Questions from the Floor 2009
Board Meeting Held on Wednesday 27th January 2010 in the Boardroom, Princess Royal University Hospital
|i.||Mr Williams expressed concern that as reported in the minutes of the Finance Committee held on 22nd December 2009, Item 052/09 the Trust was in ‘financial meltdown' and that Non Executive Directors had stated they were not receiving answers to their questions. Mr Williams stated that at a recent meeting in response to a question asked regarding the cost of the Private Finance Initiative (PFI) contract it was reported that the Chief Executive Officer (CEO) had stated the cost of the PFI deal had gone up by 12%. Why is the PFI contract costing £12m more than the Trusts first contract?
It has been reported that the Trusts financial problems are attributed to the running of 2 PFI contracts. The additional costs equate to £12m concurrently. The organisation is losing a lot of money and spending more money than it earns. The language used at the time reflects the seriousness of the situation. The Trust will prepare a written answer to your questions as you deserve to receive a detailed answer and a copy of that letter will be appended to the minutes.
|ii.||Mr Williams; I read in the code of accountability for NHS Boards that one of the duties of the Non Executives Directors is to satisfy themselves that financial information is accurate and defensible. I wish to ask why the Non Executive did not satisfy themselves that saving £1.5m in year one on agency cost was in fact at least, somewhere near accurate considering the fact that not one single penny has been saved so therefore it was not defensible.
I don't accept the point you have made. The Non Executive Directors of this Board continually challenge the Executive Team. The costs of agency staff have escalated despite constant challenge at Trust Board level. That trend has now turned. Our first priority must always be to consider Patient Safety and Patient Experience. Performance has improved, but that has cost more money than expected. Minutes of the Finance Committee record the challenge from Non Executive Directors. The Trust is recruiting more substantive medical staff to reduce the expenditure on agency. I don't accept there is any evidence that we haven't held the executive to account.
|iii.||Is it not the case that staff can earn more working for an agency than the Trust?
I would say you were right.
|iv.||Mr Mott asked for a correction to the record of Questions from the Floor dated 25th November 2009. Questions ix and x were incorrectly attributed to Mr Mott, questions ix and x were asked by Mr Warne. Questions that Mr Mott did ask on 25th November 2009 were however not minuted and were as follows; Mr Mott asked the question "has a decision on the future of the Orpington Treatment Centre (OTC) been made?" and Dr Streather replied "NO". Mr Mott then asked the question "When will a decision be made on the OTC?" and Dr Streather replied "I should all the relevant information in about a week and a decision would then be made" Mr Mott asked that these points were formally minuted
The Chairman confirmed that Mr Mott would receive a response to the questions he raised at the Trust Board meeting held on 25th November 2009.
|v.||Mr Mott asked Ms Hall the following written question in relation to Patient Safety and Experience. It states that part of the Trust objectives are "To put patients at the centre of everything we do; we will deliver high quality care through application of best practice". Can you tell me if you meet these objectives when;
The objectives and values we publicly declare are important to us. I won't respond to specific individual cases however Patient Safety, Outcomes of Care and Patient Experience are an absolute priority to this Trust. The whole National Health Service was experiencing pressure on the capacity it had at that time and for Elective Patient Pathways the Trust had to make a decision based upon a judgement of the urgency to admit patients for treatment versus the imperfect treatment they may receive. Whilst a theatre recovery area is not ideal for the patient experience it is however a safer area. The Trust has to take a balanced view between what is considered safe and what is humane.
It is understood that mixing elective and emergency patients does increase the risk of cross infection however basic hand hygiene and other precautions will minimise the spread of infection. The implementation of APOH and the separation of emergency and elective activity needs to happen as quickly as possible. I am sorry to hear about your personal experience.
|vi.||Mr Mott; The Board was informed on 2nd December that the practice was happening and the practice was still happening on 21st December.
The Chairman reported he would request an audit of such practices and the results of that audit would be reported to Trust Board. Ms Hart suggested the Estates and Facilities Director should look at the arrivals lounge.
|vii.||Mr Mott handed the Chairman a photocopied report, alleged to be a report to the Trust Executive Management Committee (EMC) regarding the Orpington Treatment Centre and asked when was the report submitted, to whom was it submitted and what decision was made to whom the report was submitted.
