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.

Four bits of news

The Royal Surrey Maternity Unit undertook UNICEF’s rigorous assessment in the spring and was awarded Gold in June. The Department has also maintained its Baby Friendly accreditation for twenty years and is one of only a few organisations in the county to be awarded the UNICEF’s Baby Friendly Gold Award.

According to latest statistics the Royal Surrey has the lowest death rate for cardiac arrest than any other hospital.

The latest national figures show that the Royal Surrey has 21% less deaths than would be expected given its case mix and is in the top 5 hospitals in the country.

Ever since the Maternity Department opened at the Royal Surrey in 1991there has been only one Obstetric Theatre and the Anaesthetic Room has been used as a back-up theatre for emergency caesarean sections when the existing theatre was in use. This has resulted in cramped working conditions for staff and potential safety issues for patients, neither of which is desirable for a unit that was graded as 'Outstanding' following last year's CQC inspection. All of this is about to change with the building of a new second Obstetric Theatre adjacent to the existing one, which will necessitate moving the existing Special Care Baby Unit to a new location. This will provide the opportunity to build a brand new unit which will offer more family-focused care by allowing new mum's to sleep alongside their poorly babies, even when those babies are requiring high dependency care. This will bring a degree of comfort and reassurance to parents at a very difficult time for them and is a new model of care which is not offered at any other Trust in the locality.

More awards for the Royal Surrey.

In an earlier blog (14 February) I reported that the Pregnancy Advice Line developed at the Royal Surrey and used across Surrey Heartlands had received a prestigious award. Well it has just received another. It scooped the Innovation in Practice award at the British Journal of Midwifery Practice Annual Awards.in Leeds

And there has been more success for the Royal Surrey. The Acute Frailty Pathway and the Emergency Laparotomy Collaborative have been shortlisted for the prestigious BMJ Awards 2019. The Acute Frailty Pathway is one of six projects to have been shortlisted for the Care of the Older Person Team award. And the Emergency Laparotomy Collaborative is a finalist in the Innovation in Quality Improvement Team category, also facing competition from six other entries.

Well done the Royal Surrey

Car Parking at the Royal Surrey

Car Parking has been a problem for years at the Royal Surrey. It was about to get much worse. Hospital staff have access to about 388 parking spaces on a plot of land near the hospital but Guildford Borough have now withdrawn permission to use it and it will be sold. Potentially that could be disastrous for staff – the hospital has enough problems recruiting and retaining staff !!! However it has been announced that monies have been included in capital allocations for a second floor over an existing area of car park probably to the rear of the hospital. It is expected to provide 400 spaces i.e. sufficient to restore the status quo. If planning proceeds smoothly it could be in operation by June next year.

But is there anything in the offing to actually relieve parking problems? It appears yes.

Firstly there are steps being taken to increase staff parking spaces which will allow more spaces on the hospital site for patients and visitors

·         Talks are well on the way to allow hospital staff to use some of the spaces at the nearby Park and Ride. With so many spaces empty that is just good common sense.

·         Talks are also underway to pay for some further staff parking spaces at another nearby area.

Secondly there are steps to reduce car traffic by improving public transport links.

·         Most significantly park and ride buses will soon stop at the hospital main entrance. The cost of Park and Ride is very much less than hospital parking charges and it will be much easier to find a space there than driving endlessly around the hospital site

·         Finally there is the new railway station proposed for Westborough with a pedestrian link to the hospital. Some way ahead I know but it has at last been approved.

Pregnancy Advice Line.    

The highly successful and popular Pregnancy Advice Line which was developed in the Royal Surrey and is used across Surrey Heartlands (approximates to West Surrey), continues to win wide acclaim. On 5 February it won the National Maternity and Midwifery Festival Innovation Award. The awards recognise the outstanding achievements and commitment by midwifery and maternity staff across the UK. It is among the shortlisted nominations for Innovation in Practice at the British Journal of Midwifery Practice Annual Awards in Leeds. Since it opened in April 2018, the service has been accessed by 10,000 women and is estimated to have freed up hundreds of hours of staff time which would previously have been taken up with phone calls. According to Jacqui Tingle, Deputy Director of Midwifery and Divisional Head of Nursing for Women and Children. ‘It’s a great example of forward thinking which has freed up our staff and hugely increased contact time in the Maternity Unit”.

Maternity team in the running for national award Royal Surrey’s maternity team and their colleagues in the Surrey Heartlands Trust have been shortlisted for the British Journal of Midwifery (BJM) Awards for ‘Innovation in Practice’.

The ‘Pregnancy Advice Line’ which was launched by Royal Surrey’s maternity team in April has been accessed by 10,000 women. Since its launch it has saved hundreds of hours of maternity staff time. Winners will be announced at the annual BJM awards in Leeds on 13 February – let’s hope they are rewarded

Latest on Stroke Services

In September 2017 a review of stroke services in Surrey recommended that the Royal Surrey lose its Hyperacute Stroke Unit (HASU) – a decision I opposed.  As reported in previous blogs, I on behalf of Royal Surrey Governors sought to persuade authorities to at least preserve Royal Surrey’s Acute Stroke Unit. That would allow those people living in Guildford and Waverley who experience a stroke and are taken to HASUs either at Frimley or St Peters, to continue acute care in the Royal Surrey close to family, friends and carers. The Royal Surrey Executive was in favour and as a result Frimley and the Royal Surrey came to an arrangement to allow this to happen and consequently Royal Surrey now has an ASU with a stroke consultant who shares her time with Frimley.

