Performance

 

Performance against national standards. Throughout the country hospitals are struggling to meet national standards because of the effect of Covid. All are seeking to catch up on waiting lists which have substantially lengthened during the pandemic. However the Royal Surrey although, like most, is not yet meeting all national standards it is doing well compared with others. For example:

·         A&E 4 hour wait 8^th of 42 national STPs

·         18 week referral to treatment 6^th of 106 Clinical Commissioning Groups

·         referral to treatment waiting list size back to pre-Covid levels

·         52 day plus long waits steadily declining 1^st of 106 Clinical Commissioning Groups

·         Diagnostic waits over 6 weeks declining 6^th of 106 Clinical Commissioning Groups

·         Cancer 2 week wait from referral to being seen, compliant with national standard 18^th  of 106 Clinical Commissioning Groups

·         Cancer 62 day standard from referral to treatment 8^th of 106 Clinical Commissioning Groups

·         Cancer waits over 104 days reducing 10^th of 42 STPs

Let us hope that there is no further Covid peak to reverse these improvements

Hospital keeps all precautions in place

 Understandably some patients have been anxious about going in to hospital during the pandemic. However the number of patients in hospital due to Covid has dropped substantially. So isolation of patients with Covid is easier (e.g. in the new Guildford Ward which is dedicated to such patients). With the Covid burden reduced the hospital is doing its utmost to catch up with a backlog and is seeking to reassure the public as to safety. In that respect you should know that despite 'freedom day' all the precautionary measures in the hospital e.g. masks, other PPP, social distancing, one way systems etc will remain in place. Those entering the hospital will need to wear masks and there will be restrictions on visiting and accompanying of Outpatients - these are detailed on the web site. Hopefully this will be reassuring and let us cross fingers that the hospital will not be inundated with Covid patients as cases in the community continue to grow exponentially.

 

Parking at Royal Surrey Hospital.

Before the Covid epidemic I initiated a programme of ‘patient chats’ to capture patient experience and feed that back to appropriate Department heads. Patient experience was generally very good but it has been the difficulty of parking that has been the concern over and over again. But now there is a chance to do something about it.

For years the hospital has sought to build a multi-storey car park but it has never materialised. However at last a planning application has been submitted to Guildford Borough Council. The application number is 21/P/00817. I hope now that current and past patients and the wider public will formally support the application to ensure it gets granted.

To support email PlanningEnquiries@guildford.gov.uk put the planning application number in the subject heading and in the text and state that you support it. Give your address and post code. PLEASE

Improving patient dignity

 

Most patients in hospital, will probably have encountered a particular patient gown used widely across the NHS. It is the backless one. They are used in the Royal Surrey as in many other hospitals.  Even those who are fit will be challenged to tie a bow behind the neck and if, in error, a knot is tied it will be a struggle to get the gown off. More significantly dignity will have been compromised by a display of underwear or worse (as in the photograph modelled by me !!!).  To solve the problem, some hospitals including the Royal Surrey give out two gowns– one for front and one for back.

For some time I have been of the view that these gowns should be replaced right across the NHS by a wrap-around style. Letters to Royal Colleges, the Department of Health, the Care Quality Commission and current Health Ministers and their shadows in opposition parties have failed to gain traction. Not unreasonably they pointed out that such matters are for local decision.

Since the Royal Surrey used these gowns I, as a Governor, raised the matter at an Annual Members Meeting. I was delighted that the Trust’s Chief Nurse agreed with the comments about the unsatisfactory aspects of the gowns and decided to undertake an investigation into a possible solutions.

Alternative gowns, including wrap-around styles, are available. However, as no gown is without its drawbacks, an evaluation was undertaken. Three options were selected and one chosen, which is known as the ‘three armed toga’ (see photograph). The Trust purchased 500 of these gowns and they were trialled over three months on different wards and departments. A questionnaire survey showed 90 per cent felt the new gown offered dignity, good coverage and a better fit. Patient comments included, “the new gown is a fantastic improvement.” 

The result is that the Trust will now be introducing the new wrap-around gowns to all suitable wards and outpatient departments. The existing style of gowns will continue to be used for some patient groups, including the very elderly and frail, who may find the toga too confusing.

So well done the Royal Surrey – a great improvement in patient dignity.

Now I hope to get my fellow Governors in other hospitals to encourage the same.

 Now that the hospital is coming out of lockdown there's more to report on. 

Anybody who has visited the hospital in the last months will have noticed the new-build 20-bed Guildford Borough Ward created to deal with Covid patients (which it still does) but is now a wonderful addition to the hospital particularly for patients needing to be isolated. 

Although still requiring the wearing of masks and restrictions on visitors, wards taken over by Covid patients are being returned to normal.

It would be great to report that staff are no longer under pressure but that's not so. Everybody is trying hard to catch up on procedures and operations which were cancelled during the height of the pandemic and the long waiting lists that resulted. How fortunate we are to have such dedicated people looking after us. One consequence of Covid is that over half of outpatient 'appointments' were conducted remotely particularly of course follow-ups. I wonder what patients think of this because this way of working will continue. I am told that many welcome  telephone appointments particularly where, for example,  it just confirms that all is OK e.g. normal blood tests. Not having to find a parking place and sit around in outpatients is very welcome! Talking of parking the hospital has been consulting on its proposed multi-storey car park. Its proposals have been widely welcomed and a planning application to Guildford Borough is in the offing. I hope the public will give it its full support.

