Trust Board papers November 2012 - Barking Havering and ...
Trust Board papers November 2012 - Barking Havering and ...
Trust Board papers November 2012 - Barking Havering and ...
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3<br />
Following Dr Dalziel’s comments regarding staff turnover <strong>and</strong> sickness absence, Mr Moloney confirmed<br />
that the <strong>Trust</strong>’s position was lower than the National average <strong>and</strong> it was the organisation’s ambition to<br />
reduce sickness absence down to the London average of 3.6%. The <strong>Trust</strong> had looked at other <strong>Trust</strong>s<br />
where they had been successful in addressing sickness absence <strong>and</strong> a Sickness Absence Plan paper had<br />
been prepared for the private <strong>Trust</strong> <strong>Board</strong> meeting later in the day. It was also agreed that Mrs Hosein<br />
<strong>and</strong> Mr Moloney would arrange for the staff turnover figure to be validated, as the trend indicated that this<br />
was going up.<br />
The <strong>Trust</strong> <strong>Board</strong> noted the content of the report <strong>and</strong> supported the actions to bring the performance back in<br />
line with trajectory/target.<br />
Action: Averil Dongworth 7.11.12<br />
Dorothy Hosein/Neill Moloney 7.11.12<br />
<strong>2012</strong>/047 EMERGENCY CARE/RESET PROGRAMME UPDATE<br />
Dr Derek Hicks, Clinical Director for Emergency Care, attended the meeting to answer questions on the<br />
update report. He confirmed that the recent changes in the Department should allow the <strong>Trust</strong> to sustain<br />
<strong>and</strong> remain on the current trajectory. The Interim Chairman raised his concerns regarding patients being<br />
left to the last five minutes of the 4 hours, even when beds were available, leaving little room for<br />
unexpected events. It was agreed a cultural change was required by everyone, as there had in the past<br />
been no pressure to move patients as soon as a decision was made. This was happening in some areas<br />
more than others <strong>and</strong> the <strong>Trust</strong> was looking at Consultants <strong>and</strong> Senior Nurses performances to see if there<br />
were any patterns of behaviour that could be addressed, in order to make people accountable for these<br />
delays. Following a point raised by the Interim Chairman, it was noted that although it was not within the<br />
<strong>Trust</strong>’s remit to amend Health Needs Assessment Forms, it was pushing to have them changed/modified to<br />
reduce the time it took to complete them. The <strong>Trust</strong> was also undertaking a lot of work with the Wards, in<br />
order to alleviate what was an onerous task with the double entry of data. This was an area that would be<br />
rectified with the implementation of the new PAS, but in the meantime the <strong>Board</strong> asked the IT Department<br />
to look into a short term solution that would minimise the time involved.<br />
Mr Langley raised the issue of inappropriate admissions <strong>and</strong> if there was a periodic Audit to check these.<br />
Dr Hicks confirmed that there was an increase in senior presence in the Department now <strong>and</strong> patients<br />
would be filtered more effectively. He also informed the <strong>Board</strong> that there were better controls for<br />
managing patients in the Emergency Department <strong>and</strong> the Medical Assessment Unit <strong>and</strong> the recruitment<br />
programme was quite well advanced, which would enable the organisation to take out more bank <strong>and</strong><br />
agency staff. Mr White commented on the low number of discharges pre-11.00 a.m. <strong>and</strong> was concerned<br />
that the <strong>Trust</strong> had the right processes in place to deal with these. As the discharges remained low, Mr<br />
White questioned whether the Discharge Lounge was working as well as the <strong>Trust</strong> expected it to. Dr Hicks<br />
informed the <strong>Board</strong> that the organisation was trying to get flow throughout the day <strong>and</strong> there were a lot of<br />
initiatives around discharging patients pre-11.00 a.m. <strong>and</strong> for using the Discharge Lounge. Discharges<br />
were coming up late in the day, so the <strong>Trust</strong> would be looking at how many discharges were required by<br />
11.00 a.m. <strong>and</strong> would be holding people to account for this. The <strong>Board</strong> noted that the new Medical<br />
Director, Dr Mike Gill, would be undertaking two sessions in the Emergency Department around Care of<br />
the Elderly, in order to assist in turning these patients around much quicker <strong>and</strong> ensuring appropriate<br />
admissions were being made. From next week there would be a Care of the Elderly Consultant in the<br />
Emergency Department everyday. The <strong>Trust</strong> had undertaken an Audit last year, in conjunction with the<br />
local GPs, to look at the quality of admissions <strong>and</strong> this exercise was going to be repeated again this year.<br />
This would provide a healthy clinical challenge with GPs <strong>and</strong> the <strong>Trust</strong>’s clinicians looking at BHRUT’s<br />
practice <strong>and</strong> would provide the evidence that the <strong>Trust</strong> was not inappropriately admitting patients.<br />
Mr White referred to the next steps for the improvement in the emergency pathway; ‘create joint team with<br />
community <strong>and</strong> social care to completely redesign <strong>and</strong> manage complex frail patients’ <strong>and</strong> questioned the<br />
<strong>Trust</strong>’s confidence in having this process in place to prevent some of the problems experienced last Winter.<br />
It was confirmed that this was an ongoing process <strong>and</strong> there were daily Jonah meetings, monthly Cross<br />
Buffer Group meetings <strong>and</strong> the <strong>Trust</strong> was just about to commence weekly meetings with the Cluster to<br />
strengthen processes, in order to get the patients discharged as soon as possible. The <strong>Board</strong> noted that<br />
last week the <strong>Trust</strong> had eleven/twelve patients waiting for community beds <strong>and</strong> the problem was going to<br />
get significantly worse. The <strong>Board</strong> therefore asked for a document to be prepared that showed the <strong>Trust</strong>’s<br />
<strong>Trust</strong> <strong>Board</strong> Minutes Part I – 5 September <strong>2012</strong>