Agenda item

 

To receive and consider the annual report from The Rotherham NHS Foundation Trust (TRFT) in respect of actions, challenges, and achievements of the Trust for the financial year ending 31 March 2024.

 

 

 

In light of the declaration of personal interest made by Councillor Garnett, they left the Chamber during consideration of this item.

 

The Chair welcomed Michael Wright, Managing Director, Sally Kilgraff, Chief Operating Officer and Helen Dobson, Chief Nurse, TRFT to the meeting and invited them to deliver the presentation.

 

The TRFT Managing Director advised the Commission that 2023/24 had been an exceptional year in terms of demands on the Trust’s services, with the Trust managing a number of challenges and delivering successes, nonetheless.

 

Chief Nurse Helen Dobson explained that there had been significant improvements in relation to a range quality and patient experience issues over the previous twelve months, with emphasis and investment on continuous quality improvement with a programme of training supporting staff enablers driving improvements in infection prevention and control, resulting in shortlisting for a national award in this area.

 

Intrinsic to the ability to deliver high quality care was a stable and well-trained workforce. There had been huge successes in this area within midwifery and support workers, with significant improvements in retention and almost all vacancies filled.  Emphasis was shifting from internationally educated nurses to local recruitment, including the ReSTORE programme which sought to integrate the refugee population with existing nursing qualifications from their home countries into the local healthcare system.

 

They outlined work undertaken through staff networks to promote and enhance diversity and inclusion, with TRFT preparing to hold its second annual cultural celebration event. This work had also resulted in a nomination for a national award.

 

 

TRFT had begun to introduce a series of ‘joy in work’ events, drawing on research which reflected that staff who were happy and enjoyed their jobs would be more productive.  Events had a health oriented underlying themes as well as boosting morale, productivity and creating healthy competition between teams.  The next planned event was veteran’s awareness, linked to remembrance Sunday in November 2025.

 

The Trust had introduced a clinical accreditation programme over the last year which assessed a broad range of domains, allowing best practice to be identified. 

 

Patient experience had also been a focus with a number of innovative initiatives implemented, some of which had drawn national attention, all with the aim of making time in hospital a more pleasant and dignified experience.  The in-patient survey conducted produced data which identified the Trust as the most improved of 70 organisations who used that provider, and when compared with CQC (Care Quality Commission) Data the Trust were amongst the 7 most improved Trust’s in England. 

 

They acknowledged that there was still more work to be done to improve patient experience but cited that the Trust’s focus was on being the best at getting better for the time being.  In order to do this, the Trust had drawn information from a range patient experience data from a range of sources such as complaints and Healthwatch. For the coming year, the Trust would focus on the launch of a patient advice and liaison service and a carers charter and the Commission was appraised of data concerning the Trust’s performance in that area during the previous year.

 

The Managing Director, TRFT, outlined the annual staff survey process and parameters, outlining that participation rates had improved from approximately 40% to 67%, with no Trust achieving more than 69% participation.  The Trust had moved from the bottom quartile in respect of the areas assessed to the upper quartile in the past four years, approaching the best in country in some areas.  The Trust was thrilled with these results and intended to build upon them.

 

They did note that one of the key challenges staff had faced was violence and aggression.  As such, the Trust had invested in body worn video cameras for staff and had worked in collaboration with South Yorkshire Police to secure prosecutions where staff had been subjected to assaults. Work to eradicate poor behaviour toward staff continued.

 

The Chief Operating Officer cited that the background of industrial action against an increase in demand on services had provided a challenging year at times, particularly in maintaining service delivery across emergency and elective care.  Despite this, progress had still been made in reducing waiting times.

 

Historically, TRFT had been one of the field test sites for the move away from the 4 hour emergency care standard, so after 4 years of working to different standards the Trust returned to working to that standard last year.  This required lots of work with staff, with different care pathways in place which staff needed to adjust to.

 

Despite this, improvements were made, with the Trust performing at 54.8% against the 4 hour standard at the start of the year, improved to 62.9% by the end of March.  The Trust acknowledged that there was more to do to improve this further and work had been progressed with the ambulance service and community services pre and post treatment to improve flow to further enhance this further.  The latest published figures from August 2024 stood at 68.7%.

 

In respect of elective care, the Trust had focussed on the return to the 18 week referral to treatment standard post Covid.  Given the impact of industrial action, targets had moved into this year however, by the end of March 2024 the Trust had only 22 patients waiting over 65 weeks.  By the September 2024, 65 week waits were eliminated in line with the national ask.

 

Cancer standards changed in year, reducing from 10 to 3 standards. These were in respect of diagnosis and treatment times.  The Trust had made real progress against those and had introduced stretch targets to exceed the national ask, including no more than 1% of patients waiting more than 6 weeks for a diagnostic test.

 

As an integrated Trust with a number of community services, the Trust had consistently achieved the 2 hour urgent community response standard and had made great progress with increasing virtual ward capacity with strong step up and step down pathways. The Trust had also worked with health and social care partners alongside the voluntary sector over the last year to develop a ‘transfer of care hub’.

