and avoid the the over-reliance on agency staffing.
b) In the event that NHS estates are sold on any local hospital site to finance transformation developments, any surplus capital stock is reinvested into local health care services.
(BHRUT/Barts Health/BHR CCGs/NHSE/NHSI/ELHCP)
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