PLEASE NOTE THIS MEETING WILL BE WEBCAST.

If you require further information about this agenda please contact: Joan Conlon 020 8583 2071. ADULTS, HEALTH AND SOCIAL CARE SCRUTINY PANEL

A meeting of the Adults, Health and Social Care Scrutiny Panel will be held in Council Chamber Civic Centre, Lampton Road, Hounslow TW3 4DN on Monday, 24 April 2006 at 10:30 am

PLEASE NOTE THIS MEETING WILL BE WEBCAST.

MEMBERSHIP

Councillor Barwood- Chair Councillors Awan, Fisher, Gill,SCS, Hibbs, Khwaja, Nakamura, Sangha, Vaught and Mel Collins.

AGENDA

1. Welcome and Introduction by the Chair of the Panel 2. Referrals from the Patient and Public Involvement Forums (Pages 1 - 148) 3. Supplementary Documents previously embedded (Pages 149 -

290) DECLARING INTERESTS

Committee members are reminded that if they have a personal interest in any matter being discussed at the meeting they must declare the interest and if the interest is also a prejudicial interest then they may not take part in any discussion or vote on the matter. T.WELSH, Director of Legal Services London Borough of Hounslow, Civic Centre, Lampton Road, Hounslow TW3 4DN 20th April 2006

OSC-Referral-2005k29-Final.doc Page 1 of 107, 2005.12.09

Pa t i en t and Pub l i c Invo lvement Fo rum for the Wes t M i dd lesex Un ive rs i ty Hosp i t a l

P P I FP P I FP P I FP P I F for

W M U HW M U HW M U HW M U H

www.cppih.org

Re f e r r a l t o Houns l ow Adu l t H ea l th & Sc r u t in y Commi t t ee o f the W es t M i d d le sex Un i ve r s i t y Hosp i t a l T r u s t b y the Pa t i en t and Pub l i c I n vo l vemen t Fo rum

1) for persistent refusal to consult the PPI Forum, in accordance with the Trust's

statutory requirement under Section 11 of the Health and Social Care Act 2001;

2) and for the abysmal quality of the inconsistent, inaccurate, unclear and

misleading information that has been drip-fed to the Forum.

B a c k g r o u n d o v e r t h e p a s t 1 6 m o n t h s

1. Closure of ward Lampton 1. In August 2004 the PPI Forum learnt that ward Lampton 1 was

about to be closed. Two members of the Forum visited the hospital: but were told that the decision

had to be taken urgently as reduced staff levels meant that the ward could no longer be run safely,

[App. 1 & 2]. Forum members were not satisfied with the Trust's response, and at a public

meeting of the Forum on 7th Sep. 2004 voted to refer the matter to Overview & Scrutiny, with the

support of local MP Vincent Cable, [App. 3 & 4] after Gail Wannell (the hospital's Chief

Executive) had admitted that consultation had not take place. However, although the PPIF's then

chair, Cherna Crome, reported this at the Overview & Scrutiny meeting on 8th Sep., she

unfortunately omitted to request an investigation. Accordingly no further action was taken. How,

when, and why the urgency to close the ward arose has never been determined: although the

Trust Board minutes [App. 4] record "Mrs. Franks added that she had raised concerns about the

standards of care on Lampton ward to the Board in May". The Forum's position that we should be

consulted and Gail Wannell's acknowledgement of lack of communication were restated at the

Forum meeting in October 2004, in the presence of the Trust's Chair, Chief Executive, and other

Board members, [App. 5].

2. Vetting patient referrals. In November 2004 the PCT's new scheme for referral of patients by

GPs to the hospital was outlined at a public meeting of the Forum by Cath Attlee from Hounslow

Agenda Item 2

1


PCT, who stated that this change was being introduced without consulting patients, as it allegedly

did not affect the service patients received. [App. 6]

3. Reduction in surgery & closure of cardiac drop-in facility. On 8th December 2004 the Trust

wrote to the PPIF, announcing that the hospital had "already started to reduce elective surgical

work", had ceased the "open-access drop-in facility" for cardiac patients, and had "implemented

these changes this week". [App. 7]

4. Reduction of Medical Day Unit. On 10th December 2004 the Trust wrote again to the PPIF,

announcing that the hospital had "agreed to reduce the service to two days per week and to

relocate the service". [App. 8]

5. Dec. 2004 – Continued refusal to consult. Just before Christmas 2004 the Trust summoned the

PPIF to hear two complaints, (one of which was withdrawn before the meeting). PPIF members

believed that the Trust was still refusing to consult. The Trust restated its view that "operational

decisions had to be made quickly": although the view of the Forum remains that, while this may

apply to crisis management, it ought not to apply to the majority of decisions made about the

running of the hospital. [App. 9]

6. Cessation of blood tests for children over six. In January 2005, Forum members learnt that the

provision of blood tests for children was about to cease. [App. 10] We have not heard any more

about this.

7. Duty to consult explained at Civic Centre. In January 2005, at a meeting attended by members

of the PPIF for the West Middlesex Hospital, by members of the PPIF for Hounslow PCT, by staff

from the West Middlesex Hospital, by staff from Hounslow PCT, and by staff supporting Overview

& Scrutiny, a solicitor, Paul Conrath, gave an invited presentation on the statutory duty of NHS

Trusts to consult, explaining that for any consultation to be meaningful it had to be

conducted at such a time and in such a manner that it could influence the eventual

outcome. Gail Wannell repeated her admission that the Trust had not yet got right the level of

debate needed when faced with the need to make emergency decisions. Paul Conrath noted that

pleading lack of funds or other resources was not a valid excuse for the Trust to avoid providing a

service or to avoid consulting, [App. 10].

8. Delay of 6½ months in answering questions on Stroke Unit. In May 2005, Dr. Platt, a

consultant from the hospital, kindly spoke at a public meeting of the PPIF on the subject of strokes.

As he had to rush away during the interval, questions relating to his talk were emailed to Joe

Johnson (Complaints Manager). Despite repeated reminders, no response was obtained until late

on the evening of 28th November: over six months later, and just one day before the formal referral

to Overview and Scrutiny. [App. 11]

9. Reduction in coronary care staff. Also in May 2005, Cherna Crome wrote to the Trust,

complaining that information about another change made without consultation, (putting on hold "the

appointment of a replacement for the Coronary Care lead") had not been forthcoming. [App. 12]

In September this was raised again, [App. 20]: but no information was available. On 24th

October a four-page proposal was emailed by the Trust: peppered with unexplained initials and

2


abbreviations, raising more questions than it answered, and devoid of any timescales, (apart from

the deadline for reply). Had we responded, we should have needed to schedule a meeting to

obtain clarification: but we were unable to do this within the deadline.

The following brief extract indicates that this service has not been provided as required under the

NSF (National Service Framework). It has taken from May to October to obtain this information:

during which period it appears that the situation has deteriorated.

• Phase 3 – Currently the only option for phase three is to come in to WMUH to have exercise. The cardiac physiotherapist who returned from leave in May 2005 and a nurse from the cardiology ward area currently provide Phase 3. There has been an intermittent problem of physio cover over the past year due to maternity and subsequently sick leave of the post holder. This post is managed and funded by the PCT who were unable to cover this post for some of this time. During this period the exercise component of this phase was not covered and has resulted in a waiting list for this service. In addition the nursing post holder resigned in September 2004 and despite advertising at a number of grades WMUH were unable to recruit. During this time the nursing element of phase 3 has been covered by nursing staff from the cardiology ward – either by permanent or bank cardiology staff who have appropriate skills required to run this service safely.

10. Trust concern in June 2005 that proposed ward closure still not quantified. In June 2005, a

paper presented at the Trust Board meeting on the "Financial Recovery Plan Progress Update"

reported as follows that plans to close 30 beds were still under discussion, that the proposed

savings had not yet been fully quantified, and that the action plan had not yet been developed.

[App. 13 & 14] –

Savings plan area: Bed Closures – 30 Acute beds Key Achievements Since Last Report: Road map of actions required to deliver

bed closures has been developed and is now under discussion.

Current Concerns: Level and timing of savings that can be made as a result of

the review have not yet been fully quantified and reviewed by the execs. Reasons for Variance and Actions Taken: Action plan to be developed

11. Unreliable data on proposed ward closure sent to Forum. The PPIF was sent a copy of details

sent to Overview & Scrutiny, with two tables listing current and projected bed capacities: although

the column totals quoted in the second table had patently not been checked, as the "Site total"

(369) was less than the "Normal" total (373). [App. 15]

12. Business case for ward closure in preparation. Although the PPIF was informed that plans to

close another ward were being made, at no stage were we ever consulted about this. A few PPIF

members attended a daytime meeting at the hospital on 19th July, and were told that a business

case for the changes was still being prepared, (though not a Health Impact Assessment), and that

the Trust was "aiming to preclude the use of escalation wards". [App. 17]

13. Trust reluctant to accept Forum's consultation protocol. Although the "consultation protocol"

was emailed to the Trust on 18th July, [App. 16], at the meeting the following day the Trust

3


"expressed its disappointment that a protocol had not yet been agreed" [App. 17]. The Forum

confirmed the protocol on 3rd

August, [App. 18].

14. Notification after event instead of prior consultation. A paper on a proposed consultation plan

dated 15th August marks the 19

th August to "inform PPI of bed model changes" (not "consult"), with

the consultation period to end on 9th September. [App. 19] However, this did not happen. At a

PPIF meeting on 15th September, the Trust informed the PPIF that the Trust "had developed the

Bed Model and would like to discuss it with members in the very near future", [App. 20]. We were

later offered five slots in the week of the Trust's Annual General Meeting: two before, and three

after, [App. 21]. A majority of PPIF members found the third slot most convenient: and

discovered that the changes had been announced the day before, at the AGM, without any

consultation having taken place. Gail Wannell stated that "the proposal was developed end of

August / early September", and that the purpose of the meeting was "to give the rationale behind

the model", [App. 23]. The ward had been closed at the beginning of the week: as nursing staff

discovered when they arrived for work!

15. Delays and errors in supplying data on waiting lists and cancellations. On 16th September

the Forum requested details of waiting lists and of cancelled operations, [App. 22, page 1],

which we wanted to study and digest in good time before the meeting on bed closures. Five further

reminders were sent over the following month. A reply was obtained just 50 minutes before the

bed closure meeting on 29th September: but at the meeting Gail Wannell realised that the figures

were wrong. A partial reply was received on 10th October, with .XLS and SNP attachments. The

former (reproduced in [App. 22, page 2]) does not include the requested monthly breakdown

over the past year, and raises further doubts about the significance of the "suspended patients" not

included in the figures. The latter is unintelligible: and the covering email (not reproduced here in

its entirety, as it contains contributions from three Trust staff in eight different fonts) contains the

following warning. –

Please find attached the KH07 and Additions and Removals reports for the

week ending 25 September 2005.

There is a known issue with a small number of patients appearing in the long waiting time bands of the KH07 who should not be shown there. I am looking

into this issue and hope to have a resolution shortly.

16. Health Impact Assessment – was one performed?: At the meeting on 29th September where

we were informed of the bed closures, we asked whether a Health Impact Assessment had been

produced, and were told by Patricia Davies that one had. We requested a copy of this by email on

3rd

, 7th, 27

th, 31

st October, [App. 24]. We were surprised that, although the Forum's decision to

refer the Trust to Overview & Scrutiny was made public and notified to the Trust on 17th October,

this did not expedite a reply.

On 3rd

October the hospital issued a press release, [App. 25], avoiding stating how many beds

had been closed, but rationalising this on grounds of "improve[d] patient care and efficiency",

together with resultant savings, and claiming that the changes had been "planned for many months

in consultation with doctors and senior nurses", (though not with patients or the Forum).

4


We were amazed on 4th November to receive an email from Alison M

cIntosh [App. 41] denying

that any explicit Health Impact Assessment for the bed closures announced at the AGM had been

performed, apart from their daily review of the bed situation: "The bed model impact assessment

that we referred to is in fact what we do on a daily basis". Given that nurses attending the Trust's

AGM stated that they had learnt of the closure that week, (only when they arrived at work on the

Monday morning and found their customary ward closed), her statement "We have not closed the

ward yet as you already know" presumably refers to the (reopened) escalation ward.

