Report - Plymouth Hospitals

Item 10
Plymouth Hospitals NHS Trust
Report to: The Trust Board – 30 th January 2009
Report of:
Subject:
Status:
Medical Directors’
Medical Directors’ Report
For Information and Discussion
________
1. EWTD Update
Four new EWTD compliant rotas have been implemented (Cardiothoracic
Surgery SpR, Ophthalmology SpR, Paediatrics SHO and SpR), and three
more are due to begin early in 2009. (Urology, Oral Surgery and Neurology
SpR). Junior doctors are currently monitoring their hours, and the outcomes of
monitoring should be ready for our next report.
We have reported nationally that we consider the major risk to meeting the
EWTD is the lack of doctors available to fill vacant posts. Compliant rotas in
paediatrics and general medicine are at risk because of problems filling
vacancies when they arise. A Medical Workforce group is being established,
to ensure that we maintain clear oversight of workforce issues and maximise
our opportunities to recruit in the UK and overseas. Recent advertisements for
junior doctor posts have included notification that we can recruit doctors
through the Tier 2 overseas process - this means that we can recruit outside
the European Union.
2. New Contract for Specialty Doctors
The Trust has formally invited expressions of interest in the new national
contracts for Specialty Doctors. A local implementation framework has been
agreed, and training for doctors and Clinical Directors will take place over the
next two months. The new contract provides an increase in salary in return for
increased flexibility in job planning for these grades. The funding for the
contract has been provided nationally and is currently held in reserves.
3. Remuneration for Additional Clinical Work
The Trust has negotiated a temporary suspension of the policy for payment
for “Additional Clinical Work”. Under the policy, consultant staff working out of
hours can receive up to four times their usual rate of pay for out of hours work.
The consultant body have recognised the importance of this agreement in
securing the long term financial health of the organisation, and the LNC and
HMSC have been very helpful in obtaining the settlement. Continued
additional work is being delivered by most staff groups using the option for
time in lieu or a temporary amendment to their job plans.
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Item 10
4. WHO Safe Surgery Saves Lives update
The Safe Surgery Saves Lives Campaign is proud to announce that the
results of the WHO Surgical Safety Checklist Pilot Study were published
online this month by the New England Journal of Medicine. The WHO Surgical
Safety Checklist (Annex 1) reduced the rate of deaths and complications by
more than one third in eight pilot hospitals (located in Toronto, Canada; New
Delhi, India; Amman, Jordan; Auckland, New Zealand; Manila, Philippines;
Ifakara, Tanzania; London, UK; Seattle, USA). Following implementation of
the checklist, the rate of major inpatient complications dropped from 11% to
7%, and inpatient death rate following major operations fell from 1.5% to
0.8%. The effect was of similar magnitude in both high and low/middle income
country sites. As part of the PHNT Patient Safety First Campaign (See Trust
Board Symposium February 09), this Checklist will be introduced into clinical
practice at this Trust during 2009.
4. Infection Control
i. There were 2 MRSA bacteraemias recorded in December (the Trust
needs to average 3.25 cases per month to remain on target).
ii.
iii.
There were 15 post-48 hour cases of C. difficile (the Trust needs to
average 13.7 cases per month to remain on target).
There were 3 ward closures due to norovirus:
Date Ward Norovirus Patients Staff Days closed
08.12.08 Tavy Positive 14 2 5
12.12.08 Hexworthy Positive 19 11 6
15.12.08 Hound Positive 17 8 6
iv.
All 47 wards performed hand hygiene audits. The mean score for the
Trust was 96%, with 27 wards achieving a perfect 100%. All wards in
the Gastroenterology, Haematology and Oncology, Children's Services,
Head and Neck and Ambulatory Services Directorates scored 100%.
v. Saving Lives data for the care of peripheral lines was received from 33
of the 46 wards that had these devices. 19 wards scored 100%.
vi.
vii.
viii.
Saving Lives data for the care of urinary catheters was received from
30 of the 42 wards that had patients with these devices. 26 wards
scored 100%, including all wards in the Cardiothoracic, Critical Care,
Gastroenterology and Directorates.
Saving Lives data for the care of central lines was received from 17 out
21 wards that had patients with these devices. 10 wards scored 100%,
including all wards in the Gastroenterology Directorate.
There were 8 wards that achieved 100% compliance with MRSA
screening.
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