Agenda item

Interview with:

·  Glenn Douglas, Chief Executive;

·  Claire Roberts, Head of Quality; and 

·  Darren Yates, Head of Communications

Kat Hicks, Overview and Scrutiny Officer, introduced witnesses from the Maidstone and Tunbridge Wells NHS Trust :

·  Glenn Douglas, Chief Executive

·  Claire Roberts, Head of Quality; and

·  Darren Yates, Head of Communications

Mr Douglas described the progress the Trust had made in a variety of different areas over the year and responded to Members’ questions. It was explained that the publishing of Quality Accounts was a new process to the NHS. They set out the previous years performance and how the Trust will be judged over the coming year, and he welcomed input and feedback from the Committee on the progress made by the Trust.  The Trust had achieved the majority of its targets in 2009/10, and 90% of patients in all specialities had been treated within 18 weeks of referral.  Financially, in 2010 the Trust had balanced its budget for the second year in a row for the first time since 2001.

Mr Douglas said there had been a significant fall in Clostridium difficile (‘C diff’) infections in the Trust’s Hospitals, which now had the lowest rates in the Strategic Health Authority’s area. He explained the statistics for C diff infections included patients who were already infected at the time of admission. Although the overall number of cases for the year was low, there had been a sharp rise in the recorded number of patients with C diff throughout the winter. He attributed this to the high incidence of patients presenting with other viruses, such as the norovirus. During that period the hospital had tested all patients for infections on admission, leading to an increase in the number of recorded C Diff infections.

Mr Douglas said the rate of hospital acquired infection was very low. The Trust now routinely tested all patients for infection at the time of admission and would investigate whether they could set a separate target for hospital acquired infections. He added a survey of over 500 patients this year had shown that 95% of Hospital staff were using hand-cleaning gels before coming into contact with patients. The Committee was informed that the LINks report on infection control had found the Trust to be the best in Kent. But there were problems relating to hand hygiene at the entrance to the Pembury and Kent and Sussex Hospitals, partly due to the multiple entrances. Hand hygiene at the entrance to the wards was very good in all locations. He confirmed the Trust would issue a formal response to the LINks report.

Mr Douglas explained that, of the 23 cases of MRSA bacteraemia infection, 16 were acquired in hospital. Analysis had identified poor sampling procedures, resulting in cross contamination creating false positives, as a cause for the some of those cases.  The Trust had introduced new procedures and training to address this and expected the rates to reduce in 2010/11. He stressed that, although the actual number of MRSA infections was quite small, it was important to eradicate avoidable hospital acquired infection. There had only been one case of MRSA infection in the last two months. Members suggested this should be explained in the report and he agreed to consider this.

The Committee heard that although The Trust could not explain the monthly variation in recorded patient trips slips and falls, the target was important. All incidents were reported and analysed and action taken to resolve any problems. There were relatively few instances of falls arising as a result of floor conditions, nevertheless a lot of thought had been given to the flooring in the new hospital to further minimise the risk of falls.

In response to questions, Mr Douglas explained that low rise beds were used when a patient was assessed as being at risk of falling out of bed. The beds were lowered to the floor when the patient was in it, thus negating the risk.

Mr Douglas informed the Committee that the Trust had implemented several measures to improve patient nutrition. These included ensuring meal times were not disturbed by visitors or ward rounds. Patients who needed help with eating were served meals on a red tray so that staff could easily identify and help those in need of assistance.

Mr Douglas acknowledged the Trust had, in his view justifiably, been criticised for not engaging enough with the public. The Trust had taken steps to improve this and had responded to patient concerns. The Committee was informed that patients were provided with hand-held electronic questionnaires so they could give feedback prior to discharge from hospital. 

Mr Yates explained that the Trust had introduced processes to analyse patient’s concerns, establish the cause, and identify ways to prevent the problem recurring. In addition, Matrons and ward Sisters were listening to patients and, where possible, dealt with problems at the time. He believed the Trust had improved significantly in this area and added the Royal College of Nursing had recently praised the Trust as a good example of listening and responding to patient’s concerns.

The Committee was told that the new hospital at Pembury was on target for completion, with the first patients expected in early 2011. The hospital would be a significant improvement over the facilities previously available, with a large number of single occupancy rooms that would improve patient privacy. However Mr Douglas recognised that too many people still shared mixed sex facilities such as bathrooms in the Trust’s other hospitals. He explained the Trust was investing in better toilet facilities and re-organising wards in those hospitals to improve patient privacy.