The PPIF has thus been unable to obtain reliable and consistent information on what planning (if

any) the Trust may have conducted, (whether Health Impact Assessment or business case) whilst

planning the bed closures.

17. Escalation wards: One week after the Trust's announcement of bed closures, the PPIF

discovered that two escalation wards were in operation, with over forty patients, despite the

attempt to close over 30 beds with no adverse impact on patient care. A hospital press release on

12th October states that this is "due to unpredictably high numbers of emergency admissions over

the past week". It explains: "the closure of one ward has not yet been possible. We are reviewing

the situation on a daily basis with the aim of closing the ward as soon as we can. This ward will

remain available for escalation purposes and we are fortunate to have this extra capacity and

flexibility should the need arise". [App. 28]

It therefore appears that whatever planning of the bed closures may have been performed,

(whether business case or Health Impact Assessment), was woefully inadequate. We wonder how

the hospital will respond during winter peaks; whether it has any developed any robust plans in this

regard; and what may happen should avian 'flu strike.

(In May 2005 Joe Johnson informed Andris Vanags, then a Forum member, that ward Lampton 1,

closed in August 2004, had been reopened as an escalation ward to take "the overflow of patients

from other wards". Yet at the same time the Trust was already planning the closures announced in

September 2005. – For all the reports that are produced by Trust staff at meetings, are decision-

makers in possession of a suitable perspective and appropriate internally-available facts in

sufficient time to make good decisions? They are certainly not in possession of externally-available

facts, for the simple reason that they do not consult.)

18. Data accessibility and presentation: Graphic interpretations of the "bed model" changes (i.e.

ward closures) were received on 10th October, [App. 26]. These were received as Powerpoint

presentations. Most members of our Forum have no access to Powerpoint: and as Powerpoint

displays only one of these at a time, it requires more IT skill than most members possess to view

the two charts simultaneously for comparison.

Comparison of the two diagrams indicates the closure of two wards (Crane 1 and Crane 2),

totalling 61 beds. At the bottom of the second diagram is a new section, referring to 28 beds:

5


though with no geographical location. The fragmented manner in which information is supplied

makes it very difficult to determine what is happening at the hospital. The great delays in obtaining

information mean that, far from being consulted about future events, the Forum is not even being

kept up to date with changes that have already occurred.

The same day we were emailed the "SITREP" report, without commentary, [App. 27]. As most of

the entries are either zero or blank, the information conveyed to Forum members is low. The data

descriptions are obscure: e.g. Section A refers to Types I, II, and III, without any explanation of

what these may be. Computed values appear to be incorrect: e.g. item D1, column 3 shows

0.00% (allegedly correct to two decimal places) – yet, while it is not clear whether this is intended

to represent 4 / 316 or 5 / 316, these should display (to two decimal places) as 0.01 and 0.02,

respectively. The final section, for Trust commentary, is totally blank: suggesting either that the

Trust is subject to no pressures (which we do not believe), or that they are unable to agree a view

to report, (which we think more likely).

19. Impossible deadlines and data accessibility: At the Forum's public meeting on 15th September

we were informed that the Trust "would be sending their draft declaration on Standards for Better

Health to the forum in the near future", [App. 20]. We were therefore surprised to receive on 13th

October a reminder that our response was expected by 14th October, [App. 29]. The Draft had

been emailed to members on 10th October: but as an Excel file, (which most members are unable

to open), and formated to print in an incredibly small font size.

We were granted a brief extension to submit our response. During this period we obtained hard

copies of the Draft, in a readable font: together with a 12-page document from CPPIH, dated 19th

July, containing guidance on how to respond. We replied on 19th October, [App. 31].

20. Inspection of escalation wards: On 13th October the Forum's two cochairs conducted an

informal visit to inspect the two escalation wards, giving 90 minutes' notice, (in excess of the one

hour required by the CPPIH Handbook). There were 48 patients in the two wards at the time of our

visit, being cared for by just eight staff (nurses and health care assistants). [App. 30] A team of

doctors visited both wards during our visit, and voiced the following concerns. –

A consultant's patients are now scattered over several wards

Lower levels of supplies are stocked on these wards

Lack of staff permanently assigned to escalation wards, hence:

�� ward staff are not familiar with the patients

�� lack of continuity

�� information is lost more easily at handover between shifts

�� staff not familiar with the ward have difficulty in locating supplies

During an unrelated visit to check the availability of hot water, Francis Brown, a Forum member,

was told by the engineer from Ecovert (the maintenance subcontractor) that it was considered

significant that previous problems with hot water (in the new building) had coincided with the recent

6


recommissioning of an escalation ward (in the old Marjorie Warren building). [Email dated 28th

October.]

The opening of these two escalation wards so soon after the announced bed closure, and the

comments offered by staff indicate that information gathering, planning, and consultation with the

Trust's own staff were inadequate.

21. Decision by Forum to refer to Overview & Scrutiny: Given repeated failure by the Trust to

consult the PPI Forum about changes and to provide accurate information within the twenty

working days required by the 2001 Health and Social Care Act, (as evidenced above), the seven

Forum members present at the meeting on 11th October voted unanimously to refer the Trust to the

London Borough of Hounslow's Adult Health and Social Care Overview & Scrutiny Panel. Present

at this meeting was Lesley Forsyth, Director of Operations at the Commission for Public and

Patient Involvement for Health, who recommended a press release announcing that this decision

would be formally confirmed at the Forum's next public meeting on 8th November. The wording of

the press release was revised slightly by the Commission, then emailed on 17th October to the

Trust, and one hour later to the local press and to all Forum members. The referral was duly

confirmed at the public meeting of the Forum on 8th November, which was attended by five of the

PPIF members present on 11th October and two others. A further formal announcement was made

at the public meeting of the Overview & Scrutiny Panel on 29th November.

Forum members note with some surprise that, after the Trust was notified of the impending referral

on 17th October, no significant change in behaviour was detected.

22. Staffing on escalation wards and hours worked: During the visit on 13th October, we asked

Jackie Hardy, as a measure of the continuity of staffing on the escalation wards, for statistics of

staff turnover in these wards: number of distinct individuals working each week, number of people

working just one shift, working two shifts, etc.. Following a reminder emailed on 4th November, a

partial reply was obtained on 7th November, indicating that currently the Trust is unable to

regulate or monitor the number of hours worked by staff in any given period. It concludes

optimistically, "for the future, our nurse rostering system will also help us to monitor this more

robustly": though with no indication as to when this is expected to be introduced.

On 11th November an Agency nurse who had been working in an escalation ward at the West

Middlesex reported that she liked working there, as "a lot of the staff are Agency": so there is a

sense of community, and she doesn't feel like an outsider, as is generally the case when

performing agency work in other wards or at other hospitals.

23. Floor Plans: These were requested as part of the Cleanliness Inspection Report submitted by the

Forum in December 2004: "Please can you provide floor plans, identifying for each ward all the

rooms (main ward, side rooms, toilets, utility rooms, cupboards, etc.)?". At the PPIF meeting on

11th October 2005, members agreed to submit a formal request, referring to the statutory

requirement for a reply within 20 working days. During an unrelated visit on 4th November,

members were allowed to view a set of plans on large format paper. Trust staff refused to copy

7


them on grounds of cost: and in fact they were too large for Forum use. An electronic version was

requested: but further delays ensued. Finally files were made available on 24th November: but

only for the new building, and only in AutoCAD format. Despite the availability of a freely

downloadable utility to view these files, the Forum has not yet been able to convert these to a

useful format. We acknowledge that the Trust does not have appropriate software: but we are

surprised that the architects were not contractually obliged to supply a set of useful plans in an

easily accessible electronic format. Plans of wards in the old Marjorie Warren building have not yet

been supplied.

24. Trust Board papers: These papers from the board meeting on 27th October 2005 demonstrate.

♦ Chief Executive's Report [App. 32] Section 2 ("Bed reconfigurations and IARDS ward")

dismisses these two items in just four brief sentences, crowing "we undertook a major configuration of our bed base … and at the same time opened a 14-place rehabilitation ward … planned with military precision …". There is no mention of the unscheduled opening of two escalation wards with over forty beds which had occurred just two weeks later. The cover page specifies the formal action required as "cascade through the directorates and CEO briefings". Does "cascade" mean anything more than "just flick through the pages"?

♦ Minutes from 21st July [App. 33] Item "TB05.86.07 Proposed bed reductions" reports

meetings with the Forum on 18th Feb. and 19

th July. There was a public meeting of the Forum

on 17th Feb., and a few members attended meetings at the hospital on 25

th Feb. and 19

th July.

We are not aware of any meeting on 18th Feb.. The minutes of the meeting on 29

th Sep. record:

"The proposal was developed end of August early September". As explained above, it was only on 29

th Sep. that details were given to Forum members: after the public announcement the day

before. There is no way that this can be considered consultation.

♦ Remuneration/HR Committee [App. 34] "Sue Ellen stated that the bed closures and staffing

reductions should have resulted in greater savings". Stephen Clark said: "we need to be reducing staffing levels". These statements appear to contradict Gail Wannell's "planned with military precision": unless, of course, she was thinking of famous military disasters.

♦ Patient Experience committee minutes [App. 35] The Forum's representative stated the PPIF

view that "they appeared to be continually ‘playing catch up’ and were only finding out about changes after the event … the Forum was not being involved at the planning stage when they could actually contribute something". A Trust director agreed that "the Trust needed to work within the Act".

♦ Performance Report [App. 36] "We need to ensure that performance does not further

deteriorate, especially with potentially extra pressures arising from the recent reduction in bed capacity, the onset of Winter and the impact from February of the Ashford emergency services reconfiguration." Yet the Forum was assured that the bed reduction would not impact on patient care. If the Forum is being told one story and the Trust Board another, this suggests at best bad planning, (military precision?), or at worst deliberate deceit. In the latter case, any consultation is totally meaningless.

♦ Financial update [App. 37] This reports "At the same time a proposal to ‘turn away primary

care related attendees is being worked through": although this was not mentioned to the PPIF

until 4th November, [App. 42].

♦ Finance sub committee minutes [App. 38] "GW confirmed that the Trust will deliver on bed

reductions from October and will slow down expenditure on training, development and other non-pay areas" Options mention include "Downsizing outpatients" and "Turning away primary care patients from A&E, or capping the level at 04/05 levels". There is no mention of consultation.

♦ Nursing Acuity & Dependency [App. 39] Item 4 refers to a report by Leeds University on

Syon and Crane wards. "4.8 Whilst it is pleasing that our nurses in both wards are ‘extraordinarily patient centred’, it

8


appears that important indirect care activities like communication and reporting are not given adequate time. This has potential serious medico-legal consequences with nurses failing to assess, plan and evaluate their care. These core-nursing activities have a direct impact on quality of provision and must not be ignored." "4.11 … Anecdotally it is recognised that front line staff are frequently exhausted by increasing workload demand and as a result of the complexity of the patients" "4.15 The author of the report warns ‘This problem is usually a symptom of excessive workload and grade-mix imbalance as corners are cut. Medico-legally this is dangerous practice since tribunals view unrecorded care negatively.’ …" Both Crane and Syon understaffed. No mention of this in relation to the two escalation wards and the problem of staffing them on an ad-hoc basis. You would have to question SC comment on the need to further reduce staffing levels.

25. "Strictly Confidential" appendix: A Board paper on published on the Trust's web site and mailed

to regular attenders contains an appendix marked "Strictly Confidential", [App. 39]. If this is how

the hospital treats its own strictly confidential data, it inspires no trust or confidence that staff will

maintain the confidentiality of patients' personal data.

26. Consultation on reduction in A&E Service: On 4th November Alison M

cIntosh emailed PPIF

members an attachment with no cover note. At the end of the attachment was a brief and vague

proposal with a request to respond by 14th November, [App. 42]. The two cochairs therefore

requested a meeting to obtain more detail, and included a list of questions, [App. 43]. No reply

was forthcoming, despite a reminder: but Joe Johnson eventually scheduled the meeting for 24th

November.

