Outsourcing

As reported in the Surrey Advertiser the RSCH has decided to out source a number of functions including housekeeping (cleaners). When the vogue for out sourcing was at its peak some years ago the RSCH, wisely to my mind, decided to keep cleaning in -house and expressed itself proud to have done so. They wished to keep a firm and direct hold of cleanliness.

The hospital has clearly changed its mind and to many it appears to have happened very quickly not least because there was no public, competitive tendering (Governors were not consulted or pre-warned). Hospital staff transferred will have their conditions safeguarded through TUPE but understandably are not happy.We must hope that cleanliness standards are upheld as of course they can be. The checks which governors have just agreed to undertake (see earlier blog) will help to ensure that.

Cleanliness, hygiene and maintenance checks

Cleanliness, hygiene and maintenance are extremely important aspects of any hospital. I used to be a member of the Surrey LINk RSCH Group and over a period of about 6 years I organised checks of these features throughout the hospital . When LINk folded to be replaced by Surrey Healthwatch (yet to get in to its stride) such checks lapsed. However I am pleased to say that the Council of Governors has recently agreed to a proposal from me that these checks should be undertaken by a volunteer group of 8 governors working in pairs.

We intend to cover all parts of the hospital other than the wards (wards are encompassed in a different manner and will also involve governors). Our first check visit (to Nuclear medicine and day Surgery) has taken place and we expect to cover all the ground over a 10 month period. Reports will be sent for action to the hospital's  Patient Quality and Safety Committee and to the appropriate head of department.

Mortality up-date

In my blog of 28 February I reported on mortality statistics (please see for background). At that time RSCH’s performance according to the national index ‘SHMI’ was good (and still is but according to statistics published by Dr Foster performance was poor. The reason suspected was the way the hospital was coding palliative care. This plus events in Mid-Staffordshire caused the hospital to mount a substantial review by examining the notes of all deaths in 2012, recoding where appropriate and resubmitting the data to Dr Foster for reprocessing. The work was checked by a group of GPs to ensure there was no bias.

 The hospital does not use Dr Foster’s services but uses another company CHKS. Recoded data was also sent to them for reprocessing.

 The results confirmed that the main reason for the poor results from Dr Foster was substantial undercoding of palliative care ( the criteria and guidance for palliative coding is open to interpretation and this is widely recognised). The position of RSCH compared with other hospitals changed from being near the bottom to approaching the average. Also the results from CHKS changed from around average to very good. The national index SHMI is unaffected by palliative coding and remains good (5 to 10 percent less deaths than expected).

This review has been followed not only by a focus on better coding but also has led to more formalised monthly reviews of statistics and deaths in all specialties and the formation of a top level Mortality Review Committee. This is all good news and will be reassuring to patients, I continue to keep an eye on mortality data and will be interested to see what the next Dr Foster publication has to say – it is due soon.

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.