Overview of the event:
The East Kent Hospital University NHS Foundation Trust Annual Members’ Meeting took place on 2 October 2014. More than 130 members were in attendance as well as members of the public, members of the Council of Governors and Board of Directors, representatives from partner organisations and members of the Trust’s staff. A copy of the attendance register is held by the Trust Secretary.
Trust Directors presented an overview of the Trust’s business in the 2013/14, with an opportunity for questions from the public. Prior to the meeting, there was an opportunity to view a number of Trust exhibitions from various departments within the organisation.
A copy of the 2013/14 Annual Report and Financial Statements was made available at the meeting. You can view these online now >
Presentations:
- Welcome and Introductory video – Nicholas Wells, Chairman
- A review of the previous year – Presentation by Stuart Bain, Chief Executive, on the key achievements and challenges during 2013/14
- Financial Performance Overview – Presentation by Jeff Buggle, Director of Finance and Performance Management, outlining the Trust’s financial position during 2013/14. He also outlined the work of the East Kent Hospitals Charity during 2012/13
- Latest Developments in Cardiology Services - Presentation by Dr Kayvan Kamalvand, Consultant Cardiologist, providing an overview of the developments in cardiology services explaining the benefits to patients and to staff
- “Delivering Our Future” – Presentation by Liz Shutler, Director of Strategic Development and Capital Planning, on the Trust’s 5-10 year strategy
- Report from the Council of Governors – Presentation by Brian Glew, Lead Governor, on the activity of the Council during 2013/14 and key areas of focus for 2014/15.
Members of the public also endorsed the notes of the previous Annual Members meeting as an accurate record of proceedings.
Questions
A review of the previous year
Is a list available of facilities/services intended for the new Dover Hospital?
Although there will not be inpatient care at this hospital, facilities would include emergency care/minor injury service; renal dialysis; and a range of outpatient and diagnostic services. The hospital will serve people in the community and deliver the vast majority of their needs without travel to main hospital sites.
Financial Performance Overview
Has consideration been given by the Trust to charge people who arrive drunk in A&E at the weekend?
The Trust was bound by the NHS Constitution to deliver services free at the point of care. Misuse of NHS services was subject to national debate.
Has anything been done to encourage CCGs to use the facilities of the hospitals rather than to move to private concerns?
The Trust would continue to aim to deliver excellent, timely and high quality services to ensure they were kept local to population of East Kent.
Latest Developments in Cardiology Services
There had been significant investment in services over the last 10-15 years – has this impacted positively on cardiology mortality rates?
A paper published by the European Society of Cardiology reported a 50% reduction in mortality overall as a result of early Primary Percutaneous Coronary Intervention.
There were 8 GPs with special interests (GPSIs) – does this cover the whole of Kent?
These trained GPSIs were available in East Kent, supported by secondary care.
Why was it not possible to provide a 24/7 cardiology service at every hospital?
Studies carried out shows that if a heart attack patient is received by a cardiac centre for insertion of a stent within 150 minutes from the time of call, outcomes were better than administering clot busting drugs.
Extensive travel times (isochrones studies) were undertaken to identify the most appropriate site for the Kent Cardiac Centre. William Harvey Hospital was determined to be the optimal location in Kent.
It would not be possible to resource a highly specialised cardiac centre on each hospital site in Kent.
When inserting the guide wires through major arteries, what was the chance of dislodging plaque?
Thinners and anticoagulants were used during the procedures. Special catheters were used to remove the clot when required.
General comments
The presentation demonstrated the rapid development of medical technology and the increased benefit to patient outcomes. The importance of generating a financial surplus to continually invest in services was reiterated.
The presentation also demonstrated the importance of collaborative working with key partner organisations.
“Delivering Our Future”
The CQC highlighted in their Report published in August 2014 a disconnect between management and staff. How would this affect the ability of the Trust to recruit and retain staff, specifically to support the future developments of the Trust? What would the Board put in place to address this issue highlighted by the CQC that had the confidence of clinicians?
The Trust recognised the issues identified by the CQC in their report and an improvement plan was in place. The Trust would be focussing on how services could be delivered differently and more efficiently with engagement from front line staff. The Trust’s clinical strategy would reflect ideas from within the organisation and respond to challenges the Trust faced as a health economy.
The themes from the CQC report focussed on three main areas: staff engagement; workforce issues; and culture of the organisation.
A separate staff engagement improvement plan would be put in place to address the disconnect felt by staff. The CQC action plan and staff engagement improvement plan needed to be owned by the whole organisation. The Chairman was working on the staff engagement element with the Director of Human Resources.