Three hours before the meeting, a message was left for one of the cochairs, cancelling the

meeting. It was received just one hour before the meeting. No message had been left for the other

cochair, who at that point was just about to leave home to brave the driving sleet and face a one-

hour journey to attend the meeting. We were staggered at this unprofessional attitude.

The meeting was rescheduled for 6th December. However, this was also cancelled on the

afternoon of the meeting. On this occasion messages were left for both cochairs, explaining that

the Trust has now put its plans for A&E on hold, and expects to consult the Forum "early in the

New Year".

We wonder whether it is coincidence that the plans should suddenly be put on hold just a few hours

before the rescheduled meeting. None of the questions has yet been answered.

27. Paper for Patient Experience Committee: A paper on consultation with the PPI Forum

containing several glaring errors, for presentation to the Patient Experience Committee on 8th

December, [App. 44], was handed to a Forum member the evening before the PEC meeting. We

do not know whether this was an act of obstinacy or one of incompetence. A response was

emailed the same night, recalling the previously notified consultation criteria and consultation

process. We do not yet know whether the paper was withdrawn, or whether it was presented with

errors or with (valid) corrections.

9


Summary Items 1 – 7, 9, 12 – 14, 17, 19, 20, 24, 26, and 27 relate to the hospital's refusal to consult.

Items 8 – 12, 15, 16, 18, 19, 22, 23, and 25 relate to poor data quality and delays in supplying information.

F o rm a l R e q u e s t

The PPI Forum accordingly refers this to the Overview & Scrutiny Panel for due investigation

and report, and requests the Panel to exercise whatever powers it considers appropriate in order to

ensure that in future the Trust performs its statutory duty of consulting the Forum about changes in

services, (as provided by the 2001 Health and Social Care Act), and that the Trust responds to

enquiries by supplying accurate and relevant information in timely fashion and with good grace.

Jean Doherty

John Hunt

10


Con t en t s

Referral to Hounslow Adult Health & Scrutiny Committee of the West Middlesex University Hospital Trust by the Patient and Public Involvement Forum ........................ 1 App. 1. Closure of Ward Lampton 1, Alison M

cIntosh, mid-August 2004, Scanned .................. 13

App. 2. Letter from Gail Wannell to Cherna Chrome, 3rd

Sep. 2004, Scanned .......................... 14

App. 3. Richmond & Twickenham Times, 10th Sep. 2004........................................................... 16

App. 4. Extract from WMUHT Board Minutes, 16th Sep. 2004, Scanned ................................... 17

App. 5. Extract from PPIF Minutes, 4th Oct. 2004 ....................................................................... 20

App. 6. Extract from PPIF Minutes, 23rd Nov. 2004 ................................................................... 22

App. 7. Letter from Alison McIntosh to Cherna Crome, 8

th Dec. 2004, Scanned........................ 24

App. 8. Letter from Alison McIntosh to Cherna Crome, 10

th Dec. 2004, Scanned...................... 27

App. 9. Notes on Meeting, 22nd

Dec. 2004.................................................................................. 29

App. 10. PPIF Minutes, 13th Jan. 2005 ....................................................................................31

Update from West Middlesex University Hospital ..........................................................................31 Talk by Mr Paul Conrath – Options available to PPI Forums in the event of non-compliance with “Section 11” duty to consult ............................................................................................................32

App. 11. Questions on Strokes, emailed to Joe Johnson, 11th May 2005...............................34

App. 12. Letter from Cherna Crome to Yvonne Franks, 18th May 2005, Scanned..................35

App. 13. WMUHT, Financial Recovery Plan Progress Update, 30th June 2005, Scanned .....36

App. 14. Extract from WMUHT, Critical Care Service Plan Update, 30th June 2005, Scanned

38

App. 15. Bed Model, emailed by Yvonne Franks to Scope, 1st July 2005............................... 40

App. 16. Protocol emailed by Scope to Yvonne Franks, 18th July 2005.................................. 47

App. 17. Minutes of Meeting, 19th July 2005............................................................................ 49

1. Introduction ................................................................................................................................ 49 2. Issues raised on the Savings and Service Improvement Plans ................................................ 49 3. Outpatient Service Improvement Plan....................................................................................... 52 4. Sunday Times Good Hospital Guide - Dr Foster....................................................................... 52 5. Trust Board Sub Committees .................................................................................................... 52 6. Consultation Protocol ................................................................................................................ 52

App. 18. Protocol confirmed by Scope to WMUHT by post, 3rd

August 2005 ......................... 53

App. 19. Extract from Bed Model Proposed Consultation Plan, Patricia Davies, 15th August

2005, Scanned ................................................................................................................ 54

App. 20. Extract from PPIF Minutes, 15th Sep. ........................................................................ 56

App. 21. Email from Yvonne Franks re Bed Closures, 16th Sep. 2005.................................... 58

App. 22. Enquiry emailed to Yvonne Franks re Waiting Lists, 16th Sep. 2005 ........................ 59

App. 23. Meeting on Bed Closures, 29th Sep. 2005.................................................................61

App. 24. Enquiry emailed to Yvonne Franks re Waiting Lists, 3rd

Oct. 2005...........................65

App. 25. WMUHT Press Release, 3rd

October 2005 ...............................................................66

App. 26. WMUHT Beds Model 10 and 11-b, emailed 10th October 2005................................67

Bed Model 10..................................................................................................................................67 Bed Model 11-b ..............................................................................................................................67

App. 27. Trust "SITREP" report, emailed 10th October 2005...................................................68

App. 28. WMUHT Press Release, 12th October 2005 ............................................................. 76

11


App. 29. Request for comments on Better Health Draft Declaration, received 13th Oct. 200577

App. 30. Excerpt from email to PPIF members, 13th October 2005 ........................................ 78

Informal Inspection Visit, Escalation Wards ................................................................................... 78 Crane Escalation Ward (lower level) .............................................................................................. 78 Lampton Escalation Ward (upper level) ......................................................................................... 79 Briefing by North West London Strategic Health Authority, 20th October...................................... 79 http://news.independent.co.uk/uk/politics/article320599.ece ......................................................... 80

App. 31. Forum's response to Draft Declaration on "Standards for Better Health", 19th October

2005................................................................................................................................. 81

App. 32. Extract from WMUHT Chief Executive's Report, Gail Wannell, 27th October 2005 ..84

App. 33. Extract from WMUHT Minutes from 21st July, Jane Brennan, 27

th October 2005 .... 86

App. 34. Extract from WMUHT Remuneration/HR Committee, Nina Singh, 27th October 2005

88

App. 35. Extract from WMUHT Patient Experience Committee Minutes, 27th October 2005..90

App. 36. WMUHT Performance Report, Stephen Piper, 27th October 2005 ........................... 92

App. 37. WMUHT Financial Update Report, Simon Marshall, 27th October 2005................... 94

App. 38. WMUHT Finance Subcommittee Minutes, Andrew Daws, 27th October 2005.......... 96

App. 39. WMUHT Nursing Acuity & Dependency, Yvonne Franks, 27th October 2005 ......... 97

App. 40. Extract from WMUHT Service Improvement Journey – Progress Report, 27th Oct.

2005...............................................................................................................................101

App. 41. Reply from Alison McIntosh re Health Impact Assessment, 4

th Nov. 2005 .............103

App. 42. Invitation from Alison McIntosh re Cessation of GP service in A&E, 4

th Nov. 2005104

App. 43. Reply to Alison McIntosh re Cessation of GP service in A&E, 14

th Nov. 2005.......106

App. 44. Excerpt from Papers for Patient Experience Committee, 8th Dec. 2005, Scanned107

Key In the Appendices, text highlighted in bold on a yellow background represents emphasis which

has been added to the original text. Comments have been added between square brackets as [text in pink].

12


App . 1. Closure of Ward Lampton 1 , Al ison Mc Intosh , mid-August 2004 , Scanned

13


App . 2. Letter from Ga i l Wanne l l to Cherna Chrome , 3 rd Sep . 2004 , Scanned

14


15


App . 3 . Richmond & Tw ickenham Times , 10 th Sep . 2004 www.rttimes.co.uk/search/display.var.526413.0.anger_over_back_door_ward_closure.php

Anger over back door ward closure ANGER followed West Middlesex Hospital's decision to press ahead with a ward closure without consulting the local community.

A heated public and patient forum meeting took place this week at York House when the chief executive of the hospital publicly apologised for the closure of Lampton Ward.

Chief executive Gail Wannell explained that she had been obliged to take the decision quickly since an acute shortage of staff was creating clinical safety problems and she described the new arrangements based on day treatment rather than overnight stays.

Twickenham MP Vincent Cable, who was at the meeting, said: "This new forum is already proving its worth by holding hospital management to account for their failure to comply with their statutory requirement to consult. It is entirely understandable that those responsible for life and death decisions have to move quickly and there may well have been a genuine safety issue here.

"But the forum is right to insist that hospital managers cannot get into the habit of ignoring the law under which they operate. There are clearly serious staffing problems at the hospital and it is right that the community should be told what is going on."

The hospital maintain that they will re-provide the acute medical beds in this ward elsewhere in the building and introduce a new medical day unit. A spokesperson said: "As well as providing more appropriate care, there will be a marked reduction in our need for agency staff which will improve the overall quality and consistency of our care for patients and cut our expenditure in this area.

"Staff have been fully involved in the decision and are supportive of the changes.

"We believe that these changes will genuinely improve the quality of care that we are able to provide to this group of patients. It is not just driven by financial pressures."

16


App . 4. Extract from WMUHT Board M inutes , 16 th Sep . 2004 , Scanned

17


18


19


App . 5 . Extract from PPIF M inutes , 4 th Oct . 2004

I t em A c t i o n

1

Present:

• Cherna Crome – in the Chair (a Chairman) (CC)

• Jean Doherty (JD)

• Trizah Ndwaru (TN)

• Francis Brown (FB)

• John Hunt (JH)

• Anthony Foster (TF)

• Basil Mann (BM)

• Timothy Spring (TS) In Attendance: West Middlesex University Hospital

• Gail Wannell – Chief Executive (GW)

• Sue Ellen (SE) Chairman

• Shan Jones (SJ) acting Director of Family & Sexual Health

• Sue Daw (SD) asst. Director of Nursing

• Yvonne Franks (YF) Director of Nursing

• Joe Johnson (JJ) Complaints Manager

• Baz Gard (BG) PALS

SCOPE

• Daisi Ogunro (DO)

• Tanya Marius (TM) Apologies:

• Noshaba Sainsbury

• Andris Vanags

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I t em A c t i o n

4 4.1 4.2 4.3 4.4 4.5

Meeting with West Middlesex University Hospital Consultation Protocols and Communication Methods CC welcomed the West Middlesex University Hospital; Chairman, Chief Executive and staff. CC stated the Forum was much the same as the Community Health Council and mu s t b e c o n s u l t e d o n e v e r y t h i n g a s t h e y n e e d e d t o b e aw a r e o f w h a t w a s g o i n g o n . GW said they hoped to get ideas from the Forum and for there to be a regular dialog between themselves and the Forum. I t w a s r e c o g n i s e d t h a t l i n e s o f c ommu n i c a t i o n h a d n o t b e e n r i g h t u p t i l l n o w , b u t a f o r m a l i s e d p r o c e s s o f c ommun i c a t i o n w o u l d b e p u t i n p l a c e .They would like to share their thoughts with the Forum and hoped whatever needed consultation would be identified in the course of regular dialog, in the future. It was agreed by the Forum, that c ommu n i c a t i o n s h o u l d b e v i a S c o p e em a i l a d d r e s s and CC should be copied. A member of staff from West Middlesex should be available once a month at a forum meeting for about 10 – 15 minutes with an update. Important dates would be sorted out and given to West Middlesex by the next public meeting. YF requested if written background was needed to back the information given to the Forum. It was agreed this was not usually necessary and CC would take the lead if extra information was needed. If she was not available another member would be nominated and the Hospital informed. It was also agreed by the Forum that YF would be the liaison for the Forum on was Forum business and any personal complaints would be through JJ.

