Agenda item

Purpose: To provide the Board with an update on capacity and performance over the winter period and how this has been affected by Covid.

Councillor Graham Bridgman declared a personal interest in Agenda Item 11 by virtue of the fact that he was a governor of the Royal Berkshire Hospital NHS Foundation Trust. As his interest was personal and not prejudicial or a disclosable pecuniary interest, he determined to remain to take part in the debate.)

Dr Alex Evans gave a presentation on the current situation at the Royal Berkshire Hospital and the challenges they faced. Key points from the presentation were as follows:

Covid Situation:

·         There were 109 inpatients with Covid, with three patients in the intensive care unit, one of whom was on mechanical ventilation.

·         40 Covid patients were being treated on a virtual ward and received daily contact from physicians and remote monitoring of blood oxygen levels.

·         These numbers were much less than in the second wave, when there had been 280 Covid inpatients.

·         The main challenge was in keeping Covid patients separate from other patients. The Trust was amongst the top performers in England in avoiding nosocomial infections.

·         A disproportionate number of Covid inpatients had not been fully vaccinated.

·         96.3% of the Trust’s staff had received at least one jab – the Trust was ranked 13 out of 126 in England for uptake.

·         Approximately 150 out of more than 6,000 staff were off work with Covid – this was an improving situation.

Challenges:

·         Teams had been working well to meet elective waiting lists.

·         There were very high pressures on the Emergency Department (ED, with 400+ patients per day (up from 300 on a bad day pre-Covid).

·         Mitigating measures put in place included:

o   A new discharge lounge

o   A Complex Discharge Liaison Team and Patient Flow Co-ordinators assigned to bring expert knowledge to complex discharge cases

o   Same day emergency care unit that assessed and treated more than 100 patients per week

o   A Covid Medicines Delivery Unit had been set up to provide high-risk patients with new Covid anti-viral treatments

o   Additional Point of Care Testing had been brought into the ED to provide rapid testing of patients for Covid, flu, norovirus, etc.

·         It was one the few Trusts to continue diagnostic work and elective procedures through Covid and 92.7% of suspected cancer patients were being seen within two weeks.

·         Efforts were being made to bring performance back to standard for all patients to be seen within six weeks of referral.

·         There were challenges in diagnostics (MRI, CT and endoscopy) and plans were in place to improve capacity, with a new diagnostic hub created at West Berkshire Community Hospital.

Activity at West Berkshire Community Hospital:

·         Day surgery unit running 3-4 Saturday endoscopy lists every month

·         All services resumed with mix of face-to-face and telephone services

·         Additional outpatient clinics being run to clear backlogs

·         Clinic space provided at weekends to support the Covid vaccine programme for 12-15 year olds

·         WBCH was one of the first Community Diagnostic Centres in the country to open – a new MRI and PET-CT scanning facility will open later this year

·         Two MRI scanners purchased using £2m charitable donation – will increase scanning capacity, reduce waiting times and provide better patient experience.

Achievements:

·         ENT ‘super Saturday’ carried out 18 tonsillectomies to clear the backlog – similar events are planned for general surgery

·         Opthamology carried out 315 operations, leaving just 31 patients waiting more than 18 weeks (these were awaiting suitable donor material)

·         Health Improvement Programme with University of Reading – public health specialists were working with clinicians on health inequalities, with a focus on prehabilitation, smoking cessation, and maternity outcomes in mothers from ethnic minority backgrounds.

Independent Sector and Mutual Aid:

·         434 patients transferred mid-pathway to the independent sector and 2.850 transferred at source to speed up treatment

·         The Trust has provided mutual aid for Oxford University Hospital and Buckinghamshire Healthcare NHS Trust, including ear nose and throat, orthopaedics and urology

·         The Trust had also worked with the Integrated Care System to share good practice and offer further support to acute providers

Winter Campaign:

·         A communication campaign was run with the CCG, South Central Ambulance Service, local councils and Pharmacy Thames Valley

·         The main themes were: Be Prepared; Choose the Right Service; and See Your GP Diferently.

·         The campaign attracted 253,000 social media hits

Building Berkshire Together:

·         RBH selected as one of 48 UK sites in the Governmnet’s New Hospital Programme – the Strategic Outline Business Case has been submitted and the Trust was awaiting feedback to progress to the next stage.

·         A range of options had been devised to redevelop or relocate the main hospital site and further work will take place to reach a preferred option.

·         Options were being developed with patients, carers, staff and the local community. Interested parties were encouraged to get in touch.

Green Plan to Reach Net Zero

·         The NHS had pledged to reach net zero direct carbon emissions by 2040. The Trust was due to launch its Green Plan in March 2022, which would set out how it would work towards net zero carbon:

o   Reduced use of desflurane in surgery

o   Alternative travel options for staff and patients

o   Increased recycling

o   Sustainable models of care

·         Achievements to date included:

o   Removed two miles of leaking, inefficient underground pipework on the RBH site

o   Installed a new eco-friendly boiler

o   Five electric pool cars for staff

Paul Coe praised the joint work that had been undertaken around rapid community discharge from hospital to make best use of the additional funds from Government. However, it was noted that this funding would cease at the end of March 2022 and the partners would need to manage the transition.

It was confirmed that most of the additional posts funded by Government would remain in place once the funding had ceased.

Councillor Lynne Doherty noted the positive aspects in the presentation, but asked about waiting lists at RBH relative to the rest of the country.

Dr Evans indicated that RBH was in a good position regarding cancer care and elective surgery, but RBH was failing to meet the target of seeing 90% of  patients visiting the ED within four hours – this was down to the volume of patients and challenges in maintaining flow through the hospital.  This made it particularly important to improve the flow out of hospital.

Councillor Martha Vickers asked if there was a lot of inappropriate visits to the ED, and whether this could be linked to local shortages of GPs.

Dr Evans stated that higher ED attendance was not translating into higher levels of admissions. He recognised that GPs were under pressure and were experiencing difficulties with recruitment. This suggested that solutions needed to be sought as a system (e.g. educating people about accessing the right services, and making use of allied health professional to free up GPs’ time).

Dr Abid Irfan noted that Winter Access funds had provided extra investment in GP services. Private providers were being used to deliver additional capacity, including telephone consultations. Dr Irfan welcomed the improved diagnostics at West Berkshire Community Hospital – he asked what facilities would be provided there and if direct access would be provided for patients without the need for GP referral, provided they met certain criteria.

Dr Evans confirmed that the new facility would have the same functionality as the one at RBH. There would be two fixed MRI scanners and a PET-CT scanner, which was used to detect cancer that had spread. These would be in addition to the existing CT and endoscopy, as well as x-ray and phlebotomy.  Patients would only have to travel to RBH for very specialist diagnostics. With regards to direct access, Dr Evans was not aware of any plans to do this and suggested that clear pathways would need to be prepared in order to make best use of the limited resource without introducing unnecessary delay or workload.