The Chairman confirmed Mr Mott would receive a written response to his question.
|viii.||Mr Mott stated that the EMC meeting had been held before Trust Board. Mr Mott asked why Trust managers were telling staff not to speak to his wife and himself, was it because they were getting more information than the Trust Board.
The Chairman asked Mr Mott to confirm the Trust manager that is alleged to have told Trust staff not to speak to his wife and himself.
|ix.||Mr Mott named the member of Trust Staff that was alleged to have told staff not to speak to his wife and himself.
The Chairman confirmed that through the Chief Executive Officer he would ask the Interim Chief Operating Officer to investigate the claims made by Mr Mott. Patients were entitled to ask questions and he would be surprised and angry if such action had taken place.
|x.||Mr Lane asked the following written question in relation to Trust Registration with the Care Quality Commission (CQC). The registration of SLHT with the CQC has found 4 areas where the Healthcare Trust concedes non compliance. Two of these child safeguarding and appraisal of staff give extreme cause for concern.
There have been legacy issues that needed to be addressed. Appraisal should be in place for all staff and very often it would appear that staff appraisals have happened and not been recorded, that is not acceptable and so we have identified that we do not comply. The position on appraisal is monitored on a regular basis and ownership for appraisal rests with the managers of the organisation. Progress is being made and we will improve the position in 6 months.
|xi.||Mr Lane stated it was important to support staff, for the sake of their morale and to ensure that they feel valued.
The Serious Case reviews reported to Trust Board today pre-date this organisation. Our inherited position was that one of our sites was not compliant on 1st April 2009. Key roles needed to be appointed and this took longer than we anticipated. There is a policy and procedure based on best practice that staff are asked to follow and we have named nurses responsible for safeguarding.
|xii.||Mr Lane asked if there was inter-agency working.
Yes, as reported in the Trust Board report presented today.
|xiii.||Ms Choppin asked the following written question in relation to pressure ulcers and patient falls. Concern was raised at the last Board meeting concerning the high number of pressure ulcers and patient falls. There is conflicting information n the current prevalence of pressure ulcers which still seem unacceptably high? Is there a correlation between nurse shortage and pressure ulcers or patient falls? Pressure ulcers are indicative of poor nursing and nurse should be on the look out for pressure sores, why was it allowed to get so bad?
Ms Hall confirmed that there had been a demonstrable improvement in the number of severe pressure ulcers. The Trust was confident that with improvements in the quality of data being collected we would minimise the risk of double counting patients with pressure ulcers. Patient falls is an known risk when someone is trying to become more mobile and independent. The Trust was finalising new guidance to staff that would establish Trust wide approach to the management of falls. Our evidence suggests that there is no direct correlation between staff numbers and patient falls however we do accept that patient need to be better assessed to minimise the potential for them to fall
|xiv.||Ms Choppin asked the following written question in relation to movement of stroke patients from Queen Marys to Queen Elizabeth Hospital. The movement of stroke patients from Queen Marys to Queen Elizabeth Hospital apparently led to 25 stroke nursing vacancies. Please confirm this. If verified please provide reasons for this large stroke nurse vacancy list. What plans are there to rapidly recruit qualified stroke nurses?
The Trust had commenced the recruitment of staff before patients were moved from Queen Marys to Queen Elizabeth Hospital. There is a shortage of stroke staff across London and Nationally. The Trust was training staff and utilising the Trust Bank, its own Trust staff to fill vacancies.
|xiv.||Mr Warne asked for an explanation of the apparent contradiction between the figures quoted for the Trust not paying its bills on time and its reported financial position.
The Trust accounting system is an accrual process. The numbers were correct and the Trust has confidence in the reported figures.
|xvi.||Mr Warne asked when the Trust would appoint a Non Executive Director (NED) to become a Patient Experience Champion.
It was hoped the Trust would appoint a fifth NED in the next 2 weeks.
