Issue - meetings

Representatives of the Stockport NHS Foundation Trust will attend the meeting to update the Scrutiny Committee on the implementation of the Trust’s Financial Improvement Plan and provide an update on developments with Urgent Care.

Officer contact: Jonathan Vali, 0161 474 3201, jonathan.vali@stockport.gov.uk

Ann Barnes (Chief Executive), Sue Toal (Acting Chief Operating Officer) and Feroz Patel (Director of Finance) from Stockport NHS Foundation Trust attended the meeting and made a presentation on (i) the Trust’s ongoing work to improve urgent care flow and improve performance against the 4-hour admission target, and (ii) the implementation of the Trust’s Financial Improvement Plan.

The first part of the presentation covered the following areas:-

·         The challenges at Stepping Hill were reflective of national and Greater Manchester trend, with the health and care system under increasing pressure.

·         The types of work being done to address performance relating to the target included preventing unnecessary admission at the Hospital included enhanced triage arrangements, expanded ambulatory care provision, ‘decongestion’ of the Emergency Department during surges in attendance, and streaming patients more quickly to appropriate clinicians. This had been facilitated through external support and excellent internal engagement with staff. The new building at the hospital had improved the flexibility within the site to deploy staff where needed.

·         Performance had been on an upward trajectory since September, and it was anticipated that performance in November will have been at 80% of target.

·         There was an ongoing challenge of increasing attendances, and significantly finding appropriate facilities/ support into which acute patients could be discharge. A whole economy approach was needed to address this latter challenge, although the Trust itself was taking steps such as planning discharge on admission and ‘discharge to assess’.

Councillors asked questions and made comments, including:-

·         How sustainable were the initiatives/ improvements that had been put in place? In response, it was stated that these initiatives were not short term fixes but were expected to provide long term sustainable improvements. Provision had been made to allow the hospital to better respond to increases in demand.

·         Concerns were expressed about ‘discharge to assess’ and where the balance was between discharging and not when a patient had complex needs. In response it was stated that the process was not intended to discharge patients into a permanent care setting, but rather into a more natural environment for them so as to better understand their needs, be that in their own home or an intermediate setting, rather than an acute hospital bed which often led to additional challenges such as deconditioning.

·         Had there been a culture change at the hospital that had contributed to the changes? In response it was acknowledged that this was the case, which had partly been the result of changes in leadership. The new building had allowed for the co-location of urgent care facilities to improve responsiveness.

·         How engaged and supportive were staff in the change process? In response it was stated that those staff immediately affected or involved had been very supportive as they were able to see the benefit of the changes, although it was acknowledged that work would continue to involve staff in the transformative agenda. The physical changes to the configuration of the hospital had also contributed to the sense of improvement as the quality of the accommodation now matched the high quality of the staff.

·         How was the Trust managing the expectation of patients, given the changing focus? In response it was stated that working with the Emergency Care Improvement Programme and their Safer Start campaign, the hospital were using the steps to better understand the needs of patients and for staff to overcome their natural inclination to ‘keep hold’ of patients beyond the point at which their hospital stay was beneficial.

·         Was there sufficient capacity within the processes to cope to the expected winter surge in demand? In response it was acknowledge that the scheme had only recently begun, and recruitment was ongoing, but that early indications were that over the course of the winter the hospital would be able to ‘hold its own’.

·         What was the scope for horizontal integration to share capacity with other local hospitals in the area when Stockport  ...  view the full minutes text for item 4

(Note: the Chair has agreed that this item be included on the agenda in accordance with Section 100B (4)(b) so that the Committee can consider the matter prior to the next scheduled meeting)

The Chief Executive of Stockport NHS Foundation Trust will attend the meeting to report on current issues and developments at the Trust that may be of interest to the Scrutiny Committee.

Officer contact: Jonathan Vali, 0161 474 3201, jonathan.vali@stockport.gov.uk

Ann Barnes (Chief Executive) and Andrew Burn (Director of Financial Improvement) from Stockport NHS Foundation Trust attended the meeting to report on the Trust’s involvement in the Financial Improvement Programme, being led by NHS Improvement.

The Trust had been invited us to take part in the programme which was aimed at those Trusts with sustainable financial challenges, and provided focussed support to identified challenges and implement measures to improve sustainability of the Trust. The Professional Services company KPMG has been assigned to the Trust to provide additional capacity and insight.

The Trust had completed the first phase of the programme during which an analysis was completed and recommendations developed, and this had been reported to the Board. Phase 2 had now begun with the implementation of the findings.

The challenge for the Trust was that each year it was required by NHS England to make savings, but this meant the Trust was then making a loss. It was hoped that through this Programme to make additional savings of approximately £16m to ensure the financial sustainability of the Trust.

Some of the key areas that the Programme Team were looking at included:-

·         length of stay

·         theatres

·         estate

·         delayed discharge (reduce delays to reduce cost and to improve patient experience)

·         spending thresholds

·         addressing absenteeism

·         reduced reliance on agency staff and better co-ordination of their use

·         reviewing budgeting process.

It was emphasised that these measures would not be to the detriment of operational activity at this hospital and that although being delivered quickly, proposals were quality assessed to ensure clinical considerations taken into account.

Councillors asked questions and made comments, including:-

·         What was the impact of the Programme on the Trust’s Five Year Strategy? In response it was stated that Strategy and its objectives remained in places, in particular the committmint to Stockprot Together and an integrated health and social care organisation, as well as a focus on cancer care and older people. The ‘complexion’ of the Trust was likely to change in the future, given the changes under consideration but the form of the organisation would follow from decisions about its function.

·         What steps were being taken to improve existing capacity within the Tryst’s management team to address the problems being encountered? In response it was stated that one of the reasons for the Trust getting involved with the programme was because KPMG would provide development capacity to enable the Trust’s staff to improve management practices.

·         Further information was requested in relation to work to improve delayed discharges. In response it was stated that KPMG were working closely with the Trust’s senior managers to address this area of work, and this included addressing activity on each ward; bringing activity forward in the day to ensure prevent conflict with other activity; working with Council staff to ensure practice and activity was effective. Early efforts had resulted in an increase in discharges and a positive trend in activity. Work was also underway to accelerating ‘front door’ activity to deflected inappropriate attendances and to ensure improved monitoring of patients to improve appropriate hand-off. Further comments were then made about the need for early conversations between hospital and social care staff, and the variability in practice between wards. The issues were acknowledged and assurances were given that these issues were being addressed through this work.

·         Had the ability to recruit of staff improved since the decision on Healthier Together, reducing the reliance on Bank and Agency staff? In response it was stated processes had now changed so that Bank staff were now arrange through a central office to provide greater co-ordination. Bank staff were, for the most part Trust staff so were desirable to use. The Trust was actively working to reduce the use of agency staff, and there were also national targets to do so.

·         What was being done to reduce/ discourage people from attending? In response it was stated that this was the  ...  view the full minutes text for item 5