Attached is the draft of the Quality Account document in full for you to review and provide comment.
Jeremy Vanes Chair of Royal Wolverhampton NHS Trust (RWT) and David Loughton Chief Executive of RWT provided the draft Quality Account . He advised that there had been changes to the report since publication of the draft version and that it was an evolving document. He highlighted the priorities around safe nurse staffing levels, safe care and the sign up to the safety issues such as sepsis, preventing infection and patient experience. He invited the panel to comment and provide a statement from this panel to be included in the document when published on 30 June 2016.
The Chair Cllr Jasbir Jaspal advised that a draft statement was in preparation and any comments of the panel would be included in the response statement.
In response to points raised the Chief Executive RWT confirmed that there were currently 230 vacancies which were approximately nine per cent of total nurse staffing. He clarified that there was some evidence to indicate that the shortage is impacting on the service provided but that this issue was not unique to Wolverhampton and that it was a national problem. He indicated that recruiting nurses from outside of the EU was a slow process out of 220 nurse posts offered to Philippine applicants earlier in the year only six visa’s had been secured, he suggested that when competing with Canada and the USA for nursing applicants the visa process needs to be more efficient. He highlighted that a big problem for recruiting nurses in the NHS moving forward was the removal of a bursary for student nurses, meaning that student nurses now would have to apply for a student loan. The full impact on the numbers of trainee nurses due to the bursary being removed would not be known until August 2016.
In response to questions from Cllr Wendy Thompson relating to the bursary scheme, medical training and recruitment, the Chief Executive advised that approximately half of trainees complete the training and that Doctors are recruited from overseas on the basis that they carry out both clinical and academic training. The recruitment on the basis responds to the need for staff and reduces the use of interims or agency staff.
Helen Hibbs, CCG responded to further questions about why more universities do not establish specialist training facilities highlighting that there was a high dropout rate. The Chief Executive RWT advised that the has previously been on the Government Advisory Board and although it is preferable that the number of medical schools are increased it would be a ten to twelve year journey and that in his opinion it was unlikely that there would be an expansion of medical schools in the UK in the short term, there may however be more spaces created at existing facilities. He clarified that RWT were in final discussion with the armed services about Accident and Emergency services. (A&E).
Cllr Peter O’Neill welcomed the style of the document, well put together, open and transparent. He particularly welcomed the ‘never events’ being included on the calendar and suggested that the RWT risk register and never events should be looked at during the scrutiny work programme this year.
The Chair RWT advised that the judgements in the document relate to the Care Quality Commission (CQC) inspection 2015. Safety in the medical wards was highlighted by CQC and the RWT did not agree; the number of vacancies impacted on the ‘well led’ section of the inspection as well. David Loughton advised that RWT had appealed the ratings and nine months on there had been no response to the appeal.
Following a discussion about never events it was agreed that further information about never events and the risk register should be submitted to Health Scrutiny Panel.
In response to questions from Cllr Martin Waite the Chair RWT advised that work would be undertaken over the next couple of years to adapt nursing roles, upgrading and looking at emerging and interesting areas. He advised they would be looking at the way the bank of nurses in used; he further advised that to keep the numbers of nurses in the bank up they needed to upgrade the bank.
The panel considered other sections of the draft report including the clinical audit and the catalogue of previous report, highlighting that changes take time to implement and sometimes do not work out too well. They highlighted that following CQC inspections at Stoke and Stafford there are improvements and financially they are achieving what they wanted to.
The Chief Executive RWT responded to questions about the maternity services and how the Trust had invested money, where neighbouring Authorities had not. He advised that approximately 600 additional maternity cases were coming through Wolverhampton as a result of CQC decision to push maternity cases to RWT. He advised that there was good news data to share with the panel.
Cllr Stephen Simkins voiced concerns that the lack of capacity would have impact on delivery of services and care of the patient. The Chief Executive acknowledged the concerns about capacity and advised that there would be an announcement about potential closures shortly. The panel recognised the need for more money to be allocated to hospitals and that things cannot be run if money is not sufficient.
Tracey Cresswell, Health Watch representative advised the panel that there had been no negative experience feedback from patients travelling to Cannock Hospital, the only issues seemed to be the cost of travel. She asked about the plans for 2016-17 and the increased patient and user engagement (including improving links within the community in particular the marginalised groups), and asked how the RWT would engage hard to reach groups. The Chair RWT advised that the Head of Complaints was carrying out some ambitious work to engage people. He advised that the Board had been charged with challenging targets and that there would be more efficiency savings to come over the next couple of years.
There was reference to the future Sustainability and Transformation Programmes (STPs) and how the RWT had worked closely to shape STPs. The Panel requested further information on STPs.