Dementia Quality Mark

I am a member of the Trust’s Dementia Steering Group. The hospital is making good progress in meeting the needs of patients with dementia and related conditions. More and more staff at all levels are being trained, patient information leaflets are now available around the hospital as is information on notice boards.  

Wisley and Ewhurst wards have just achieved the stage 1 ‘Quality Mark for care of elderly people’. This is a mark awarded by the College of Psychiatry and involves questionnaire surveys of dementia patients and their families/carers and staff questionnaires. These wards will be seeking the stage 2 mark next year based on even more rigorous criteria. Eashing ward is planning to seek Stage 1 soon.  This is good progress and greatly welcome. I am anxious to see this excellent work extended across all relevant wards.

Care Quality Commission (CQC) new inspection regime

Professor Sir Mike Richards the new chief inspector of hospitals has announced that from now on CQC will be beefing up its inspections – bigger teams (perhaps 20), longer inspections (perhaps a week) and a mix of real health professionals and trained members of the public. All acute hospitals will be inspected by the end of 2015.

The first step will be trial inspections starting soon of 18 hospitals selected to represent different levels of ‘risk’, There will be 6 ‘low’ risk, 6 ‘high’ risk and 6 with a ‘variety of risks between’. The Royal Surrey will be one of them being in the middle category so an inspection in the coming months can be expected.

Results will be published and every hospital will be given a rating of ‘outstanding; good; require improvement; or inadequate’. I can’t say I’m in favour of such a broad single rating – hospitals are far more complex than hotels and my fear is that a good overall rating will hide aspects which are not so good but leave the public believing everything is grand. However we will see – the proof is in the pudding!

 

ITU expansion

If you go round the back of the hospital you will see building works. Here a new £multi-million expansion of ITU is underway. Good news for us all.

PLACE inspection of the hospital

Every year RSCH is obliged by the DoH to conduct a survey of the hospital's environment with results being sent to the DoH for analysis. This year the arrangement changed under the acronym PLACE (Patient Led Assessment of the Care Environment) and had to increase the involvement of patients (at least 50%). Overall results, which will allow the public to see how their hospital performs compared with others, will be published in September.

I was pleased to join the inspection teams to look at cleanliness, décor/maintenance, hygiene, tidiness/clutter and food quality. Overall the inspections covered all the wards and OP Departments, Day Surgery, Short Stay Surgical Unit, Endoscopy, A&E, ICU and EAU - so very comprehensive. As you can imagine results were mixed - some excellent and a few not so good and the latter will now be addressed.

When the national results are published I will put up a blog. Meanwhile if anyone wishes to be involved next year's PLACE let the hospital know.

Shared Interest Forum created

My fellow Governors have agreed to my suggestion that there should be a Shared Interest Forum for understanding the clinical performance of the Trust. I will be the facilitator and I and eleven other governors will comprise the group. Governors tend to concentrate on patient experience which of course is very important. However to my mind the critical issue for patients is how good the clinical care is e.g. clinical outcomes,. The latter is not so clear to patients or the public and when I put myself forward for election that is what I promised to concentrate on.

The Forum will be seeking to understand clinical performance by looking to see what clinical standards the Trust sets for itself, from where those atandards derive and what they mean in terms of ambition. We will work to understand to what extent the Trust meets its own standards and how the Trust compares will others in the locality and more widely e.g. nationally. We have decided to start with clinical performance in avoiding venous throboembolism and pressure damage/pressure sores. I will report from time to time on the results.

Eye Clinic Update

I was recently briefed by the Ophthalmology team on progress with the Eye Clinic improvements. The Clinic Manager computer system is in place but it was agree that the screens could be better placed and another would be warranted. Also what is displayed is not very clear to patients. They will address both these issues.

New staff have now been recruited and the new rooms are in operation. Some extra waiting space has been created. A drinks machine is being installed.

A new system for getting and tracking notes has been implemented with significant improvements albeit I have heard from one patient that it is not perfect.

A 'time and motion' study is underway to identify bottlenecks in patient flow. This will be used to see how to improve the worst aspects of the clinic – extremely variable waiting experience.

By July all improvements which are deemed possible with the current restrictions on space and equipment will have been implemented. A longer term business plan for extensive changes will then be presented to the hospital Board. I have been briefed on its essence and it will, if it comes about, be great for patients.

Finally a weekly one page summary of progress is now being produced and will be handed out to Eye Clinic patients.

I am pleased to say that the team has agreed to include in their deliberations an Eye Clinic patient who I nominated.

So far so good but some way to go which the Board and the Chief Executive both acknowledge.

Maternity Services

20% of all litigation claims in England involve maternity care and these represent 61% by value. Thus the RSCH belongs to the CNST (Clinical Negligence Scheme for Trusts). This scheme routinely assesses maternity units to ensure they comply with best practice thereby ensuring patients are safe and the likelihood of claims is low.  There are 4 levels of achievement: zero, 1, 2 and 3. Levels 2 and 3 are the highest and involve a gruelling assessment every 3 years. RSCH's maternity unit has just been assessed and has achieved the highest Level 3. This is not only excellent for mothers and babies but also means that the hospital receives the maximum insurance premium discount.

Part of the assessment checks that the midwife to mother/birth ratio is appropriate.

The Royal College of Midwives  and the Royal College of Obstetrics and Gynaecology both recommend a ratio 1:28. However they also recommend that hospitals should determine the ratio appropriate for them by using the Birthrate Plus toolkit into which data about type and volume of work and case mix etc. are fed with the output being the recommended ratio for safe and effective care.

The CNST assessment expects the ratio to be as determined by Birthrate Plus. If it is not then there has to be a plan in place to achieve it otherwise Level 3 would not be awarded.

I have made Freedom of Information requests to the major hospitals in Surrey to ascertain what there midwife to mother/births ratios are/have been over the last 12 months and their plans in the context of the RCM and RCOG recommended 1:28 or Birthrate Plus appropriate levels.

RSCH has been between 1:34 and 1:41 during 2012 against a Birthrate Plus appropriate level of 1:30. The Trust recognises that this is not satisfactory. A Business case for improvement has been accepted and the appropriate ratio of 1:30 will be achieved by 2014 – recruitment is underway.

For Frimley Park the Birthrate Plus appropriate level is 1:31. Through 2012 the level has been in excess of this: the Chief Executive has decided on a level of 1:33. There is a plan to work to 1:31 by 2015.

At Ashford and St Peters the ratio as of March13 was 1:31. They seek to reduce this to "national requirements" over the next 3 years.

St Heliers state that over the last 12 months they have always complied with the RCM's recommended ratio of 1:28.