 

TRFT’s Managing Director confirmed that the Trust had achieved its financial plan, noting that this was a deficit plan of £4.715 million, achieving £11 million in efficiency savings and spent £12.3 million of capital on investments in estate, IT infrastructure and medical equipment.

 

They explained that TRFT had a partnership with Barnsley Hospital NHS Foundation Trust, with Dr. Richard Jenkins as Chief Executive of both, a joint strategic partnership group and joint delivery group which considered opportunities for collaboration, synergy and efficiencies which had delivered a joint gastroenterology service, considered clinical services reviews, commissioned a joint leadership development programme and explored commercial opportunities such as joint tendering to realise better value for money.

 

The Chair thanked TRFT for the comprehensive report and presentation and invited questions.

 

 

Councillor Bennett-Sylvester drew on personal experience and noted inconsistency in care ranging from very good to so poor that care was sought elsewhere.  He queried whether those who had elected to seek care elsewhere were considered as a driver of improvement, given that this might represent difficulties around engagement but mindful of the learning opportunities those experiences might provide.

 

The Chief Nurse advised that where the Trust is aware that service users had sought care elsewhere due to dissatisfaction, this was looked at.  They explained that this was why they encouraged patients and family members to come forward and share their views and experiences, acknowledging that complaints were a valuable tool for driving service improvements.  Written responses were offered to complaints where required, however, local resolution meetings were preferred to allow those affected to communicate their experiences face-to-face.

 

Councillor Bennett-Sylvester noted that the complaints data reflected in the report and presentation appeared to have remained stable in terms of numbers, however, given that this was against a backdrop of increased demand, queried whether this was indicated of a reduction in complaints in real terms.

 

The Chief Nurse confirmed that this was a reduction in real terms.

 

Councillor Havard noted that the report and presentation made mention of a new public health Consultant.  They asked for more information about that role and their focus, aside from the working groups outlined in the presentation.

 

The Managing Director advised that Andrew Turvey was a joint appointment working across the Trust and RMBC, who had been in role for just over a year. They explained that a lot of work had been done around patients who failed to attend appointments, they had worked with the quit team in relation to smoking cessation and managed the healthy hospitals team and prevention work in conjunction with Ben Anderson, Director of Public Health, RMBC.

 

The Director of Public Health, RMBC advised members that Andrew had been a good addition to the place team in terms of public health, supported by the Better Care Fund prevention programme working across the community, primary and acute sectors and leading on the development of the update of the health and wellbeing strategy.

 

Councillor Havard queried how the Trust engaged with GP services e.g. in terms of training etc.

 

The TRFT Managing Director explained that he worked with Dr. Jason Page who was a GP and the Medical Director for the South Yorkshire Integrated Care Board (ICB), Rotherham Place, who provided advice and support as required.  TRFT’s Medical Director and Deputy Medical Director were closely linked with GP practices, and the out of hours service included GPs.  The Chief Nurse added that training opportunities delivered by the Trust accommodated wider participation across all primary care as appropriate.

 

Councillor Thorp asked why the decision had been taken to close down staff accommodation, querying whether this was solely based on costs or whether there were other factors involved and if the Council had been approached to see if anything more could be done to allow those properties to remain in use.

 

The TRFT Managing Director explained that the Trust had conducted ongoing assessments of the accommodation, and more recently fire risk assessments which had identified that significant amounts would have to be spent to maintain the buildings.  They explained that annual capital available to the Trust as outlined in the presentation was £12 million, which included all medical equipment, maintenance, wards and strategic works.  As such, the costs associated with maintaining the accommodation was not affordable.

 

Councillor Thorp asked whether the Trust had any plans to address parking issues at the hospital which were affecting residents in neighbouring properties. They also asked whether consideration had been given to building a mutli-storey parking facility.

 

The TRFT Managing Director advised that parking had been an issue for some time, which had seen the Trust invest in ANPR technology to manage parking more effectively, alongside creating additional spaces a short distance away from the hospital building and encouraging the use of public transport where possible.  They stated this remained and ongoing challenge which the Trust would continue to review.

 

Councillor Keenan advised the Commission that the accommodation closure was an area which had prompted concerns and invited Council officers to provide further information concerning the Council’s readiness to respond.

 

The Governance Advisor outlined that as a result of concerns raised the Chair had consulted with Councillor Baker-Rogers, Cabinet Member for Adult Social Care who had in turn contacted TRFT, and Health and Ian Spicer, Strategic Director of Adults, Housing and Public Health.  As a result the Chair was advised that the Trust had conducted listening events and were conducting one to ones with staff members affected by accommodation closures to understand individual needs and develop solutions.  Likewise, the Council’s Homeless Team was available to offer advice and support to those affected.

 

Councillor Thorp asked whether there was any potential to seek external investment in both the accommodation and/or car parking, through the Council or otherwise to resolve the issues for Rotherham residents with financial neutrality from the Trust’s perspective.

 

The TRFT Managing Director advised that he did not believe that had been explored and could be considered and was aware of other hospitals using outsourced parking functions and multi-storeys. There would likely be significant costs associated with any multi-storey development, but agreed that TRFT would discuss this further.