However no similar agreement proved possible with St Peters and, as reported in other blogs. I continue to pursue the matter particularly since it is people from Guildford who are most likely to be taken to St Peters and I am an elected Governor for Guildford.

In August last year I met with Claire Fuller who heads up the Surrey Heartlands Healthcare Partnership. She was sympathetic to the problem and told me several activities were underway which might have an impact and we agreed to meet again when matters were clearer. Thus on 2 January I met again with Claire Fuller who was joined by Mathew Tait who is the Chair of the Stroke Oversight Group for the Surrey Clinical Commissioning Groups (CCGs).

They were both very sympathetic to governors’ concerns but pointed out that

1.    An NHS England review was underway of stroke services in Surrey, Kent and Sussex. That will report later this year and might impact on HASU/ASU provision in Surrey but whatever the result any impact would be a long way off. Whether it would affect St Peters’ HASU and thus relationship with Royal Surrey is unknown.

2.    The number of stroke patients arriving at St Peters is significantly below the predictions of the modelling undertaken in the original CCGs review. Discussions with SECAMB had increased numbers slightly but this shortfall is of obvious concern. An audit is underway of stroke patients who have been taken to St Peters to get a clearer view of their pathways. This will report soon.

In the Guildford and Waverly CCG risk management report of 24 July 2018 the following was in the top 10 risks

“(Surrey Heartlands CCGs) if the flows from Guildford to ASPH for stroke patients are not achieved as modelled there is a risk that the clinical benefits and critical mass will not be realised and patient outcomes will not improve; workforce challenges and recruitment deteriorates; financial sustainability of the HASU/ASU at ASPH”

This has consequences for the likelihood of an agreement for patients from Guildford to be able to go to the Royal Surrey ASU after care in St Peters’ HASU.  Such an agreement would damage the fragile financial viability of St Peters stoke services – a consequence which would be unacceptable in that it would put at risk all the patients who they treat from other areas.

An audit of St Peters stroke patient pathways is underway. Mathew Tait said he would request that figures for patients originating in the Guildford area be analysed. It could be that ambulances are in fact taking ”Guildford” patients to Frimley hence the numbers problem at St Peters. If so the number of “Guildford” patients could be small thus diminishing the problem and, ifnumbers are small, perhaps they could transfer without much financial consequence.

Secondly stroke patients are likely to be away from home for the longest period when in a community rehabilitation facility and perhaps it is here that patients will most want visitors. Maybe it is at this stage that “Guildford” patients could transfer to a community rehabilitation closer to home rather than to Woking which is the default at the moment. Claire and Mathew said they would look in to this together with the results of the audit.

It was agreed that another meeting would take place as soon as the audit analysis had been completed – probably in 3 or 4 months. I will report.

New Chief Nursing Officer

I reported in an earlier blog that Louise Stead the Royal Surrey's Chief Nursing Officer (CNO) had been promoted to Chief Executive leaving a vacancy. That vacancy has just been filled by Jo Embleton who was Louise's deputy. The CNO is a key person in any hospital and we are lucky to have Jo stepping in to that post. I know her well and she is extremely competent, efficient and well liked.

Christmas decorations

I and fellow Governors had the pleasure of judging the hospital’s Christmas decorations. I always look forward to it. All wards participate and the effort which staff put in to it in their own time is wonderful. The winner is always announced on Christmas day and this year the winner was Eashing Ward which looks after the frail elderly and those with dementia. I mention it because of its theme. Apparently dementia patients tend to lose their will to eat because they lose their sense of taste. The last sense of taste to go is that of sweetness and so that was the theme chosen. Each bed bay was decorated with a different aspect of sweetness – donuts, fairy cakes, sweets, hockey-stick rocks – all beautifully hand made much with recycled materials. The other wards were also great but Eashing stood out. We are fortunate to have such dedicated staff at the Royal Surrey.

Major new equipment

The hospital continues to make major investments in costly equipment.

• two new linear accelerators in Radiotherapy
• a third Robot has been ordered - the Royal Surrey is a world leader in robotic surgery
• a MRI scanner is to be installed in Cranleigh Hospital
• the Royal Surrey's CT scanners are to be replaced with the latest.

Excellent news for patients and a sign that the hospital has recovered from the financial crisis which it experienced such a short while ago.

New Urology Centre
The newly built Urology Centre was handed over to the Royal Surrey this week and I was shown round yesterday. It is a great addition to the hospital and will greatly enhance its services in an area where demand is high The centre has been funded 50% by the Prostate charity which is an amazing fund raising achievement driven by Colin Stokes after whom the centre will be named. The centre is now being equipped and should be up and running by the turn of the year.

An accolade.  

Prof Bill Fawcett Consultant in Anaesthesia and Pain has been awarded the 2018 British Medical Association first prize for his publication 'How to survive in Anaesthesia'. Good to know we are in the hands of such eminent clinicians !!

The Royal Surrey has appointed a new Chief Executive. After a tough process of head hunting, presentations and role playing the Royal Surrey has appointed Louise Stead as its new CEO. Paula Head the existing CEO will leave the Trust in September after being in post for 2 years.

Louise Stead has for some years been the hospital's Chief Nursing Officer (CNO) and has acted as deputy CEO in what has been a rotating post between senior executives. As CNO she has been first class - decisive, energetic, loyal and well liked and respected by clinicians across the board. Her appointment as CEO is great news.

The Royal Surrey has been nominated for a National Health Service Journal award for a new advice and guidance service. It provides rapid advice to GPs on treatments and referrals Whist getting fast access to specialist advice to patients it has to date avoided 1,600 appointments and saved £430,000. Good use of  IT and innovation.