Board Meeting held at 14:00 on Wednesday 25 November 2009, in the Conference Centre, Queen Elizabeth Hospital
- Mr Angell enquired whether the Trust monitored readmission rates of elderly patients and particularly those with dementia. Mr Cass replied that readmission rates were monitored within the Trust’s performance report under measure CQ10 and CQ11 on page 103 of the Board papers. These represented the overall readmission figures and he would need to check whether data was available specifically for elderly patients and those with dementia.
Trust Response: The Trust does not routinely monitor readmission rates of patients in specific age-groups or patients with specific conditions as part of our Board assurance process. The Trust does, however, monitor readmission rates within 14 days for all of our emergency patients. From the information we hold, it is possible to analyse readmission rates by age group and/or diagnosis
- In response to questions from a number of members of the public, the Chairman agreed that, where a question was answered outside the meeting, the reply would be included within the minutes in future.
- A question was asked when the Trust would allow the Primrose Centre to open. The Chairman replied that the Primrose Centre was currently the subject of action in the High Court but he was able to confirm that the Trust was keen for it to open and operate the service from these premises as soon as possible.
- In response to a question from Mr Williams, the Chairman replied that the minute of his question on page 14 of the Board papers (minute number 127/09) would amend the word “exactly” to “accurately”.
- Mr Williams noted that in the May Trust Board papers reference had been made to the Trust looking to save £1.5m in agency costs during the current financial year and £1m in the subsequent year. He enquired how much money had in fact been saved. Mr Gentile agreed to establish the correct figure outside the meeting and record the answer in the minutes.
Trust Response: Against the original plan for agency spending the Trust has overspent rather than saved the £1.5m; however in the later part of the financial year the overspend is being reduced considerably. On a general point, the Chairman repeated his suggestion that if members of the public submitted questions in advance of the meeting Board members would have a better chance of being able to answer them at the meeting, rather than subsequently.
- Mrs Hook noted that at two of the Trust sites, ISS Mediclean were employed to provide facilities services. This company had been found to have employed illegal immigrants at another London trust at which it was the facilities contractor. She enquired whether the Trust was satisfied with the checks ISS Mediclean were making at South London Healthcare. Ms Hall replied that within 24 hours of the story, to which Mrs Hook was referring, breaking the Trust had been contacted by ISS and reassured about the checks undertaken on staff employed at South London Healthcare.
- Mrs Hook expressed concern that community facilities were not included in the business case for stroke services. Dr Streather replied that research suggested that the first 72 hours after a stroke was the most critical period for the patient’s survival and the business case therefore aimed to ensure that the services provided during this period were of the highest standard. He also noted that in general it was clinically better for patients to be discharged as soon as they no longer required the specialist services that could only be provided in hospital.
- Referring to page 233 of the Board papers, Mr Williams noted the Chairman’s comments in the Finance Committee minutes that non executives’ questions at each meeting were being answered with descriptions of future plans when what they needed to hear was action that had been and would be taken. The Chairman replied that this reflected the position at the meeting on 29 September and as had been stated earlier in the meeting, non executives were now satisfied with the quality of information they were receiving about financial matters.
- Mr Mott enquired why staff at Orpington Hospital were being told that the hospital would close six months after the decision to close the facility had been made. Dr Streather replied that the Secretary of State for Health’s decision had been to close the facility before March 2011 on the condition that staff were involved in the timing of this move. The Trust had been consulting with its staff ever since to ensure that the Secretary of State for Health’s instructions were observed.
- Mr Mott enquired whether the vacated premises at Orpington would be re-used for other health purposes. Dr Streather replied that this decision rested with the commissioning authorities.
- Referring to his previous question on page 14 of the Board papers (minute number 127/09 vii), Mr Mott enquired when exactly outsourcing contracts had ceased. Mr Cass replied that he would include the details in the minutes.
Trust Response: The Trust phased out the outsourcing of patient treatment to deliver the 18 week standard by September 2009. However, the Trust sometimes experiences increases in demand for particular services, which cannot be met by running additional in-house clinics/theatre lists alone. The Trust will, therefore, on an exceptional basis, outsource some of the demand to a suitable, third-party provider.