Engagement with staff was an important way to ensure their voice was heard and to strengthen commitment and motivation.
The Trust would be meeting with Monitor, the Trust’s regulator, on a monthly basis to report progress against implementation of the action plan.
The Trust recognises that staff engagement was key to “delivering our future”.
What was the impact on the Trust as a result of the special measures placed on Medway Maritime Hospital?
The Trust would be working with key partners to address patient flows across the whole health economy.
Medway was still designated as a trauma unit. Would the Trust be retracting from this agreement?
The designation of a Trauma Unit was determined by Trauma Networks and not individual Trusts.
What was the role of HealthWatch?
This was an organisation which coordinated public views on health and consultations in relation to health services.
Could you explain more about what integrated services would look like?
The average A&E attendance had increased significantly. In July 2014, attendances were around 600 per day.
Healthwatch had undertaken a study of A&E attendance which reported that young people were more likely to attend A&E rather than seek help within primary care. The Trust had also undertaken analysis which reported increased attendances from 18-30 year olds.
The Trust was discussing this with the commissioners in terms of patient flow.
The Trust held a ‘Providers Event’ in September 2014 to review CCG commissioning plans and opportunities for integration.
The presentation mentioned working with nursing homes – could you explain more about what this will mean in practice?
The Trust is exploring opportunities of co-locating a nursing home on an acute site. Research was being undertaken to include workforce models.
Report from the Council of Governors
I am impressed with the assurance provided by the Chairman regarding the Trust’s response to the CQC Report. I was not impressed with the Governors’ letter to Trust membership – I felt it protested too much.
The Council of Governors accepted the challenges faced by the Trust and improvement work required to address issues raised by the CQC. However, the communication circulated by Governors raised a challenge to the CQC as to whether the Report was fair in every respect.
With regard to the CQC report, was there a lesson for Governors in terms of degree of scrutiny? Was the Council confident it has sufficient overview of what is going on in the organisation?
The Council operates within the context of the Health and Social Care Act. There are lessons for all in the CQC report and the Council will continually review how it discharges its duties.
The CQC highlighted that the Trust’s complaints process was not clear. Was the Council clear on the way it dealt with problems and complaints raised by members of the public?
Governors do not receive many complaints directly from members of the public. There was a clear process in place to forward any concerns raised by members of the public to the Trust.
The presentation referred to Governors reflecting views of the public and the membership to the Board of Directors. What opportunities were in place for staff to feedback to the Board?
The Trust has a number of communication channels in place and part of the staff engagement improvement programme will be to ensure staff was aware of these and to obtain feedback on additional mechanisms which would be useful.
General Questions
One of the problems both in the community and acute trusts was ensuring staff received ongoing training to maintain skill sets or learn advancing technologies. Staff were often allocated training but then refused access time. This could be one of the areas of disconnect felt by staff.
The Trust reviewed establishments on wards on a 6 monthly basis. A budget was in place for staff training. Challenges arise during periods of vacancies. The Trust’s learning and development team review and prioritise training requirements which were identified through appraisal processes. Work was ongoing to introduce more creative ways in which people could learn in the work place. In addition, the Trust was ensuring staff was appropriately supported. In particular, investment had been made in additional practice educators to support new nurses.
All members of staff are also required to undertake core mandatory training relevant to their position. The Trust was working to resolve technical issues faced by some members of staff.
The Trust was encouraged to listen to all staff during the implementation of the action plan.
Closing comments from the Trust
The CQC report highlighted the Trust was “Good” at caring. Staff are the Trust’s most valuable resource and members of the public acknowledged recognition by the Trust of the issues raised by the CQC in their report. However, staff would need to be adequately supported to implement the changes required.
The Trust had recognised that staff engagement had been a challenge for the Trust for some time and resolving this was fundamental to service delivery.
The Trust had held a series of listening events with staff following publication of the CQC report. Feedback had been incorporated into the Trust’s action plan. Staff spoken to had a positive attitude towards the improvements needed.
The Trust would continue to strive to be an organisation with a good reputation for providing excellent care.
The CQC reported the Trust as ‘Good’ for caring which reflected the immense efforts of front line staff.
Monitor, the Trust’s regulator, had allocated an Improvement Director to the Trust to work at the Trust 2/3 days per week to assist with the delivery of the CQC Action Plan. This role was an independent role to provide support to the Trust and assurance to Monitor.
Nicholas Wells, Chairman, thanked all members of the public, staff and representatives from key stakeholder organisations for attending.
October 2014
Previous meetings