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App . 6 . Extract from PPIF M inutes , 23rd Nov. 2004

Minutes of Public Meeting Tuesday, 23

rd November 2004, 7.00pm

Committee Rooms 1 & 2 Hounslow Civic Centre

Hounslow

Item Action

1

Present:

• Cherna Crome (CC) – in the Chair


• Francis Brown (FB)

• Andris Vanags (AV)

• John Hunt (JH)

• Timothy Spring (TS)

• Anthony Foster (TF)

• Basil Mann (BM)

In Attendance Members of the Public

• Douglas Edwards – Bedfont Forum

• Peter Martin – Bedfont Forum

• Mrs A. D’Amico – Housewife

• Eric Carrington – Tasha Foundation

• T. Chapman

• J. Chapman

• M.Kirk – Feltham Forum

• Morris Shaer – Richmond & Twickenham PPIF

• Mel Collins – Hounslow PCT PPIF

• John Diamond – Hounslow PCT PPIF

• Nousheen Ashtiani – Refugee Arrivals Project West Middlesex University Hospital

• Sue Daw (SD)

• Joe Johnson (JJ)

• Jacqueline Hardy (JacH)

• Ranjit Kooner (RK) Hounslow PCT Cath Attlee (CA) Scope

• Daisi Ogunro (DO)

• Philip Hatcher (PH)

• Bob Hardy-King (BHK) Apologies

• John Murphy – Hounslow PCT PPIF

• Patricia Seers – Ealing PCT PPIF

• Ann Keen – MP for Brentford & Isleworth

• Maurice Press – Richmond & Twickenham PPIF

• Yvonne Franks – West Middlesex University Hospital

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6 6.1

Open Forum It was stated by CC that the Forum would not deal with personal complaints but issues of general interest. She then briefly stated the roles of the West Middlesex Staff present at the meeting.

6.2 A member of the public asked about the GP referrals going through the PCT management referral system.

6.3 The new process of GP referrals was explained by Cath Attlee. This new system is intended to provide feedback to practice on the pattern of referrals, manage referrals for those that need to be attended to and for others alternative routes, to control number of referrals to ensure they are the right referrals. The GP referral letter would come through the Hounslow PCT’s management centre, it would be logged on and then put through to the hospital, urgent referrals would be logged on and go straight through. Any query on insufficient information would be put aside for the GP. There would be no time delay as it would be sent back immediately to the GPs. No decision would be made by the administrative staff as they would only ensure information is logged on. The system would be completely confidential with a confidential database. The GPs must work to the guidelines, there are nationally agreed guidelines being developed which would be going to the West Middlesex University Hospital’s Medical Assessment Unit the following week. The GPs would have a greater involvement in the services commissioned for their patients. The centre would enable this information be made available to GPs. This was a long term initiative, though patients have not been consulted, however, access to services remained unchanged. The system is intended for a simplistic review of data.

6.4 It was asked by CC how the new system fitted into the ‘Choose and Book’ system.

6.5 The response given by CA was that the PCT wanted the different systems to work in a complementary way. The GPs would still offer a clear choice.

6.6 Concerns were raised about confidentiality, time and consultation and also Section 11 of the Public Health & Safety Act was read in the hearing of all by

JDJDJDJD.

6.7 CA CA CA CA stated the issue of consultation did not arise because there was no

alteration of the service provided and the PCT only looked to administrative pathways and the process by which referrals are made. The model has been tested elsewhere and good practices are intended to improve services.

6.8 A member of the public felt it was another level of bureaucracy which costs money that the PCT does not have. Another member of the public requested for how this system would improve service.

6.9 It was stated by CA that the quality of a number of GP referrals were poor and they wanted the GPs to provide the best possible practice. The referral centre was a standard of good practice.

6.10 There was a further discussion about confidentiality and consultation. Concerns were raised by members of the public about their right to be involved in the decisions that affected their health.

6.11 It was suggested by the West Middlesex PPIFWest Middlesex PPIFWest Middlesex PPIFWest Middlesex PPIF that the issue of consultation

be raised by the Hounslow PCT PPIF (whose representatives were present) to raise the issue with the Overview & Scrutiny Committee.

6.12 It was stated by CA that it would not be possible to consult on every single decision and issue. They intend to talk this through with the GPs but they had to start up because of the financial situation.

6.13 It was stated by TS that confidentiality was not absolute, a monitoring mechanism needed to be put in place and NHS got people involved only on a need to know basis. The need to enforce standards would not be regarded as confidential.

6.14 CC said these issues would need to be taken further.

6.15 A question about urgent referrals was asked by JD. It was stated by CA that urgent referrals would go through the Centre but straight through.

23


App . 7 . Letter from Al ison Mc Intosh to Cherna Crome , 8 th Dec . 2004 , Scanned

24


25


26


App . 8 . Letter from Al ison Mc Intosh to Cherna Crome , 10 th Dec . 2004 , Scanned

27


28


App . 9. Notes on Meet ing, 22nd Dec . 2004 Notes on meeting between West Middlesex PPI Forum and West Middlesex University Hospital on 22

nd December 2004 starting at 1 pm in the Education Centre at West Middlesex University

Hospital.

Present. Janet Baldwin West Middlesex Hospital Medical Director Francis Brown PPI Forum Member Cherna Crome PPI Forum Chairman Patricia Davies West Middlesex Hospital Associate Director for Acute Care Jean Docherty PPI Forum Member Yvonne Franks West Middlesex Hospital Director of Nursing and Midwifery John Hunt PPI Forum Member Joe Johnson West Middlesex Hospital PPI Lead Gail Wannell West Middlesex Hospital Chief Executive In Attendance. Bob Hardy-King Forum Support Organisation Community Liaison Officer Yvonne Franks thanked everyone for attending, especially at such short notice, and explained that the meeting had been called because the Hospital had concerns that the relationship with the Forum was in danger of degenerating. This could have the effect of both sides disengaging; the losers would be the patients. It was agreed that this must not be allowed to happen; patients were the people the Forum represents and the hospital’s customers. It was agreed that a working relationship must be re-established, and that the meeting would be an honest discussion, with both sides listening to the others perspective. The Hospital’s position was that they provided staff to speak at Forum meetings, and their expectation was that those staff should not be verbally harassed or insulted by Forum members. The Forum’s position was that staff who attended meetings should be briefed, and sufficiently informed, to speak, and answer questions. Forum members did not feel that staff at meetings had been harassed or insulted by Forum members. F u r t h e rm o r e , t h e F o r um a n d i t s memb e r s s h o u l d n o t h a v e b e e n a c c u s e d o f a c t i o n s t h a t t h e y h a d n o t u n d e r t a k e n . M r s F r a n k s e x p l a i n e d t h a t s h e h a d a l r e a d y a p o l o g i z e d f o r t h i s e r r o r . Mrs Franks explained that, at a recent meeting Patricia Davies (who was standing in for Alison MacIntosh) had attended for a 15 to 20 minutes slot, on a particular subject, with a brief from the Director of the department. The slot had extended to an hour, and went beyond the agreed brief. Patricia felt that she had been verbally attacked, and had become defensive, and this had led to controversy. The Hospital felt that this behaviour was inappropriate. Members explained that the issue, where the controversy had arisen, was in fact, part of the subject on the Agenda, and also part of a report ( that Patricia had contributed to) presented to the Board of Trustees. At the meeting, a member of the Forum f e l t t h a t i s s u e s o f c o n s u l t a t i o n w e r e b e i n g i g n o r e d , a n d t h e F o r um w a s b e i n g s i d e l i n e d a g a i n . The point had been made forcefully. Forum members did not feel that the questioning had been inappropriate. Forum members had families that used the Hospital, and when it was perceived that patients were not being served well, some members did get upset. Staff made the point that it was not what, had been said, but the way, it had been said. Patricia felt that the questions had been phrased in such as way as to be a personal attack. C o n s u l t a t i o n w a s n o t a l w a y s p o s s i b l e , a s s om e t i m e s o p e r a t i o n a l d e c i s i o n s h a d t o b e ma d e q u i c k l y a n d i n s t r u c t i o n s f r o m t h e D e p a r t m e n t o f H e a l t h

h a d t o b e a c t e d u p o n . [There was no suggestion that the DoH had issued any instructions in this case.] Failure to do so would be bad management. It was not

29


possible to consult on every issue that affected patients, because every decision affected patients. That was who the hospital was there for. With regard to the issue raised at the meeting, t h e

F o r um h a d b e e n i n f o rm e d [but NOT consulted ] before the Hospital Trust Board, and

that was an indication of how important the Hospital considered their relationship with the Forum; this was also part of the reason for their concerns over a breakdown of trust between the Hospital and the Forum. The Chairman of the Forum apologized to Miss Davies and explained that the critical comments were in no way intended to be personal. At this point Miss Davies left the meeting for another appointment. Forum members explained that when the staff member had appeared to back track and become defensive i t h a d b e e n f e l t t h a t t h e H o s p i t a l w e r e c o v e r i n g u p , a n d

p r e s e n t i n g t h e F o r um w i t h a fait accompli a g a i n . Members felt that they tried to

keep their questions ‘patient centered’. A l e t t e r h a d b e e n p r om i s e d b y t h e H o s p i t a l a n d t h i s h a d n o t a r r i v e d t i l l t h e d a y o f t h e me e t i n g , i f t h i s h a d a r r i v e d wh e n p r om i s e d M em b e r s w o u l d h a v e h a d t i m e t o s t u d y t h e i s s u e s a n d n o t h a v e t o ma k e s n a p d e c i s i o n s . Staff agreed that the letter was late and apologized for that. However, the issue of body language and what needed consultation had yet to be addressed. It was important that the Forum was involved/informed of changes, even small ones, as it was possible that a number of small seemingly unconnected changes could result in a major problem which might not be evident to staff making decisions. It was agreed that the way forward was to set out in writing a ‘Compact or Rules of Engagement’

[subsequently termed "Consultation Protocol"]; the Forum would make a draft with

assistance from their Support Organisation and the Hospital PPI. The compact/rules of engagement should encompass, Representation, Consultation, Behaviour, Visiting, Information sharing, Information provision and other issues from both sides, and following discussion be adopted by both parties at their meetings in public. It was further agreed that the compact/rules of engagement must not detract from statutory functions of both the Forum and the Hospital, rather that they establish guidelines for the performance of the functions; so that the Forum can be the ‘ independent critical friend’ working closely with the hospital, but representing the public’s and patient’s views. It was further agreed that the two points of contact for this issue would be Yvonne Franks for the Hospital and Cherna Crome for the Forum. Yvonne Franks thanked everyone for attending.

30


App . 10 . PPIF M inutes , 13 th Jan . 2005

PATIENT AND PUBLIC INVOLVEMENT FORUM FOR WEST MIDDLESEX UNIVERSITY HOSPITAL TRUST

Minutes of Special Meeting

Thursday, 13th

January 2005, 7.00pm Council Chamber,

Hounslow Civic Centre, Lampton Road Hounslow

Present: Cherna Crome (CC) – Chair WMUH PPI Forum Francis Brown (FB) – WMUH PPI Forum

Jean Doherty (JD) – WMUH PPI Forum John Hunt (JH) - WMUH PPI Forum Basil Mann (BM) – WMUH PPI Forum Timothy Spring (TS) – WMUH PPI Forum Andris Vanags (AV) – WMUH PPI Forum John Murphy (JM) – Hounslow PCT PPI Forum John Dimond (JDM) – Ashford & St Peter’s PPI Forum Morris Shaer (MS) – Richmond & Twickenham PPI Forum Paul Conrath (PC) – Speaker (Solicitor) Gail Wannell (GW) – Chief Exec WMUH Yvonne Franks (YF) – Director of Nursing WMUH Jacqueline Hardy (JacH) – WMUH Joe Johnson (JJ) – Complaints Manager WMUH Baz Gard (BZ) – WMUH Christine Hay (CH) – Hounslow PCT, Chairman John James (JMS) – Hounslow PCT, Chief Executive Cath Attlee (CA) – Hounslow PCT Julie Fuller (JF) – Hounslow PCT, PALS Manager Isabel Granet – Overview & Scrutiny Committee Daisi Ogunro – Forum Support Organisation (FSO) Admin. Tanya Marius – FSO Administrator Bob Hardy- King – FSO Community Liaison Officer Apologies Noshaba Sainsbury – WMUH PPI Forum Trizah Ndwaru – WMUH PPI Forum Mel Collins – Chair, Hounslow PCT PPI Forum Clive Casey – Hounslow PCT PPI Forum

Update f rom Wes t M idd lesex Univers i ty Hosp i ta l YF updated the Forum stating that the hospital was under pressure from Admissions; they were in the

middle 90’s on A&E [??] and would be updating PPI strategy by the following week, which would be

circulated to members. The PPI strategy would be launched in April. There would be a cleaning hands campaign starting on Monday, in which they would be working in partnership with Ecovert. The Trust board minutes and Agenda would be available on the web as well as performance data. The report of the Forum’s visit to the hospital and comments had been received and the Trust’s response would be received the following week.