- A question was asked whether the Trust now regarded its capacity as sufficient such that it would no longer need to outsource work. Mr Cass replied that, with the exception of neurology, the Trust did now believe its capacity was adequate. However, he could not guarantee that the outsourcing of work would not occur in future since the Trust could not control the number of patients wishing to use its services.
- A member of the public asked the Board to comment on a statement made by a previous chief executive of Bromley Hospitals NHS Trust that Orpington Hospital was closing for financial rather than clinical reasons. The Chairman replied that questions about what a previous chief executive had said would need to be directed to that individual. He was, however, clear that in closing the Orpington facility the Trust was implementing an instruction from the Secretary of State for Health as part of the actions necessary to implement APOH.
- Noting that staff were being consulted on four possible options for Orpington Hospital, Mr Mott enquired which of these options was preferred by the Board. The Chairman replied that the Trust was in the process of consultation with its staff and would not form a view until that consultation had been completed.
- Mrs Loughton enquired whether the Trust had involved patients and the public in its plans for stroke services. Ms Hall replied that stroke services had been discussed at the Patient Strategy Experience Group, on which patients and the public were represented, on two separate occasions. She also confirmed that members of the LINk participated in the Leading in Improving Patient Safety (LIPS) walkabouts.
Board Meeting held at 10:30 on Wednesday 30 September 2009, in the Ash Room, Training and Education Centre, Queen Mary's Hospital
- Mr Lane, Chair Bromley LINk, enquired how many missed diagnoses had been identified by the Trust and how many of these had contributed to a patient's death. The Chairman asked Mr Lane to confirm the details of his question in writing so that he could receive a written response.
- Mr Lane enquired whether the Trust would reconsider its decision not to permit a LINk representative to sit at the Board table as a non voting member. The Chairman replied that he would reconsider this decision in the new financial year, once the Trust had a full complement of non executive directors. In doing so, the Trust would need to consider whether or not a LINk member sitting at the Board table would conflict with the LINk's role in representing the views of the public and staff to the Board.
- Concern was expressed that the accommodation for the Urgent Care Centre at QMS was inadequate and were there any plans to alter the premises. Mr Cass replied that the Trust had received no complaints about the Urgent Care accommodation prior to this question and he agreed to discuss the matter with the questioner in more detail outside the meeting.
- A question was asked how many consultants were now working 8pm to 8am in A&E at Princess Royal and Queen Elizabeth sites, and how many consultants were working in A&E on all three sites during the day shift. Mr Cass agreed to discuss this matter with the questioner outside the meeting.
- Ms Choppin enquired whether the Trust's measure of Did Not Attend rates took account of the fact that many clinics were intentionally overbooked by the Trust. Mr Cass agreed to establish how the rate was calculated and to inform Ms Choppin outside the meeting.
- Ms Choppin also expressed concern that the Trust's proposals to reduce DNA rates appeared punitive and she asked for reassurance that these would be discussed with patient representatives. Mr Cass replied that the proposals reflected the national NHS model but confirmed that they would be the subject of consultation.
- Mr Mott enquired when the Trust would cease to send patients to the private sector for treatment. Mr Cass replied that this would take place as soon as possible but could not take place immediately because some arrangements were subject to pre-existing contracts and commitments. He agreed to report back to the next meeting with the contract end dates.
- A question was asked about the future of Orpington Hospital. Dr Streather replied that APOH envisaged the closure of Orpington Hospital to elective surgery by March 2011. It was, however, sensible for the Trust to start working towards this goal as soon as it could so that the transition could be achieved in a planned way with minimum disruption to patients. An early change would be separation of the emergency and non emergency clinical pathways in orthopaedics which would improve the quality of care the Trust was able to provide to those patients. Dr Streather reminded the Board that in approving the change with regard to Orpington Hospital, the Secretary of State had made it conditional upon staff being involved in the planning for change. The Trust would therefore be consulting on its plans.
- Mr Mott noted that a recent request for information had shown that, on a number of occasions, the staffing levels at the Orpington Treatment Centre had exceeded the number of patients admitted. He enquired whether this meant that the Trust was not using its existing capacity efficiently. Dr Streather replied that this illustrated the difficulty in managing services on a small scale. In line with best practice evidence, APOH aimed to develop services in larger units where capacity could be more fully utilised.
