Thursday 28 February 2013

Proposed staff reductions

I have been asked a variety of questions following reports in the media of proposed staff reductions in the Royal Surrey so this is what I know. As in all Trusts financial pressures are great putting pressure on the hospital to make savings. The following is what is proposed and is now subject to consultation with unions.
Ø All vacancies are being reviewed and cannot be filled without permission of senior management
Ø Strenuous efforts are to be made to reduce the use of agency nurses
Ø Loss of one specialist palliative nurse
Ø Loss of one specialist gynaecological nurse
Ø Loss of one care assistant on each ward
Ø Some sharing of medical secretaries
Ø Some loss of non-frontline staff

There will be no loss of consultants or other medical staff.

Governors have been assured that all this has been formally risk assessed to ensure that there is no danger to patients.

Naturally I and other governors do not welcome loss of staff particularly frontline staff such as nurses. Of course we will watch out for any significant deterioration of quality of care and should we have concerns will make our views clear. However it has to be recognised that is exceedingly difficult to associate any deficiency to a staff reduction with any degree of certainty not least because we all know that care staff will as always up their effort to ensure patients continue to be well cared for. I am particularly sad to see the loss of a specialist palliative nurse and the impact it will inevitably have on those who are experiencing the ultimate in suffering.

Thursday 21 February 2013

Mortality statistics

When I sought election I said I would concentrate on looking at information about clinical outcomes in areas which are life threatening or life changing. One of those areas is mortality statistics. I have spent the last 5 months collecting data on hospitals in the S.E. and getting to grips with the intricacies of the various mortality indices which hospitals use. There are five: one national from the NHS Information Centre (NHSIC) which everybody uses, two from the company Dr Foster  and two from the company CHKS. RSCH uses the CHKS's.

The first thing to say is that having five different indices is a mess. One of the indices from CHKS is terrible (NHSIC agrees) and its meaning is widely misunderstood including within RSCH. I am pleased that RSCH has agreed not to rely solely on this indicator. One of the recommendation from the recent Francis Report on Staffordshire Hospital recognises that it's all a mess and calls for an in-depth review. I intend to do what I can to encourage that review (I will report on that another time).

Pleasingly RSCH is in the top 15% judged by the national NHSIC index (an excellent indicator). Its value indicates that for RSCH deaths are about 10% lower than would be expected. However this index looks at deaths in hospital plus deaths outside within 30 days of discharge. It needs therefore to be used in conjunction with an index or indices which deal solely with deaths occurring within the hospital. For that purpose RSCH uses the two indices from CHKS.

I have examined RSCH's monthly Performance Reports for 2012 to see how it reports on mortality and have looked also at Dr Fosters indices for RSCH and various national data. Just before I was due to discuss what I found with hospital staff:
Ø Dr Foster published its 2012 statistics on mortality;
Ø The Francis Report was published throwing a spotlight on how hospitals handled their mortality statistics (it was Dr Foster's statistics which threw Staffordshire Hospital in to the limelight).

These events have caused a flurry of media interest with the Department of Health announcing an investigation of mortality in a number of hospitals where Dr Foster and NHSIC indices look particularly bad. RSCH is not one of them but, like all hospitals, it has been stimulated to look closely at its figures.

Even though its performance judged by the NHSIC index is very good, its performance judged by the recent Dr Foster publication is not. The hospital is determined to discover why. One of the likely reasons is technical in that, where a patient is receiving palliative
care and thus likely to die, the hospital is failing to capture that fact in its coding of the patient's care episode. Indeed in national statistics RSCH appears to have far fewer deaths coded palliative than the great majority of other hospitals. The affect of this deficiency in coding is to make the mortality index worse than it would be if coding was better.

I have met with the Medical Director and the Chairman of the Board and discussed the reporting on mortality in Performance Reports, NHSIC and Dr Foster's figures and the matter of coding of palliative cases. The meetings have been extremely constructive and results will be fed in to the major review of coding and mortality which the hospital is undertaking in the light of the Dr Foster data and backlash of the Francis Report. Nothing to date leads me to believe that quality of care is poor.  I am being kept in the loop. RSCH will not be the only hospital taking a good look at how it deals with its mortality statistics and that can only be good for patients.

I have also been looking at cancer survival rates – more later.

Monday 11 February 2013

Eye clinic

One of my main preoccupations over the last month or two has been the Eye Clinic. I was aware of complaints about excessive waiting and the poor cramped waiting area. So I met with the lead clinician and sat in the clinic on two occasions to see what was going on. Whilst there I spoke with 30 patients and it was very apparent that all is far from well. Waiting is excessively variable even for the same sequence of events and can be from 1 hour to 5 hours. No information is given to patients and often there are so many people in the clinic there are no spare seats. Four of the patients had bad experiences with missing notes.

I have written a report and had a very constructive meeting with the Chief Executive and his senior staff. I also copied the report to the other governors who are now also seeking a resolution of the problems.

In essence the hospital recognises the problems and is determined to do something about them including
Ø Making more waiting space for the clinic;
Ø Implementing the computerised Clinic Manager as in other OP clinics which will provide overhead screens with information on clinic progress of patients;
Ø Reviewing the question of missing notes;
Ø Employing more clinical staff.

Already a new member of staff has been appointed to improve the flow of patients through the clinic and I hear she has had a very favourable impact.

The hospital is documenting a timetabled plan which it will soon share with me and the governors. They have also indicated they will produce a note on all of this so that patients can know what is going on.

So far so good but realising this all will take a bit of time.