CC asked about the cessation of blood tests for children over six. [NOT consulted ] TF noted they had approached the PCT if children between the ages of 5-12 could have their blood tests in the community. The PCT wanted training issues to be addressed. They were trying to re-recruit the nurses that had resigned. CC asked if this was a temporary or permanent change. GW stated this would be temporary.

31


CA also added that they had just heard at the end of the previous week and she would be writing to West Middx and work with them on this. JD requested if the service was being provided at present. GW confirmed service was still being provided. There was a further discussion about t h e i s s u e o f c o n s u l t a t i o n b r o u g h t u p b y

JD r e f e r r i n g t o l e t t e r s r e c e i v e d f r om A l i s o n McI n t o s h a n d s t a t i n g

t h e F o r um h a d n o t b e e n c o n s u l t e d , e v e n t h o u g h a t e l e p h o n e c a l l

h a d b e e n mad e t o CC . T h e r e s p o n s e o f t h e s t a f f w a s t h a t

s om e t i m e s , em e r g e n c y s i t u a t i o n s o c c u r a n d t h e y n e e d t o r e a c t p r om p t l y , p o s i t i v e c ommun i c a t i o n w a s n e e d e d . At this stage, CC called the discussion to a halt; however, she noted that even though a telephone call was made to her, a t e l e p h o n e c a l l i n i t s e l f w a s NO T c o n s u l t a t i o n . She stated the reason they were all there was to receive some clarification regarding the issue of consultation and the options open to the Forum if this was not complied with. The speaker, Mr Paul Conrath was introduced by CC.

Ta lk by Mr Paul Conrath – Op t ions avai lab le to PPI Forums in the event of non-comp l iance with “Section 11 ” du ty to consult PC explained the role of PPI and their powers. P P I w a s a b o u t p a t i e n t p ow e r , p a t i e n t i n v o l v em e n t a n d p a t i e n t c o n s u l t a t i o n . The functions are to obtain information, evaluate information and make recommendations. T h e s e p o w e r s a r e g i v e n t o t h em b y s t a t u t e . The Patient Forums also have the power enter and inspect NHS premises, obtain information and make reference to the Overview & Scrutiny Committee (OSC). He then went on to read out S e c t i o n 1 1 and explained t h i s s e c t i o n i s v e r y f a r r e a c h i n g and the courts had made decisions based on the circumstances of each case and had looked on a number of issues for instance lack of resources, waiting lists. He further stated that c o n s u l t a t i o n s h o u l d o c c u r a t t h e s t a g e o f p l a n n i n g a n d t h e r e w a s a c l e a r b r e a c h i f t h e r e w a s n o c o n s u l t a t i o n . T h e s e c t i o n w a s p u t i n p l a c e t o p r e v e n t t h e a u t h o r i t y d o i n g wh a t t h e y w a n t t o d o . In addition, consultation opens the door to legal challenge. He then mentioned dispute resolution was to be considered because according to the regulations, referral to the OSC is after all discussions with the authority had failed. Finally, going to court was a last resort and a protective remedy, which was also an available option. CC thanked PC and asked if anyone had questions. Questions & Discussion JDM asked if the Trust would accept consultation and that they had not practiced it. It was stated by GW that the issue they needed clarification on was the right level of debate when they need to make em e r g e n c y d e c i s i o n s b e c a u s e o f l a c k o f s t a f f o r r e s o u r c e s which they had not got right yet. How to manage an emergency situation; reasonableness, when it looked like they had not consulted. In response to this, PC stated that statute had not laid down a time scale and the case was situation dependent, the definition of emergency depended on reasonableness. C o n s u l t a t i o n s h o u l d o c c u r i n t h e p l a n n i n g s t a g e , w h e n t h e i r m i n d i s n o t ma d e u p a n d t h e r e c o u l d b e a r a n g e o f p o s s i b l e o u t c ome s . It was stated by CA, that another area that could be looked at was different responsibility. The individual versus collective balance of one statutory duty against another statutory duty.

I t w a s a d v i s e d b y PC , t h a t i n t h e i s s u e o f c o n s u l t a t i o n , t h e y c o u l d

NO T r u n r e s o u r c e a r g um e n t s a s t h e d u t y t o c o n s u l t w a s n o t q u a l i f i e d . JM asked if there were other choices which can be put into consultation. PC stated there was a challenge when the court was faced with the patient standing before the court.

32


The letter received from the Trust, informing them that changes would take place and the second letter received two days later, stating changes had been implemented was referred to again by JD and she asked PC’s opinion on this issue. PC said on the face of it, it seemed to be a b r e a c h o f S e c t i o n 1 1 . He further explained there could be a technical breach or a substantive breach but he would have to look into the case further and he would be judge or jury at that point. TS asked about the funding options available. It was stated by PC that legal aid was available based on certain considerations like merit, moderation and financially eligibility. JH asked if the Forum brought a case to court what would be the provision for funding in that situation. It was advised by PC that a PPI Forum would not get legal aid funding. YF asked for advice on how to define reasonable and who determines what is reasonable. It was stated by PC that it depended on different sets of circumstances and the concept of an open mind. At this stage JDM stated that his question had not been answered. CA said it was agreed they had a duty to consult and they were trying to involve the Forum and the users in the changes. The issue was the proportionality of that, they are changing services all the time, the complexity of change and if they consulted all the time a great deal of time would be spent. She suggested that set down protocols be put in place. It was advised by PC that technically t h e T r u s t w a s i n a w e a k p o s i t i o n i f t h e y d o n o t c o n s u l t , t h e y n e e d e d t o i mmu n i s e t h em s e l v e s t o l e g a l c h a l l e n g e a n d e s t a b l i s h w h a t i s r e a s o n a b l e . T h e T r u s t s h o u l d n o t a s s um e a t e c h n i c a l b r e a c h h a d n o t h i n g b e h i n d i t , a s i t p o r t r a y s t h em i n a b a d l i g h t a n d t h e r e w a s n o r o om f o r c omp l a c e n c y . The PPI however, have many opportunities to litigate and patients have more power than the courts would give. CH asked if a service was being provided but at a different time or place and PC stated it was possibly a breach. There was a discussion about orthopaedic services which had moved to Ravenscourt Park Hospital. It was mentioned by JH that more information was needed about the Freedom of Information Act that had come into force on January 1

st 2005.

CC said it would be discussed in a future meeting. There was a discussion about working out a protocol and it was agreed this would be done. CC announced the Workshop on Health Development Plan by the Hounslow PCT on the 19t of January 2005. She then thanked PC again, called for a comfort break and excused the Trust and PCT staff. The formal part of the meeting ended at 8.30pm.

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App . 11. Quest ions on Strokes , ema i led to Joe Johnson , 11 th May 2005 Date: Wed, 11 May 2005 22:11:20 +0100 To: Johnson Joe <[email protected]> From: John Hunt <[email protected]> Subject: RE: Date for video

Joe, At 10:31 11/05/2005, you wrote:

I have checked the diary and the Wednesday in mid-June is 15th June. Do you want me to

approach the photograph team to see if we fix that as the date for the video work? Yes, any time will do. Please let me know what they say. These are the questions for Dr. Platt. -- 1) Are the 25% of stroke patients who aren't admitted to the stroke unit selected: a) luck of the draw, according to spare capacity available when they are admitted; b) less severe cases; c) randomly; d) some other system? 2) What is the difference in outcomes between those who are admitted to the stroke unit and those who aren't? 3) Is screening recommended for any section of the population, to minimise the risk of having a stroke? 4) Why is a chest X-ray part of the procedure for confirming the diagnosis? Question (3) could be amended for inclusion in similar presentations: heart disease, cancer, ... Regards, John.

[ Reminders were emai led on 29th August, 23rd Sep., and 11th Nov.. Answers were final ly forwarded late on the evening of 28th Nov..]

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App . 12. Letter from Cherna Crome to Yvonne Franks , 18 th May 2005, Scanned

35


App . 13 . WMUHT, F inancia l Recovery Plan Progress Update , 30 th June 2005, Scanned

Financial Recovery Plan Progress Update, p. 1 of 5, Summary

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Financial Recovery Plan Progress Update, p. 3 of 5, Commentary / Bed closures …

37


App . 14. Extract from WMUHT, Cr it ica l Care Service Plan Update , 30 th June 2005, Scanned

Critical Care Services Plan Update, p. 1 of 10, Summary

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Critical Care Services Plan Update, p. 2 of 10, Introduction

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App . 15 . Bed Mode l , ema i led by Yvonne Franks to Scope , 1s t July 2005

WEST MIDDLESEX UNIVERSITY HOSPITAL OVERVIEW AND SCRUTINY COMMITTEE

BED CAPACITY

1. INTRODUCTION The Overview and Scrutiny Committee have asked for some details surrounding West Middlesex University Hospital’s (WMUH) plans to reduce the acute bed base at the Trust. Specifically, the committee has asked for the following information: 1. Actual bed capacity broken down by specialities/departments; 2. Projected bed capacity broken down by specialities/departments, short and long term; 3. Identified current and potential spare capacity, and 4. Interactions between booking in-patients admissions and hospital capacity requirements.

2. THE CURRENT ACTUAL BED CAPACITY The bed number and configuration of funded beds at West Mid in May 2005 is shown in the table below

Speciality

ITU beds (level 3) HDU beds (level 2)

“Normal” beds (level 1)

Site total

General Surgery/Trauma and Orthopaedics - Emergency 60 60

General Surgery - Planned 26 26

General Medicine 30 30

Cardiology 6 18 24

Paediatrics 12 28 40

Geriatric Medicine 42 42

Maternity 10 38 48

Accident & Emergency 8 8

Gastroenterology 40 40

Endocrinology 28 28

Clinical Haematology 4 4

Thoracic Medicine 12 12

Rheumatology 13 13

Stroke 14 14

ITU & HDU 6 4 10

Total 12 26 361 399

Figure 1 - Current bed configuration As can be seen from Figure 1, the vast majority of adult beds (359 = 399 - 40) are for emergency admissions (333 = 359 - 26), approximately 93%.

3. PROJECTED BED CAPACITY SHORT AND LONG TERM The projected bed capacity from 1 Oct 2005 is shown in Figure 2. There is a planned reduction of 30 beds. This has been shown against the line for general surgery/trauma and orthopaedic emergency surgery although the configuration of the bed reduction has not yet been confirmed. No further decisions have been taken at this time about the longer-term bed capacity. However, as will be shown later in this paper, the Trust has a considerable number of patients that stay for a long time after the acute phase of their illness. The Trust is actively considering how some of its beds can be configured to support the faster rehabilitation of patients to facilitate a speedier recovery and a shorter length of stay.

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Speciality


“Normal” beds (level 1) Site total

General Surgery/Trauma and Orthopaedics – Emergency 30 30

General Surgery – Planned 26 26


Cardiology 6 18 24



Maternity 10 38 48



Endocrinology 28 28



Rheumatology 13 13

Stroke 14 14

ITU & HDU 6 4 10

Total 12 26 373 369

Figure 2 - Projected bed capacity from 1 Oct 2005 [

1) The total in Fig. 2 for "Normal" beds is shown as 373, when in fact it is only 331.

2) The "Site total" is shown as 369: less than the alleged total for "Normal" beds.