- Mr Williams expressed concern that his questions were not being recorded exactly in the minutes. The Chairman replied that the minutes were not a verbatim account of all that was said at the meeting. He suggested that if members of the public wished to have their questions recorded exactly, they should hand a written account to the Secretary at the meeting. In response to a question from Mr Lane, the Chairman also added that, if members of the public wished, they could submit questions to the Trust Board Secretary two days before a Board meeting which, depending upon the nature of the question, may allow a fuller response to be made at the meeting.
- Mrs Lowton wished to record her thanks to Queen Mary's staff for the care that she had received and enquired whether the Trust ensured that such thanks were made more widely known. Dr Streather replied that he always acknowledged compliments, which far exceeded the number of complaints, and ensured that they were passed on to particular members of staff or departments where this was clear. Mr Shoben encouraged members of the public to write to their local newspapers if they wished to bring examples of good care to the notice of the wider community.
Board Meeting held at 10:30 on Wednesday 29 July 2009, in the Board Room, Princess Royal University Hospital
- Referring to minute number 064/09 vii, a member of the public asked for a specific report detailing how far the Trust was achieving its target of saving £1.5m on agency staff costs during the year. The Chairman reminded the Board that information to enable it to monitor progress with the Trust’s CRES programme was already contained within the Finance report that was available to the public. The Trust could not agree to prepare specific additional reports where it felt that the information it already received was adequate for it to discharge its duties.
- A member of the public drew the attention of the Board to a local newspaper article expressing concern about the cleanliness of the Trust’s colonoscopy equipment. He asked for reassurance that the Trust’s procedures and resources were adequate to ensure such concerns were addressed. Mr Cass referred the questioner to section 7 of the IPC update report on page 42 of the Board papers and also reported that the Trust had a decontamination plan which included the replacement of equipment that did not meet cleanliness standards. He was able to reassure the public that the Trust had procedures designed to ensure equipment was clean before it was used and that, if this was found not to be the case, this equipment would be withdrawn so as to safeguard patient safety. This would be done even if it involved the cancellation of a patient’s procedure as a result.
- Referring to minute number 061/09 on page 11, a member of the public enquired whether it was still intended to have a standing item on the Board agenda for LINk issues. The Chairman replied that the three LINks were currently considering this proposal.
- A member of the public commented that his hard copy of the Board papers had only arrived the previous day. The Chairman replied that they had been sent out on the intended date but another member of the public commented that local disruption to postal services may have accounted for the delay.
- A member of the public enquired about bullet point two in section 3.1 of the Finance report on page 55 of the Board papers. Mr Kirton replied that, with the exit of the private patient provider, the Trust had decided to operate a private patient facility itself, which would contribute towards its savings target.
- Referring to the previous discussion about governance matters and APOH, Ms Choppin commended the Board for its emphasis upon ensuring good clinical governance for patients across the patient pathway, even when other service providers were involved.
- With regard to improving clinical governance across agencies, Mrs Hook suggested that LINk representatives could be invited to attend meetings between GP representatives and the Trust when such matters were discussed.
Board Meeting held at 10:30 on Wednesday 27 May 2009, in the Conference Centre, Queen Elizabeth Hospital
- A member of the public disputed the Chairman's interpretation that paragraph 2.1 of Annex A to the NHS Code of Openness (as amended 2003), only applied to the Annual General Meeting. He referred to a letter from the NHS Appointments Commission saying that the availability of papers seven days in advance applied to board meetings also. The Chairman stood by his interpretation, but stated that he would seek appropriate advice from the Department of Health.
- Referring to the availability of Board papers in advance of the meeting, a member of the public enquired whether those that were available seven days in advance were sent out then and later ones tabled to members of the public on the day of the meeting. Dr Streather replied that the need to ensure that the Board had up to date information available to it meant that the Trust could not guarantee to be in a position to send out Board papers seven days in advance of the meeting.
