Agenda item

In relation to the inspection carried out by the Care Quality Commission (CQC) last September West Hertfordshire Hospitals NHS Trust issued the attached Press Release.

The release was accompanied by the following comments:

“The Trust’s overall rating has improved from ‘inadequate’ to ‘requires improvement’. Next stop is ‘good’!

The attached release is quite comprehensive, but here are some key facts:-

·         Two areas made a significant improvement by moving up two ratings from ‘inadequate’ to ‘good’ - maternity & gynaecology and critical care.

·         Inspectors commended the trust’s children’s emergency department, the treatment of patients with hip fractures and the hard work of the trust’s estate team in keeping the hospital’s estate as safe and clean as possible and contributing to low infection rates.

·         Urgent and emergency care at Watford General Hospital was rated ‘inadequate’ for a second year running.

·         We were commended for our low mortality rates and our stroke care.

·         At Hemel Hempstead, there was a mixed picture related to more services (14) being reviewed, compared to eight in 2015. The overall rating has moved from ‘requires improvement’ to ‘inadequate’, despite outpatients & diagnostic services improving one rating to ‘good’.

·         Inspectors were concerned by the high number of inpatients who are well enough to leave hospital but are waiting for arrangements to be put into place for their return home or to a nursing or residential care setting. They observed that this limited the flow of patients through the trust.

·         At St Albans City Hospital the overall rating had moved up from ‘inadequate’ to ‘requires improvement’ but for the minor injuries unit the rating was down from ‘good’ to ‘requires improvement’.

·         Inspectors praised progress with recruitment and also noted the percentage of savings made in 2015/16 – these are areas where the trust is bucking the national trend.”

Detailed reports are available from the CQC’s website http://www.cqc.org.uk/

The committee moved on to consider the CQC report at this point which Helen Brown (HB), Director of Strategy & Corporate Services, West Hertfordshire Hospitals NHS Trust led on.

Councillor W Wyatt-Lowe referred to a recent programme put out by the local BBC implying there is no improvement in general in local health services. HB felt that the CQC report on West Herts was balanced and the BBC had been keen to present a negative picture.

Cllr Timmis drew attention to the fact that the inspectors had expressed concern regarding the numbers and length of waiting times - she added that in this case wouldn’t that mean it is not a good idea to cut things like Gossoms end. HB responded that the issues faced are profound and there are issues with flow through the hospital.

In Cllr Timmis’ opinion the current good points of the service are what the Trust are intending to cut - Outpatients and Diagnostics. HB pointed out that the plan is to develop St Albans as the place for complex diagnostics. At the moment the Trust intend to offer over 90 specialities from HH and she went on to list some examples. Cllr Timmis responded that there are ‘good’ facilities At HH Hospital - so why move these to St Albans?

The group then discussed the reasons for ‘bed-blocking’, the impact of maintaining the beds at Gossoms End; a rehabilitation at home approach as opposed to a stay in hospital and the need for acute beds. The health professionals felt that more beds is not the answer.

Cllr Hicks felt that the flaw in this argument is that the problems would simply occur at home. However CA countered that at home patients ‘mobilise’ on their own and are better off, healing faster.

E Glatter challenged that view that we have enough beds as the statistics prove the Trust do not have enough beds compared to the national average. In her opinion there are too many trusts/bodies trying to provide a fragmented service. DE admitted that they are in the middle of initiatives trying to address the problem of too many providers and rationalise the service to avoid fragmentation. He warned that If we buy more beds we will compromise support services - Partnerships are the best way of dealing with the shortages.

Cllr Mahmood advised that the Trust has adopted the wrong approach in attempting to move services to centres of population; he suggested they stop moving facilities around as it is ineffective; they should develop the sites we already have.

Cameron Ward, NHS Herts Valleys Interim Accountable Officer replied that services are moving out of hospitals and into the home - unless it is a specialist service which need to be concentrated in smaller centres. In his opinion this improves services to the patients: he added patients go a little bit further but they get better care.

Dr F added that the level of service needs to be high for some things and that these are concentrated in centres of excellence. He contest that services are being moved away as x-ray, orthopaedics etc - are better locally.

HB –felt the Trust had addressed many of the issues causing ‘special measures’ and predicted they would move out of special measures in the next twelve months. CW expressed the support of the CCG for the work being done by WHHT; the CCG will continue to oversee this and check that the changes are embedded and continues to improve.

EG then raised the issue of MRI and CT scanners – saying modern ones are smaller and more compact so continue their use in the smaller HH Hosp and do not move them to St Albans. She felt the concentration of population in Dacorum is the largest in West Herts and would support the service being retained in HH. HB replied that from the trust perspective there is now a range of services at St Albans that require the MRI and CT scanners, so they need to be moved there as is set out in the West Herts strategic outline case.

Cllr Guest asked what has been done to achieve the current improvements?

HB went through the five themes of the Quality improvement plan and the time and effort involved.

l  People - well able to recruit at all levels - around the workforce

l  Getting the basics right - systematic approach to consistently improving the basics

l  Patient Focus -

l  Infrastructure - better managing the poor buildings -IT

Well-led - risk management and governance improvements.