Mr Douglas said here had been significant investment in Maidstone Hospital, which now had a World leading Laparoscopic training centre. Laparoscopy [key-hole surgery] techniques reduced the length of hospital stay and improved the speed of patient recovery. RapidArc radiotherapy machines had also been installed in Maidstone and Canterbury Hospitals. They provided precise control of the dose of radio therapy administered, which improved the quality of care and patient outcomes. He said the Trust was now able to provide top quality radiotherapy services to patients.

The Committee heard that the Trust had a proposal for the location of a birthing centre at Maidstone, a midwife-led site adjacent to the main hospital site. Pembury Hospital had a midwife-led birthing facility as part of the main birthing centre.

The Committee was informed that work was underway on the new Histopathology laboratory [for examination of biopsy samples] in Maidstone Hospital. This would replace obsolete facilities at Preston Hall and Pembury and support  cancer services.

Mr Douglas said the provision of stroke services had been a priority for the Trust over the last 12 months, and both Maidstone and Tunbridge Wells now had good services. He explained the Trust’s performance against the Sentinel Stroke Audit, which had previously been poor, had improved significantly.

In response to questions, Mr Douglas confirmed the Trust intended to apply for planning permission for more parking spaces at Pembury Hospital.

In response to Members’ questions, Mr Douglas confirmed there had been complaints regarding staff parking in streets near Maidstone Hospital. Managers had tried to deal with this, but there was a limit to what they could do to prevent staff parking legally on public roads. Although staff had to pay for parking at the Hospital, the cost was £104 per year which the Trust considered to be reasonable.

Mr Douglas confirmed the Trust would work with partners to pursue development of duelling works for the A21. It was hoping to attract patients from Sevenoaks and believed improvements to the A21 would help this.

The Committee heard that the Trust’s funding had been frozen for 2010/11, and was likely to remain frozen for the next few years. While confident it could meet its targets this year, this would have to be kept under review.

A Member asked about the measures the Trust took to cater for the needs of disabled or vulnerable people. Mr Douglas said this was high on his personal priorities. He said that generally the Trust managed this quite well, but there were examples where it had not performed as well as he would like. He believed the opening of Pembury Hospital was an opportunity to look again at how the Trust responded to their needs.

The Committee considered the format of the report and in response to questions, was informed that the term ‘cum’ in the tables on page 4 of the report meant ‘cumulative’, while ‘breach’ on pages 22, 25 and 26 of the report meant that a target had been exceeded.

Members suggested that, as the report contained acronyms and abbreviations, a glossary would be useful. Members also suggested that a summary of the report would make it more accessible to members of the Public. Mr Douglas said the Trust was required to follow a specific format for the report, but would consider producing a summary document. 

Members noted that the Trust was reminding patients by text or telephone of their appointments, and noted this would be beneficial to both patients and the Trust.

The Chairman thanked the witnesses for attending and answering questions from the Committee.

Resolved: That the Committee write to the Trust, suggesting that:

a)  A glossary should be included;

b)  A summary should be produced to make the report more accessible to non health care professionals;

c)  The term ‘cum’ in the tables on page 4 should be expanded or an explanation be included to show this referred to a cumulative total;

d)  an explanation of why low-rise beds, referred to in page 6, reduce the incidence of patient slip, trips or falls, should be included;

e)  An explanation of how the Red Tray system, referred to in page 21, improves patient nutrition would be helpful;

f)  There should be a clearer explanation that a ‘breach’, referred to in pages 22, 25 and 28, meant a target had been exceeded;

g)  The report should clarify that the rates of Hospital acquired infections of both Clostridium difficile and MRSA were lower than the recorded infection rates, due to the inclusion of patients with an existing infection on admission. 

h)  The report should explain why the rate of MRSA infections had not reduced in a similar proportion to that of C Diff infections, and why the measures proposed for 2010/11 were expected to reduce infection rates;

And the letter should:

i)  Confirm the Committee believed the steps taken to remind  patients by text or telephone of their appointments would prove to be beneficial to both patients and the Trust; and

j)  Record that the Committee welcomed the agreement to publish a formal response to the LINks report on infection.

The web cast from this session is available at: http://clients.westminster-digital.co.uk/maidstone/Archive.aspx