- A question was asked how far children at risk could be monitored by health and other services if they moved around the country. Ms Dalziel replied that, whilst communication between agencies was improving and the Contactapoint database would help, it did not offer a complete solution.
- A question was asked what steps the Trust was taking to implement the recommendations for improved dementia care as set out in a recently released Department of Health document. Ms Grant replied that the Matrons for Older People on the Queen Elizabeth site were considering this document and she felt sure that Ms Hall would look to ensure recommendations were considered across the three sites.
- In response to a question about the development of stroke services locally, Dr Sulch replied that the results of consultation should be available in July and any changes to stroke services should be agreed by October.
- Referring to minute number 029/09 on page 34 of the Board papers, Ms Mott corrected the minute in the penultimate paragraph which should have recorded that Ms Choppin rather than herself had asked the question.
- In response to a question about the Cash Releasing Efficiency Savings programme, the Chairman confirmed that progress with the programme would form part of the finance report at each Board meeting.
- A member of the public questioned the Trust's proposed expenditure of between £80-90k per annum on a Director of Communications at a time when the Trust faced a significant financial deficit. The Chairman replied that in order for the Trust to deliver the best possible services to local people, it needed to ensure that both its external messages to the public and internal messages to staff were of the highest order. Investment in a first class Director of Communications would be essential to achieving this.
- In response to a question about the ratio of trained to untrained nurses and whether there was a link between the higher use of untrained staff and the higher incidence of pressure sores, Ms Grant replied that the two were not necessarily linked. Both trained and untrained nursing
- A member of the public commended the Trust for its performance with regard to the 18-week and 4-hour A&E targets. He also enquired why some patients were being told they would be treated at a private hospital when he believed sufficient capacity existing within the Trust. The Chairman replied that if he informed him of the specific details, the matter could be looked into
Board Meeting held at 10:00 on Wednesday 29 April 2009, in the Board Room, Princess Royal University Hospital
- In response to a number of comments from members of the public, the Chairman apologised that some of those present had not received their Trust Board papers before the meeting. He gave an undertaking that Trust Board papers would be sent out to members of the public at the same time as they would be made available to Board members.
- In response to a question from Mrs Mott, the Chairman agreed to ask Ms Burchett whether the names of Trust Board directors could be shown in a larger font on their name plates.
- In response to a question from Mr Williams, the Chairman confirmed that Trust Board meetings were business meetings in public, rather than public meetings, and members of the public whether LINk representatives or not, would need the Chairman’s permission to ask a question during the conduct of business.
- In response to a further question from Mr Williams, Mr Perry agreed to write to him giving the figure for the overall historic deficit of South London Healthcare NHS Trust.
- Mr Williams enquired whether the Trust had systems in place to recover income due to it from overseas patients, not entitled to receive NHS care. Mr Perry replied that it did, and that such income represented a small proportion of the Trust’s overall budget.
- Mr Bruce enquired what steps the Trust was taking to attract staff to fill the vacancies within the A&E departments. Dr Sulch replied that the non training grade medical staff that formed a significant part of the workforce in A&E on the QE site were not now available and he would be discussing with A&E leads next week the development of a service delivered more by consultant staff. The Chairman added that, in a number of areas, the new Trust appeared to be attracting more applicants of a higher quality in a number of areas because it was a larger organisation with greater opportunities for career development and more assured future.
- Mr Warn asked that NHS jargon be minimised in reports for members of the public. Mr Cass replied that both he and Ms Hall would be discussing this and other matters with LINk members and others at the June Patient Experience Steering Group.
- Mr Street enquired whether the new Trust would have sufficient resources to develop its trauma and stroke services. Dr Streather replied that NHS London had agreed to uplift by one third the national tariff for stroke. This represented a substantial increase which he believed would be sufficient to develop high quality services for patients locally. He also noted that the development of a hyper acute centre would attract a higher tariff that would facilitate investment.
- Mr Bruce enquired whether the new Trust would be appointing an Older People’s Champion from amongst its non executive directors. The Chairman replied that, once the two remaining vacant non executive director positions had been filled, he would be in a position to allocate this and other non executive responsibilities.