]

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4. CURRENT AND POTENTIAL SPARE BED CAPACITY

Currently the Trust does not have any spare bed capacity. [Is the problem shortage of beds, of space to put the beds, or of money to pay staff to tend patients in the beds?] However, the potential spare bed capacity is considerable and is best described by

considering the current bed occupancy and the current/potential length of stay for patients in WMUH beds. 4.1 Bed Occupancy The occupancy within the Trust’s beds typically runs at about 97% across any given month. Unfortunately it is not a static 97%, the pressure tends to build at the beginning of a week and then

reduce towards the end of a week. [Because patients are kept in over a weekend before being discharged?] This often means that the Trust has higher than 100% bed

occupancy which necessitates the opening of unfunded beds (which causes the Trust to overspend

against its budget). [In December 2004 the Trust strenuously denied the PPIF report that occupancy in wards visited during the Cleanl iness Inspection (Friday, 26th Nov. 2004) was 100%. Now they admit it: and want to reduce beds sti l l further! This is despite recent reports (23rd June – below) that the Commons publ ic accounts committee are demanding that Government ministers take swift action to reduce bed occupancy rates.] In overall terms, in any given month, bed occupancy is directly related to the number of patients that need a bed, the number of beds in the Trust and the length of stay of admitted patients. As such there are 3 ways that monthly bed occupancy can be reduced:

• Reduce the number of patients that are admitted as an emergency – the Trust has recently performed an audit and discovered that 22% of patients that were admitted as an emergency could have been treated within the community if services, that other parts of the country have established, were available.

• Reduce the length of stay – through many studies the Trust has recognised that it has a significantly longer length of stay in certain specialties. This area represents a viable and relatively quick way for the Trust to reduce bed occupancy.

• Increase the number of staffed beds [What are these?] – the Trust’s financial allocation

from its commissioners prevents this tactic from being used.

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4.2 An overview of Length Of Stay. To understand Length of Stay in a meaningful way patients with similar diagnoses and procedures are grouped into Healthcare Resource Groups (HRGs) of which there are about 500. Furthermore these HRGs are grouped into HRG Chapters (of which there are 18), which enables high level comparisons to be made. A recent study (Figure 3) shows how WMUH’s patients Length of Stay within each HRG Chapter compared to the national averages:

Figure 3 - Length of Stay by HRG Chapter, 2003/4 and 2004/5

Explanation of Figure 3 using Chapter A (Nervous System) as an example: Patients treatment within the Nervous System chapter are typically patients who have suffered a stroke, cerebral infarction or have parkinsons disease or Multiple sclerosis etc. The brown boxes relate to 2003/4. The yellow boxes relate to 2004/5. Ntl LOS – The national average Length of Stay of all patients in all the hospitals in England who were coded with an HRG which is part of the Nervous System chapter.

Spells [Is this what used to be called Hospital Episodes? If so, the explanation “number of inpatients” is not quite correct.] – the number of WMUH

inpatients that were treated within the Nervous System chapter. Tot Beddays - the number of WMUH Beds days that were consumed by all the inpatients in that year that were treated within the Nervous System chapter. WMUH LOS – The average Length of Stay of all WMUH inpatients within the Nervous System Chapter. This is simply the bed days divided by the number of spells. Excess Bed days – The number of bed days consumed by WMUH inpatients because they stayed longer than the national average. I.e. if the WMUH Length of Stay for Nervous System patients was exactly at the national average of 9.43 days rather than 15.8 days then 4870 bed days would have not

been needed, in 2003/4. 4870 bed days equates to about 13 beds being open all year. [Why are

43


figures quoted to two decimal places? The minus sign suggests that Mouth patients are been discharged faster than the national average: and Mental patients suspic iously so.] 4.3 Length of stay in detail Average Length of Stay hides a lot of interesting detail. Continuing with Nervous System patients as an example one can describe the 2004/5 length of stay by a simple average (14.7 days) and suggest that an improvement was made from the previous years average (15.8 days). If we delve into more detail we find that the range of LOS for all the patients within the HRG Chapter A is between 0 and 296 days. Furthermore one can look at the “shape” of the data - Figure 4 shows the frequency of observed LOS for all patients treated within Chapter A within the last 2 years.

[What information is lost by the neat division into chapters? For example: X was admitted with heart trouble, but immediately developed dementia (possibly as a result of the drug administered on admission), subsequently acquired the C. diff. infection, was isolated in a side room, fel l out of his chair while left unsupervised, and died the fol lowing day from pneumonia. Y was also admitted with heart trouble, but acquired MRSA + bed sores, was isolated in a side room, and developed depression which appeared on her death certificate, despite no previous history. Z was admitted with severe back pain, diagnosed with terminal bone cancer, and acquired MRSA + bed sores, was iso lated in a side room, and developed depression before dying.]

Figure 4 - Frequency chart for HRG Chapter A LOS (2003/4 and 2004/5)

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Figure 4 explained 80% line – 80% of all patients stayed less than 23 days. Trim point – the trim point is based on a national calculation to separate the outliers from the rest of the data set. I.e. if a patient stays more than 42 days (for this chapter) they can be statistically considered an outlier. 50 days above trim point – 31 patients, in the last 2 years have stayed more than 92 days (50 days above trim point). So for the HRG Chapter A alone, 15 beds are being used all the time in the hospital by patients who are considered outliers and 5 beds are being used all the time by patients who have stayed 50 days and more beyond the point where they would be considered outliers. 4.4. Length of Stay reductions in summary In summary, reducing length of stay as a tactic to reduce bed utilisation takes two distinct types of action.

1. Reducing the overall average length of stay – by reducing the number of days that 80% of the patients stay. This is typically by removing the inefficiencies and blockages to the patients

pathway [All under WMUH control. What timescale here?] : e.g.:

a. Increasing the frequency of ward rounds that have the authority to discharge patients when they are medically fit.

b. Reduce waiting times for complex diagnostic tests (e.g. MRI scans, echo-cardiology). c. Reduce waiting times for therapy assessments and therapeutic intervention. d. Reduce the complexity of administration surrounding patient’s discharge.

2. Reducing the number of people who stay in the acute setting well beyond the end of the acute

phase of their illness/condition. This is typically achieved by: [Not always under WMUH control, (apart from hospital-acquired infections or injuries). What timescale here? ]

a. Developing different care services in collaboration with the independent sector, voluntary sector, community services and social services for people who need to be supported in a different care setting.

b. Changing the policies associated with the transfer of patient care – i.e. currently some patients are waiting in an acute hospital bed for a place to be available in their choice of nursing/residential home.

5. INTERACTIONS BETWEEN BOOKING IN-PATIENTS ADMISSIONS AND HOSPITAL CAPACITY REQUIREMENTS.

A booked in-patient admission relates to a planned episode of care. As can be seen from Figure 1, the Trust has 26 beds which are dedicated to planned episodes of care the Trust also carries out approximately 55% of all elective operations as daycases. The Trust has efficient processes of booking and unlike emergency care typically has a lower than average LOS for planned patients. These two factors enables the Trust to manage its waiting list down to the required level, by and large, within this available bed base. Currently 73% of the patients on the Trusts elective waiting list (for both Inpatient and Day care) have been waiting less than 3 months. There is no one waiting over 9 months and the Trust expects to bring

the maximum waiting time for all elective surgery to 6 months by end of Dec 2005. [How many extra beds would it take to reduce the maximum waiting time to 3 months? And would this have any expected impact: (1) on the qual ity of the patient experience and (2) on the number of emergency admissions?]

6. CONCLUSION The Trust hopes that the above information provides a coherent answer to the questions raised by the

Overview and Scrutiny Committee. [PPIF members were sent this answer: but what questions did Overview & Scrutiny ask?

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The above provides some general insight into the problems. But the only mention of solutions is the statement: “The Trust is actively considering how some of its

beds can be configured to support the faster rehabilitation of patients to facilitate a speedier recovery

and a shorter length of stay” and the intention (by comparing tables 1 and 2) to cut the “General Surgery/Trauma and Orthopaedics - Emergency” beds from 60 to 30. For the consultation process to get off the ground, we need to know the results of the Trust’s active consideration. To proceed with the reduction without having an agreed plan would be quite irresponsible: unless, of course, this is to be written off as another example of crisis management.] It is worth taking the opportunity to make clear that none of the above discussion suggests that the Trust seeks to discharge a patient before they are medically ready. The Trust views reducing patients Length of Stay as a positive move that improves patient’s care:

• Less time away from family and friends and normal routines, in a foreign environment

• Less chance of being dependent on institutional care.

• Less exposure to hospital acquired infection.

• Less frustrations with waiting times and delays in the care process.

[The first three goals might be achieved by getting patients out faster: but the fourth should remain unaffected, as the number of elective beds is (al legedly) not being altered. ] Peter Gill Director of IM&T and Service Improvement West Middlesex University Hospital June 2005

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App . 16 . Protoco l ema i led by Scope to Yvonne Franks , 18 th July 2005 From: "Daisi Ogunro" <[email protected]> To: <[email protected]> Cc: "Cherna Crome" <[email protected]>, <[email protected]>, <[email protected]>, "francishbrown" <[email protected]>, <[email protected]>, "John Hunt" <[email protected]>, <[email protected]>, <[email protected]>, <[email protected]>, <[email protected]> Subject: Consultation protocol Date: Mon, 18 Jul 2005 10:59:39 +0100

Dear Yvonne,

Please find below the terms on which the PPI Forum have agreed to work with the Trust.

Consultation between the West Middlesex University Hospital and the PPI Forum

The criteria for when the PPI Forum should be consulted and involved are very clearly set out

in section 11 of the Health and Social Care Act 2001.

The Trust must consult the Forum on-

a) The planning and provision of services.

b) The development and consideration of proposals for change in the way the services

are provided. And

c) Decisions to be made by the Trust affecting the operation of these services.

The Forum recognises that on a rare occasion the Trust may have to respond to a crisis,

making it impossible to warn the Forum. However, other than in exceptional circumstances,

the Trust will inform the Forum at the planning stage when, in the spirit of meaningful

consultation, there is still time for the Forum to influence the outcome of the consultation.

It is in the interest of both the Trust and the Forum that we have an open and honest

relationship. To that end the Trust will, at the planning stage, e-mail the chair and Forum

members when the need arises. In a crisis situation the Trust will ring the Forum chair, or in

the event that the chair is unavailable the Trust will ring................ This phone call will be

followed by the customary e-mails.

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Section 11 of the 2001 Health and Social Care Act www.opsi.gov.uk/acts/acts2001/10015--b.htm#11

11 Public involvement and consultation

(1) It is the duty of every body to which this section applies to make arrangements with a

view to securing, as respects health services for which it is responsible, that persons to

whom those services are being or may be provided are, directly or through

representatives, involved in and consulted on-

(a) the planning of the provision of those services,

(b) the development and consideration of proposals for changes in the way those

services are provided, and

(c) decisions to be made by that body affecting the operation of those services.

(2) This section applies to-

(a) Health Authorities,

(b) Primary Care Trusts, and

(c) NHS trusts.

(3) For the purposes of this section a body is responsible for health services-

(a) if the body provides or is to provide those services to individuals, or

(b) if another person provides, or is to provide, those services to individuals-

(i) at that body's direction,

(ii) on its behalf, or

(iii) in accordance with an agreement or arrangements made by that body

with that other person;

and references in this section to the provision of services include references to the

provision of services jointly with another person

Thank you Regards Daisi Daisi Ogunro Forum Administrator Tel : 020 8780 1188 Ext 208 DD : 020 8780 6237 Fax: 020 8780 1373 Mobile : 0783 400 6220

PPI Forum Support Organisation c/o Scope Ground Floor (East Suite) 113-123 Upper Richmond Road Putney London SW15 2TL

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App . 17 . M inutes of Meet ing, 19 th July 2005

Minutes of an extraordinary meeting between the Trust and the WMUH PPI Forum held on Tuesday 19th July 2005

Present: West Middlesex PPI Forum

Gail Wannell W L Ford [???] Simon Marshall Tim Spring Alison McIntosh Cherna Crome Janet Baldwin Jean Doherty Shân Jones Tony Foster Jane Brennan Basil Mann In attendance: Mr E Prosser (work shadowing Alison McIntosh)

1. Introduction Mrs Wannell opened the meeting by welcoming everyone and explaining the purpose of the meeting was to address the Forum’s concerns they had raised at the Trust Board meeting held on 20

th June. Their concerns were about the Trust’s savings programme

which includes a proposal to reduce the number of beds. The proposals have been reported in the Board papers since December 2004. A number of the executive team attended a Forum meeting on 18

th February to p r e s e n t the

savings plan and it’s implications. [NOT consulted ] The driving force behind the

saving plans is the Trust’s legal responsibility to deliver and operational break even position at the year end. In financial year 2004/05 the Trust reduced it’s deficit from around £10m to an end of year deficit of £4m. In addition to recovering the £4m deficit, the Trust is required to repay a loan of £3.5m. The North West London Strategic Health Authority’s financial position was £54m deficit at the end of the last financial year and this year’s position is set to be equally if not more challenging. Over the past few years the Trust has been on a service improvement journey which is aimed at reducing costs and improving the quality of care it provides. The Trust knows that compared to similar Trust’s it’s costs are higher, and this is in the main linked to length of stay. Within this context, t h e T r u s t h a s a r e s p o n s i b i l i t y a n d d u t y o f c a r e t o e n s u r e i t d e l i v e r s t h e r i g h t mod e l o f c a r e f o r AL L i t ’ s p a t i e n t s and one that is cost effective.