 

Councillor Yasseen queried whether the Trust intended to demolish the high rise blocks, or the single storey accommodations or both.

 

The TRFT Managing Director confirmed that there were no plans for any of the accommodation to be demolished. Due to the costs associated with maintenance the three apartment blocks were to remain unoccupied until such time as the longer term strategy was fully understood.

 

Councillor Yasseen wanted to understand what had caused the increase in demand for TRFT services, noting the progress against the 4 hour urgent and  emergency care standard despite this and alongside the shift in policy.  They also noted that the target had not been met and, whilst acknowledging the significant progress, wanted to understand what was being done to achieve that.

 

The Chief Operating Officer explained that the increased demand had presented in terms of both walk in patients and ambulance arrivals.  There was work ongoing with the new Public Health Consultant to understand levels of deprivation and how that affects services accessed. They explained that the mindset shift when reverting to the 4 hour standard had proved more challenging than expected, however discussions with other field test sites had reflected that their experiences were similar.  Further work was underway looking at pathways pre-hospital, within the hospital and within the urgent and emergency care centre.  Eight additional doctors were recruited over the Summer and rotas were redesigned in order to demand match. These changes were implemented in August and the impact was beginning to be seen.  Work had also been undertaken to strengthen the community offer which had also begun to make a difference.

 

Councillor Yasseen queried how having GP services within the urgent and emergency care centre was supporting overall service delivery.

 

The TRFT Chief Operating Officer explained that the urgent and emergency care delivered an out of hours GP service overnight, and the Trust had co-located some community services in the urgent and emergency care centre (UECC) overnight and at the weekend linked to the NHS 111 service.  The Trust had also employed some GPs to work in the UECC during normal hours servicing those patients who presented with a primary care need.

 

 

Councillor Yasseen asked whether they had understood correctly that industrial impact had less significant for Rotherham Hospital than elsewhere.

 

The TRFT Chief Operating Officer advised that doctors did take industrial action however, lots of planning was undertaken to allow the hospital to maintain its urgent and emergency care services safely and maintain elective services. The Trust had had to cancel some theatre and outpatient work to maintain emergency services, but had minimised the impact effectively which was the key difference to experiences elsewhere.

 

Councillor Yasseen noted that the report detailed that 14% of patients from deprived areas were likely to miss their appointments versus 7% of patients from more affluent areas. They queried whether the Trust understood the causes of that disparity, and asked what they were doing to address those health inequalities.

 

The TRFT Manager advised that Andrew Turvey had commenced work to understand those reasons which could be employment based, transport based or otherwise in order to develop solutions.  They noted that work was in its infancy.

 

Councillor Yasseen commented that there were differences across hospital departments in relation to how appointments were communicated, with some being via the NHS app, some via text message or email and some via hard copy correspondence. She queried whether those communication inconsistencies across services within the same hospital contributed appointments being missed and if so were there plans to address this.

 

The TRFT Chief Operating Officer explained that the Trust was moving to include more services in the app, considering the different booking processes currently used.

 

Councillor Tarmey noted the improved position around staffing level and questioned what the Trust had done differently to fill vacancies and plug gaps in rotas.

 

The TRFT Chief Nurse explained that this had been an area of focus for the Trust for a couple of years and the work undertaken was reflected in the data.  Particularly the work done around retention had been picked up by NHS England and the Trust’s shortlisting for the nurse employer of the year award was connected to the work done around retention.  There had been a focus through the people and culture strategy on the working environment, involving clinical teams and ensuring the Trust was engaging staff and focussing on the basics.  There was also a lot of work undertaken around leadership, inclusion and safety which had predominantly focussed on nursing staff but which was being extended to other staff groups. The Trust had arrived at a position where UECC, midwifery and community nursing had waiting lists of individuals wanting to join the Trust. 

 

Councillor Tarmey noted that in his experience, outsourced car parking facilities at hospitals resulted in higher costs for service users and that had the potential to widen health inequalities further and asked if TRFT would factor that into any future parking solutions.

 

The TRFT Chief Nurse referred the Commission to the launch of the carers charter detailed in the presentation and added that concessionary rates would be offered to carers which would assist in that area.  They also noted that in feedback provided both to the hospital and through Healthwatch, service users had reported wanting to see the return of reliable public transports links to the hospital which had yet returned to pre-covid levels.

 

Councillor Havard explained that constituents had reported having to access services at Bassetlaw Hospital due to a lack of available beds at Rotherham and had noted difficulties around information transfer between the hospitals and queried whether there were issues around this.

 

The TRFT Chief Operating Officer explained that it was unusual for an ambulance to divert from Rotherham to Bassetlaw, but this could occasionally happen when a particular hospital was experiencing exceptional pressure.  In terms of record sharing, this was easier the more records become electronic and was easier when transfers were planned.  They explained that they would raise this with the IT Director as they were conducting work around records integration across the wider geographical area.  They also noted that there had been significant progress made in relation to accessing GP records, but that record sharing generally remained a challenge and particularly across Counties.

 

Resolved:-

 

1.    That the Health Select Commission noted the TRFT Annual Report for 2023/24.