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.

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.

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.

Just before Christmas I joined some other governors to judge the Christmas decorations. Every ward was decorated and I was much taken by the effort many staff had put into making all sorts of hanging and standing figures and Christmas themed scenarios - most made in their own time at home and at their own expense. There was a real Xmas spirit.

Dementia Care

I have recently been shown the work which the hospital is doing to improve dementia care. At any time 25% of patients will be suffering from dementia and a further 35% from some sort of cognitive impairment and/or confusion e.g. from a stroke or delirium. Thus recognising such patients and creating a safe and comfortable environment for them is very important.

Currently two 6 bed bays in Wisley ward, one in Ewhurst and one in Eashing have been decorated and equipped with these patients specifically in mind. The bays in Wisley are the latest to be refurbished in such a way and are impressive. For example the walls are yellow (restive colour), the toilet door has a large diagrammatic picture of a toilet and is red. Things such as paper towel dispenser, grab rails, toilet seat are red or surrounded with a red colour to provide strong contrast (red is the last colour to fade with failing eye sight). Tray with water beaker and top of the water jug are red (also indicates patient needs assistance with drinking). Pictures on the walls reflect the current season. There is a large clock with the date in large letters. There is soft relaxing low music in the background and there are activities every day for those who want to participate e.g. dominoes, cards, flower arranging. Extra ceiling lights have been installed to add some brightness and to aid vision. Work is progressing on photos of meals for the hospital menus.

Finance has been secured for all Wisley bed bays to be redecorated and equipped in this way.

Additionally they are promoting patient centred care  through using the "This is me/My care passport" which contains details about the patient which can inform all carers and can be passed to carers outside hospital such as care homes and vice versa. Also all staff in the hospital are to receive some training in dementia care.

All good stuff!!

Car parking

Lots pf people complain about the parking system at the hospital. To have to pay in advance when visiting a hospital where the wait is so uncertain such as A&E is highly irritating. Even though it is possible to top up that is difficult if you are waiting in a clinic and do not wish to miss your turn. The previous system of paying on exit was infinitely better.

The hospital executive is aware of the complaints and nobody I have met likes the new arrangement. It came about because the delay in obtaining a ticket at the entrance and the time for the barrier then to rise used to cause long tail backs on Egerton Road and blocked the way to the Research Park.

The hospital has long wanted to build a multi-storey car park but the Borough and County Councils have repeatedly refused planning permission on the grounds that it would encourage more cars in to the area. I have to say that is hardly consistent with the Councils recently granting themselves planning permission for a Park and Ride car park between Egerton Road and the A3 which doubtless will overload the new junction being built. Hopefully the new lanes will avoid hindering patient access.

The Councils really should recognise the urgent need for a multi storey car park in the hospital grounds.

A report on my first days

I have attended my first Council of Governors and today attended the quarterly Trust Board Meeting. The papers included the Annual Accounts on performance and finance. In essence the Trust had a resonable financial year with a resonable surplus and the quality accounts showed very good clinical service to us the public. Obviously there were a few concerns here and there but that should not detract from all the very good stuff. This financial year is however going to be tough (as with all NHS hospitals) and the following years will be tougher! A few highlights:

• The hospital runs a suite of over 80 projects 'Patients First' all aimed at improving patient care. A considerable commitment.
• the hospital organised a Peer Group Review of its processes for dealing with those with a learning disability. The team included a service user, a carer and two learning disabilty nurses, The feedback from the day was positive and the hospital has agreed an action plan for further improvement.
• the hospital also organised a Peer Group Review of Privacy and Dignity. The review was undertaken by a senior team from Western Sussex NHS Trust. The overall result was a 'score' of 95% which is good. An action plan has been formulated based on the results.
• A recent unannounced visit by the Care Quality Commission resulted in a very good report all round. The one downside I picked up was waiting times in OPs. The report should soon be on the CQC web site.
• MRSA has all but disappeared in the hospital. One case in the year so far.

If anyone wants a copy of the Learning Disability or Privacy and Dignity Report I am sure the hospital will provide one.

Anybody can attend the hospital's quarterly Board meeting. It's a bit mechanistic but the discussion can be interesting. Dates and times on the hospital web site.