2. Issues raised on the Savings and Service Improvement P lans Mrs Crome stated that the Forum aren’t disputing the principles of the plan but rather how it’s delivered in the context of the community infrastructure or lack of it. Miss Baldwin emphasised that as part of the improvement journey to date, the Trust has

reduced it’s bed stock by 54. [NOT consulted over these 54.] T h i s w a s

o n l y d o n e o n c e t h e q u a l i t y i m p r o v em e n t s h a d b e e n ma d e t o p a t i e n t c a r e . T h i s a p p r o a c h i s p a r am o u n t – q u a l i t y i m p r o v em e n t f i r s t – b e d r e d u c t i o n s s e c o n d a n d t h e s am e

a p p r o a c h w i l l b e t a k e n w i t h t h e n e x t p h a s e . [No evidence of qual ity improvement has been presented to the Forum: and we have been given confl icting statements about whether or not the Trust performed a Health Impact Assessment before announcing further bed closures as a fait accompl i in October at their AGM.]

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There are a number of work streams underway which are reviewing patient pathways to identify bottlenecks in the patients journey through the hospital. Many recurring themes have been identified, some of which are for the Trust to resolve, others such as frequent attendees & delayed discharges are whole health economy issues. The Trust is therefore working with it’s partner organisations, PCT’s Social Services etc to address these issues. The Forum received a presentation from the IARDS team at it’s last meeting. Mrs

Wannell added that the t e am a r e d e v e l o p i n g a b u s i n e s s c a s e [a business case is NOT the same as a Health Impact Assessment] which will address the Trust’s concerns about the cohort of patient’s whose discharge is delayed due to a lack of community rehabilitation services. These patients currently sit in an acute bed awaiting discharge to a suitable community facility. The amount of patients this applies to is equivalent to a 28 bedded ward. The proposal is that the 28 beds, which are currently spread across the Trusts bed stock, should be re-provided in Kew Ward, ground floor of Marjory Warren. This is an ideal location opposite the day rehabilitation facilities. Whilst this group of patients are currently cared for throughout the hospital and are ‘safe’, they often do not receive timely attention in relation to their discharge. This new facility will provide a more appropriate environment for this group of patients, appropriately trained nursing and therapy staff and an intensive focus on the patient’s discharge. The IARDS proposal is different to the Hotel Ward at Kingston Hospital. The IARDS ward will be a dedicated area for rehabilitation, patients care will be managed with the objective of ensuring timely discharge to appropriate community facility. Hotel wards are generally used for overnight stays where day surgery patients don’t have appropriate support at home to ensure a safe discharge. T h e IARD S i n i t i a t i v e i s s e p a r a t e t o t h e b e d r e d u c t i o n p r o p o s a l s set out in the Saving Plan, although the objectives of both initiatives are to improve the quality of patient care and to reduce costs. The IARDS area will be staffed by a combination of staff who are displaced by the reconfiguration of general beds and the recruitment of permanent staff. The IARDS area will require a different skilled workforce to an acute ward but it is unlikely there will be

enough existing staff available to transfer. [While this suggests that additional staff wil l be required, there is no indication (here) as to how costs wil l be affected …] When the further bed reductions occur current staff will be relocated to the new bed/ward configuration. The Trust has a number of vacancies which should ensure all staff will be

relocated. [… although, if there are to be no redundancies, and no staff take lower-paid posts, this suggests that staffing costs wil l increase.] The Trust has agreed a Change Management policy with the Trade Unions

which will be used to initiate formal consultation at the earliest opportunity.

The Trust is aiming to preclude the need to use escalation areas. [Given the subsequent use of TWO escalation wards, it appears that the aim was woefully defic ient. ] This will be achieved in the fullness of time once the

patient pathway has been modified to eliminate the current level of inherent inefficiencies. It is important to remember that the Trust is not allowed to close it’s doors once it’s full. There will always be a need for a safety valve. Admissions are unpredictable and there will on occasion be a need to be able to flex up the number of beds, which may require the use of escalation beds. The service improvement proposals have involved clinical teams throughout the Trust with the majority of ideas originating from them. Therefore the executive team are confident they have their full support. The Trust is on the 12

th bed configuration since moving into

the new hospital [i.e. a reconfiguration on average approximately every

50


two months in the two years that the bui ld ing had then been open] and each new configuration brings improvements to the way care is provided. The identified savings will be realised from a number of sources including a reduction in the reliance of bank and agency staff. This in turn will have a positive impact on the quality of care. The proposals aim to deliver a service which is in line with national best practice, which the Trust knows is out of kilter at the moment. National benchmarks indicate a number of areas for improvement, i.e. length of stay; the number of patients having day surgery. There are no significant demographic issues relating to the local population that impact significantly on the Trust’s ability to implement the service improvement goals. Whilst there are obvious challenges, such as a lack of community rehabilitation and continuing care for the Trust, these can not be used as an excuse for inertia. It is recognised that on occasion there have been problems associated with packages of care upon patient’s discharge. Mrs McIntosh is working with key partner organisations to identify shortfalls in community provision with a view of improving care across the acute, primary and social care sectors. Mrs Wannell reiterated that a ‘do nothing’ approach was not an option. If the Trust does not address it’s financial challenges, it may result in the Trust having service changes or reductions imposed upon them. It must be remembered however, that this exercise isn’t just about delivering value for money but equally it’s about improving patient care and

improving the patient experience. [The Forum deeply regrets the total lack of any evidence to support assurances by the Trust that patient care wil l not deteriorate.] As the plans stand at the moment the Trust is not loosing any specialities but gaining a rehabilitation facility which is much needed across the health economy. In addition to the improvements already discussed staff are continually coming up with ideas on how to improve the patient pathway. Initiatives include the critical care improvements (previously presented to the PPI Forum and Trust Board) and an increase in maternity capacity. Ideas in the pipeline include direct GP referrals to the Medical Assessment Unit. Mrs McIntosh agreed to update the ‘road map’ which details the planned service improvement initiatives and circulate it to the Forum with the minutes along with the IARDS business case.

ACTION: Mrs McIntosh

Mr Marshall stated that many of the savings won’t impact fully until the next financial year although he believes that the budgets that have been set for this year are achievable. The impact of changes at Ashford & St Peter’s planned for later this year have already been factored into the Trust’s plans. At this stage it is felt that adequate provision has been made. Any unexpected increase in demand will need to be reviewed once the changes have been made. Mrs McIntosh added that part of the Trust’s plans is to analyse the demand for emergency services and to put in place effective strategies with the PCT to address these issues. A number of initiatives have been considered and one such scheme has already been implemented with the Emergency Practitioner Scheme. It was agreed that further work to understand whether the 53% of patients who are being diverted from the A&E department receive adequate care.

ACTION: Mrs McIntosh

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3 . Ou tpatient Service Improvement P lan Following discussion, it was agreed that the Forum need to carry out an independent inspection of the outpatient service. After which time both the Forum and the Trust will discuss areas for joint working. The Trust is already undertaking a comprehensive service improvement programme and believes that joint working will be beneficial to both parties. The Trust wants to be open at all times and to this end, Ms Jones agreed to provide the outpatient information the Forum has previously requested. Ms Jones undertook to circulate the Outpatient Improvement Plan so the Forum can ascertain where joint working would beneficial.

ACTION: Ms Jones

4 . Sunday T imes Good Hosp i ta l Gu ide - Dr Fos ter Miss Baldwin advised the Forum that the annual Dr Foster data published in the Sunday Times is due for publication in October. The data that will be used will be from 2003/04. This will present a negative picture for the Trust with regards to mortality rates as the Trust will be ranked within the 10 poorest performing Trust’s in the country. Whilst the Trust has to accept the reporting of factual data, Miss Baldwin advised the Forum that the Trust’s performance in this area has improved significantly since that period. In respect to the Dr Foster analysis of mortality data for 2003/04, the Trusts performance is 123 against a standardised rate of 100. Using another method of measuring mortality rates, CHKS, the Trust performs slightly better at 108 against a standardised rate of 100. Performance for 2004/05 demonstrates an improvement against both the aforementioned measures. The Trust now has a clearer idea of the issues that need addressing to improving the Trust’s mortality performance and indeed have implemented a number of corrective initiatives. One such being, the improvements to the critical care pathway which have been presented to the Forum and the Trust Board. Whilst it is too early to statistically demonstrate real improvements, the staff are confident that the initiatives are making a real difference to the patient experience and clinical outcomes Notwithstanding the Trust’s improved performance, the publication of data from 2003/04 will present PR challenges for the Trust which we will try to address through the promotion of our improved performance.

5 . Trus t Board Sub Committees It was agreed that Mrs Doherty would become a member of the newly formed Patient Experience Committee and Mr Tony Foster will become a member of the Clinical Excellence Committee.

6 . Consultat ion Protoco l

The Trust expressed its disappointment that a protocol had not yet been agreed. [The Forum's Consultation Protocol was emailed by Scope, (the Forum Support Organisation until the end of August 2005), to the Trust the day before this meeting!] Both parties agreed to have further discussions

outside the meeting with a view of gaining consensus at the earliest opportunity.

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App . 18 . Protoco l conf irmed by Scope to WMUHT by post , 3 rd August 2005

RE: CONSULTATION PROTOCOL

The Forum revisited the issue of the protocol at our meeting on 2nd August following the Trust’s request that we do so. The view of the Forum, however, is that an overly elaborate or prescriptive protocol would be likely to be interpreted as a limit or filter and possibly act as an impediment to the flow of information that should be conveyed to the Forum. The members of the Forum felt that if the Trust endeavours to put itself in the position of the reasonable patient or Forum member, the identification and selection of issues on which consultation would be required will be less problematic than the Trust perhaps fears. Central to the effective working of any consultation process is the issue of will rather than protocol content. The identification of issues which are the proper subject of consultation are readily appreciated in retrospect but the Forum feels that for a responsible and senior member of the Trust management structure, such issues can be prospectively identified. The Forum understands the Trust’s fear that the volume of issues on which consultation may be required may be considerable, but feels that if the duty to consult is exercised responsibly, these fears will prove to be more imaginary than real. For these reasons the Forum feels that a simple protocol is capable of serving the needs of the Forum and the Trust.

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App . 19. Extract from Bed Mode l Proposed Consultat ion Plan , Patr icia Davies , 15 th August 2005, Scanned

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55


App . 20 . Extract from PPIF M inutes , 15 th Sep .

