Trust Board papers November 2012 - Barking Havering and ...

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