The success of virtual outpatient appointments has led to the concept of patient-led follow-ups. Instead of patients being given, for example, a follow-up appointment every say 3 months patients will be left to request an appointment as and when they feel it is necessary. This will mean many patients will not have to come in to the hospital just to be told all is well when the patient is confident in that knowledge already. The concept needs careful assessment since it will not suit all circumstances and some patients may not be comfortable.  Evaluation is now underway in a few clinics where it might best suit. 

One of the hospital's great achievements during these difficult times has been maintaining cancer treatments including cancer surgery. In particular its surgery robots were moved in to a Covid-free area so as to be able to continue this amazing surgery unaffected by Covid. The Royal Surrey is internationally renowned for its robotic surgery which carries great benefits to patients e.g. in cancer surgery. There is less trauma and much quicker recovery. The surgical team has  been shortlisted for a Health Service Journal award (not the first award for these amazing surgeons).

Finally we should recognise the terrific efforts staff made in the Royal Surrey Vaccination Centre. As one of the first major centres in the country it involved volunteers not just from the staff but also across the wider community. Since early December last year it delivered 19,000 first doses and 17,000 second doses. Well done all.

Thought I would report on a couple of activities I have been organising with fellow Governors over the last 9 months.

I with other Governors have several times visited St Lukes Outpatient Department and spoken with patients about their experience in the hospital. The resulting reports have resulted in significant improvements. We decided to visit other OP Departments.

We began with the Eye Clinic because a few years ago I and Governors captured many adverse experiences there and the resulting report had a substantial impact leading to the new clinic we see today. We wished to see if experiences had significantly improved. I paired with three other Governors making three pairs and we visited the clinic on three different days. We chatted with 60 patients and each conversation was captured in a short paragraph in our report together with an analysis of common themes. It was clear that experiences were substantially better than 5 or 6 years ago and most patients were very satisfied particularly with their clinical care, However there was some dissatisfaction particularly with overall waiting times and the uncertainty about waits between the different stages of the clinical processes. There were some other matters such as not being able to hear one’s name called. Our report was much welcomed by managers and a number of improvements are being made.

More recently I and there other governors visited Outpatient Departments OP4 and OP5 on three different days as with the Eye Clinic. We spoke with 66 patients. These clinics cover a number of specialties and our chats revealed experiences right across the Board some particular to OP4 and OP5 clinics per se but many about the experiences which led them there or were experienced elsewhere in the hospital. Most patients were satisfied with their experiences and some effusive in their praise. But not all comments were positive. Our Report has been shared with all the Departments relevant to the stories (20 specialties).

Most of our conversations touched on the vexed question of car parking. Experience here should improve over the course of this year as explained in an earlier blog.

We plan next to chat with patients in OP2 the Orthopaedics and Fracture Clinic.

I and fellow Governors have also been engaged in visiting Departments to look at cleanliness, maintenance and general appearance e.g. clutter. This involves checking out all clinic rooms, toilets and waiting areas with the findings for each documented in a structured report shared with the Chief Nursing Officer, the Chair of the hospital Board, senior staff responsible for the clinics and those with overall responsibility for cleaning and maintenance.

Our first visit was to Audiology and ENT clinics. The latter was fine with some maintenance issues but in the Audiology clinic the specialist rooms left much to be desired both in cleanliness and maintenance. Audiology OP is due to refurbishment. We hope that happens soon and we are monitoring the matter.

The second visit was to OP departments on Level A e.g. Florence Desmond and Medical Day Unit.  They were very good with very few adverse observations. The Medical Day Unit has been recently refurbished and was excellent.

The third visit was to the Day Surgery Unit. There were a few maintenance issues (and all the clocks were wrong!!) but overall everything was good. Bed Bays were excellent particularly the Paediatric Bay which was a delight to behold.

Had a few problems with this blog and was looking for an alternative way of communicating but to no avail. So I am back on line.

Like so many hospitals, the Royal Surrey is under great pressure which is likely to increase over the next couple of months. However it is holding its own and doing OK relative to its peers. Finances are tight but under control with the main problem holding down the use of locums and agency staff in areas where recruiting is really difficult. As ever problems in discharging patients who are fit enough to leave the acute setting seem to grow not lessen. Lack of resources in local authority social services and increasing difficulties in finding care home places at affordable costs figure greatly. The Royal Surrey Trust is investing significantly in the community services for which it is now responsible including providing more beds at Haslemere and Milford hospitals. This should help with discharges from Royal Surrey Hospital.

I recently took a hard look at the Trust’s overall clinical and financial performance which I encapsulated in a short report shared with my fellow Governors, Non-Executive Directors (NEDs) and Executive members of the Board (Governors are  responsible for holding NEDs to account). Despite great efforts, a number of significant targets are not being met e.g. dealing with discharges and a number of cancer waiting time targets. Unfortunately this is not unusual across the country. Governors will be looking at all this again in February.  However there was one highlight. The 62 day cancer wait target (time from referral to treatment) was met for the first time in a number of years. The main area of difficulty has been around Urology and more staff and the new Stokes Urology Centre has at last turned things around. This is an area on which I have concentrated my monitoring and constructive emphasis over a long period of time. I hope performance will now be maintained.