Agenda item - University Hospitals Sussex NHS Foundation Trust: Presentation on Performance

Presentation from University Hospitals Sussex on recent and ongoing work to improve performance (verbal presentation).

25.1    This item was introduced by Professor Catherine Urch, Chief Medical Officer at University Hospitals Sussex NHS Foundation Trust.

25.2    Professor Urch outlines some of the challenges the Trust is facing:

·         The local health and care system is under intense pressure, with too many patients waiting too long for treatment

·         This winter has seen extreme pressures, following on from a very pressured year

·         A&E performance is improving, but much more still needs to be done

·         Elective waits are reducing

·         Waits for cancer treatment are reducing and targets are currently being met

·         There is a continued increase in the acuity of patients presenting for emergency care

·         The Care Quality Commission (CQC) conducted an inspection of the Trust in August 2023, focusing on medicine and surgery

·         The report has not yet been published, but the inspectors identified a number of positives, in terms of staff kindness and compassion, evidence of teams working well together, people being involved in decisions about their care, and promotion of healthy lifestyles

·         There are negatives also, including pressures on access to services, not always getting the basics right, and the perceived visibility of senior managers

·         A Quality & Safety Improvement Programme (QSIP) is being implemented

·         The Trust cannot comment on the live police investigation, Operation Bramber, other than to state that benchmarking demonstrates that all services at the Royal Sussex County Hospital (RSCH) are safe

·         There continues to be considerable investment in services, including phases 1 and 2 of 3Ts and the opening of new diagnostic centres

·         In summary, there are green shoots, but there is still a long way still to go.

25.3    In response to a question from Cllr Asaduzzaman on how difficult this winter has been so far, Professor Urch replied that there have been marked pressures. This has been mitigated by good planning and by the deployment of additional community beds and virtual wards, but it has been challenging nonetheless. There was a flurry of Covid and other infectious diseases, but nothing like the Covid levels of previous years. However, the RSCH is effectively operating at 100% plus capacity.

25.4    In reply to a question from Cllr Asaduzzaman on safety culture, Professor Urch told members that this is central to the Trust’s improvement. Services need to be transparent with patients, to learn from mistakes, and to foster a culture where every mistake or near miss is reported.

25.5    In response to comments from Cllr Robins regarding the value of the council opening additional leisure facilities, Professor Urch agreed that healthy lifestyles are key to physical and mental wellbeing, playing a vital role in preventing poor health.

25.6    In reply to a question from Cllr Hill about issues with the visibility of leaders, Professor Urch told the committee that the Trust has now fully recruited to its senior leadership team. All senior leaders spend time meeting staff and doing ward walk-arounds. In addition, the Trust has employed leaders for each hospital and has strengthened its divisional model. There has been good staff feedback to these moves.

25.7    In response to a question from Cllr Hill on virtual wards. Professor Urch explained that this is where patients are helped to stay at home, with support from community nurses and technology to monitor health. Virtual wards are mainly used for patients who are recovering from being acutely ill, allowing patients to be discharged from hospital earlier than would normally be the case.

25.8    In reply to a question from Cllr Hill on speak-up champions, members were told that this services provides a confidential resource where staff can take problems they have encountered. The service is well-publicised and well-used and is proving to be a good way to resolve issues.

25.9    In response to a question from Cllr Hill on maternity, members were informed that this was not part of the most recent CQC inspection. The Trust is developing maternity services via its Maternity Improvement Programme.

25.10  In reply to a question from Geoffrey Bowden on whether reductions in waiting lists may be due to patients deciding to go private instead, members were told that there are likely to be some patients choosing to go private rather than wait. Patients may also have been offered treatment by another NHS provider. In neither instance would University Hospitals Sussex necessarily be aware of why a patient had come off the waiting list.

25.11  In response to a question from Mr Bowden on delayed discharge, the committee was informed that this remains a major problem, with more than 300 people across the Trust currently occupying an acute bed despite being medically fit for discharge. This is a national issue, but Sussex performs poorly and the situation is deteriorating.

25.12  In answer to a question from Cllr McLeay on staff time spent on ‘patient first’, members were told that providing a patient-focused service was at the core of the Trust’s approach to care and would save time in the long run because it would lead to fewer incidents and to patients getting better more quickly.

25.13  In response to questions from Cllr Baghoth about culture at the RSCH, members were told that datix incident reporting had been very low, but there has been a big push to address this and reports are now near the national average. The push has included placing considerable emphasis on the culture being one of learning rather than blame where it is important that every incident or near miss is reported in order for staff to learn and improve. These improvements have been recognised by the CQC.

25.14  In response to a question from Cllr Baghoth on whether length of wait at A&E wasn’t a more important target than the percentage of people waiting in excess of 4 hours, the committee was told that the 4 hour wait is a national metric. However, the key statistic is actually waiting times for the 30% or so of attendees who are really poorly. These are relatively good.

25.15  In reply to a question from Cllr Wilkinson on the pressures placed on Trust emergency department services by patients waiting for admission to an acute mental health bed, members were informed that there has been concerted work across the system to tackle this issue, and that recent weeks have seen a significant reduction in people waiting for a bed due to the better use of community crisis pathways; although there are still people waiting for assessment or for an acute mental health bed to become available.

25.16  In response to a question from Cllr Evans on the use of masks within the RSCH, members were told that the Trust requires its staff to adhere to national guidance on testing for Covid and mask wearing. Currently it is staff’s choice whether they mask. Testing is undertaken on symptomatic patients.

25.17  In answer to a question from Cllr Evans on staff morale, the committee was told that there have been significant improvements at RSCH, particularly in terms of staffing levels, with the vacancy rate now around 7% – this is below the national average. There have been marked increases in the number of both Nurse Associates and Consultants being employed. Despite these improvements, the working environment remains exceptionally busy and junior doctor morale is low, not helped by the ongoing industrial action.

25.18  In response to a query from Cllr Evans on the use of datix reporting, members were informed that datix is a key tool for patient safety and all staff are actively encouraged to use it appropriately to record incidents and potentially unsafe working. Recent staff feedback on the system has been very positive.

25.19  The Chair thanked Professor Urch for her attendance. Members agreed that it was important that the committee continue to monitor improvement work at UHSx and that Trust representatives be invited to the next HOSC meeting to present on the latest CQC inspection report.