Minutes of Public Meeting 15

th September 2005 starting at 7 pm

At The Vestry House, Paradise Road, Richmond

Item Action

1 Present: West Middlesex PPI Forum

• John Hunt (JH) in the Chair


• Gursharan Gill (GG)

• Norman Lilford (NL)

• Basil Mann (BM)

• Noshaba Sainsbury (NS)

In Attendance London ICAS

• Dee Conaghan (DC) London Regional Co-ordinator of ICAS

West Middlesex University Hospital(WMUH)

• Yvonne Franks (YF) Director of Nursing

• Baz Gard (BG) PALS Officer

• Joe Johnson(JJ) Complaints Manager West London In-House Forum Support Team

• Robert Hardy- King (RHK)

• Miren Irazusta (MI) Apologies

• Francis Brown

• Tony Foster

• Timothy Spring

56


7 Any Other Business. 1. YF informed members the Trust would be sending their draft declaration on Standards for Better Health to the forum in the near future. 2. YF informed members that the Trust had developed the bed model and would like to discuss it with members in the very near future. It was agreed that YF would let JH have a day time and evening date and then JH would contact members and find out which was best for the majority. 3. YF asked if following Cherna Crome’s resignation there was new chair. JH explained that a new chair had not yet been elected and that the Forum intended to discuss the issue at their meeting in October. Some members had queried whether a Chair was necessary or desirable he explained. It was agreed that the Trust would contact all members on issues and the Forum would ensure that a single response was given to the Trust in the interim. 4. JH asked about Xray services at Trusts out of the Borough and how that would affect patients attending Trusts were there was a problem. YF said that she was not aware of a problem, and agreed to find out and report back. RHK asked if a copy could be sent to him so that he could pass the information to the PCT PPIF, this was agreed. 5.JD asked if the Rehabilitation Nurse had been appointed. YF said that she did not know but would find out and let the Forum know.

RHK JH/ RHK JH YF RHK YF

57


App . 21. Ema i l from Yvonne Franks re Bed Closures , 16 th Sep . 2005 Subject: Invitation to Trust meeting Date: Fri, 16 Sep 2005 16:52:46 +0100 From: "Yvonne Franks" <[email protected]> To <[email protected]>, <[email protected]>, <[email protected]>, <[email protected]>, <[email protected]>, <[email protected]>, <[email protected]>, <[email protected]>, <[email protected]> Cc: "Joe Johnson" <[email protected]>, "Execs" <[email protected]>, "Laila Rhout" <[email protected]>, "Monica O'Doherty" <Monica.O'[email protected]>, "Julie Pie" <[email protected]>

Dear All As discussed at the meeting last night, we would like to invite members of the Forum to a meeting to update you on the work to close 30 beds and describe the resulting bed configuration. The meeting will be with Alison McIntosh, Director of Acute Care and Simon Marshall, Director of Finance, others from the management team may also be in attendance. As requested, we will also use this time to provide you with a written Trust management update to leave your meeting on October 11th free for your team business. May we assume you therefore do not need anyone to attend on this date - let me know. Alison and Simon are available on the following dates and times: (Venue will be Meeting room A, second floor, East Wing) Day time: 29th Sept. 1.00 - 3.00pm Evening: 26th, 27th, 28th and 29th Sept. beginning at 6.00 - 8.00pm. You agreed to discuss the best date between you and for a single representative to inform me of the group preference. Please could you ensure that those not on email or new members are notified of these options. Including Bob Hardy-King) with best wishes Yvonne Franks Director of Nursing & Midwifery West Middlesex University Hospital 020 8321 5583 Secretary: Laila Rhout 020 8321 5599

58


App . 22. Enqu iry ema i led to Yvonne Franks re Wa it ing L ists , 16 th Sep . 2005

Date: Fri, 16 Sep 2005 14:04:17 +0100 To: "Yvonne Franks" <[email protected]> From: John Hunt <[email protected]> Subject: PPI Forum / Members / Meeting

Dear Yvonne, As agreed last night, I'm sending you a list of email addresses of Forum members. [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected] [email protected]

With regard to the proposed meeting on the "Bed Model", for which you will suggest possible dates, please can you also supply us with the latest figures for all waiting list times in all specialities, and monthly breakdown over the past year of how many operations the hospital has cancelled, together with the reasons for the cancellations? With regard to the (non-Forum) Pharmacy matter we discussed last night, I spoke to Andrew Caunce a short while ago, who suggested several useful alternative approaches. Thank you very much for your intervention. Best wishes, John.

[ A further five reminders were emailed over the following month on 26th Sep., 28th Sep., 3rd Oct., 7th Oct., 10th Oct.. On 29th Sep. we were emailed a reply at 17:11: just 50 minutes before we were due to meet WMUHT representatives to learn about the bed closures, which had been announced the day before at the WMUHT AGM. Being informed after the event is NOT consultation.

During the meeting Gail Wannel l real ised that the figures were wrong. We were promised a corrected version by the end of Monday, 3rd Oct..

An email received from Al ison McIntosh on the 10th Oct. admits " There

is a known issue with a small number of patients appearing in the long waiting time bands of the KH07

who should not be shown there": the second admission that responses to this request are unrel iable.

On the 11th Oct. we finally received the fol lowing data: stil l not what we had requested, as the monthly breakdown over the past year is not included. As there is no explanation of the term "Suspended Patients", we do not know what these figures actual ly represent.]

59


60


App . 23 . Meet ing on Bed Closures , 29 th Sep . 2005

Meeting to discuss the Hospitals plan to revise bed numbers. Present: Jean Doherty (JD) WMUH PPIF Tony Foster (TF) WMUH PPIF John Hunt (JH) WMUH PPIF Norman Lilford (NL) WMUH PPIF Dr Ahmed (DrA) WMUH Patricia Davies (PD) WMUH Yvonne Franks (YF) WMUH Joe Johnson (JJ) WMUH Simon Marshall (SM) WMUH Alison McIntosh (AM) WMUH Gail Wannell (GW) WMUH Bob Hardy-King WLFST ( Notes) GW started off by saying that the Hospital had discussed the issue of closing beds at a meeting in July 2005; some details of the proposed IARDS ward and removal of 30 from the bed compliment of the hospital were discussed. So this was not a new item. Trust Board papers had included information on bed reduction and Forum members had attended Trust Board meetings. At the meeting in July 2005 the Trust’s Road Map for changes had been discussed with the Forum. Getting the details of which beds was an issue the Trust had decided needed to be made by clinical staff and to this end had consulted with all specialities It had been intended to have this consultation complete by early August, but with other pressures it was not completed until the end of August. The proposal was developed end of August early September. Unfortunately due to the Chair if the Forum resigning at the beginning of September 2005 the Trust decided to bring the proposal to the meeting of 15

th September 2005.

The idea of the meeting today was to give the rationale behind the model. JH asked about two sets of statistical date that the Forum had asked for. YF explained that the Trust collected data in a different form to that the Forum wanted so they had had to take the data and reformat it, and two set of data were distributed. JD was concerned regarding the statement that AM could not contact the Forum following the resignation of the Chair, YF was the contact point for communication between the Trust and the Forum, and the Forum is always contactable. AM said that SM could give financial details, PD would give bed model information and YF would give the clinical details. PD said the Road Map and the IARDS (Integrated Assessment & Rehabilitation Discharge Service) Business Case were with the Trust Board papers for July 2005. The IARDS ward would enable patients to be prepared for discharge safely and sooner rather than later. There was benefit to both the patients and the Trust. Whilst 30 beds were to be closed from a number of different areas in the hospital, a single ward Lampton would be closed. Patients in the ward would be distributed to beds elsewhere in the hospital. Care of the Elderly was being remodelled and the new build made this easier. It the past all specialities for the elderly were in one ward and this was not the ideal situation. It was now possible with the help of the Care for the Elderly team to care for elderly patients in the main wards for each speciality where they would get the best attention, as well as the extra care they needed because they were elderly.

61


Elderly people who needed care and nursing ready for discharge home and this included a high amount of rehabilitation would be cared for in the IARDS ward, where specialists in rehabilitation . A Best Model for Care of the Elderly designed by Barnet and Chase Farm Hospital had been used as a basis for the changes in direction. There would also be one ward for elderly acute care ( over 80s) In Lampton ward nearly 50% require rehabilitation and not day to day medical attention. Crane 1 ward will move into the main hospital and this will leave one floor clear. This area may used as an escalation ward and in conjunction with the PCTs work on Urgent Care. JD asked for confirmation that Lampton Ward has 32 and Crane 1 has 33 beds. YF explained that some of Crane 1 patients there would be 28 beds on Kew ward 14 acute beds and 14 stroke beds. DrA said that from a clinical point of view elderly patients needing rehab at present were competing for a limited number of therapists. SM said that this was a problem in many Trusts due to lack of therapists and money. JD said that financial aspects were down to the Trust to control and not the business of the Forum. Provision of services was a forum matter, and any changes required consultation. It was the duty of the Forum to represent the patients. GW said that the Trust had been in meaningful consultation with the Forum since January 05. There was a need to save money and the Trust will need to close beds and reduce the length of stay, but this will be done in a safe way for patients, they will not be put a risk by the changes. Where the beds to be closed are selected is a clinical decision. YF confirmed that time had been given to staff in the different specialities to make the decisions. This decision has taken longer than the Trust had anticipated. GW said that she had operational management control and was required to take decisions on why and how. Now that the information was available it had been made available to the Forum and that was the purpose of the meeting. The information had only been available from the last week of August 05 and AM had tried to contact the Forum then. CC had suggested that the Trust took the information to the next meeting of the Forum on 15

th September 05, and this they had done.

JH reminded all that the agreement between the Trust and the Forum was that in matters of consultation the Trust would contact all members of the Forum not just the Chair. TF pointed out that Lampton Ward was not mentioned in the Bed Model document. What the meeting needed to do was to discuss if the changes were in the best interests of patients. JD said that if the Forum had had the information they could have made a decision. GW said that since Jan 05 there had been several meetings where Forum members had been present and it was CC who had recommended that the issue be taken to the September 05 meeting. JD said that the Forum had had some information but no detail till today, and the information provided was incomplete. GW said that the changes would provide better discharge links with outside organisations. It was a safe option and had taken time. She agreed that the detail had only just been provided. YF said that there were more side room in Kew ward, and this was an advantage when treating elderly patients who sometimes needed isolating. SM said that the changes would result in less agency staff being used and possibly less bank staff as well.

62


JD said that at the first meeting in February 05 it had been stated that 30 surgical beds might be closed, it was agreed that Janet Baldwin would write to the Forum, to date this has not happened. TF asked how many more meetings would there be to discuss the same thing, a decision needed to be made by members. GW said that maximising day care surgery had helped the Trust to reduce the number of waits, also it had resulted in better outcomes and more of them. Following the changes there would be the same number of patients going through the hospital if not more. By working on the reducing the length of stay in hospital the Trust hoped to further improve waiting times. AM said that safe discharge from hospital was a Trust priority as this was best for the patient and also reduced readmissions. There was some delay in discharge due to lack of outside services. JD asked were community care services not set up in all areas. AM said that this was correct. The Trust was working with outside organisations to rectify this situation. She went on to say that using the road map had been successful and length of stay had been reduced in some specialities. Chronic disease management needs to be improved outside hospitals. JH said that he hoped that all reductions in length of stay were carried out in a safe manner for all patients especially those elderly patients with no one at home. SM said that in the last year the majority of patients had stayed in hospital 2-3 days longer than they should have, through not fault of their own. GW said that the concentration of skills in one place for the elderly would result in an improved discharge process. JD asked about the waits in seeing patients with suspected cancers. Am said that all national standards had been met. In areas of cancer treatment most urgent cases were seen within 1 month. GW said that the hospital did have a split in the bed stock, into emergency and elective. There were 21 ring fenced elective beds. Am said that the Day Care Surgery unit had expanded enormously, and that this had been assisted by the work of the consultants especially DrA. GW said that day care surgery had been extended from 5 days to 7 and that this had been of great help to patients who were working and was another example of the hospital responding to the needs of patients. Following the changes escalation was expected and planned this would allow for settling in to the new system. PD said that at any one time there were 20 patients needing rehabilitation; those patients could now be moved to an area where they would be looked after properly. YF said that the Trust worked continuously to ensure that patients were safe, especially in a period of change. The escalation ward was now better managed with less agency staff. TF asked if slow stream rehabilitation would result in slower discharge and who was paying for that. Also would contacts with outside agencies be better managed. GW said that length of stay was sometimes longer due to rehabilitation and lack of outside care availability. IARDS ward had skilled staff who would be able to discharge patients safely and control contacts with outside agencies. It was better when this contact was handled from one place. RHK asked if there was an agreement in place between the Trust and the Local Authority for payments to the trust where discharge was delayed due to lack of provision by the Local Authority.

63


SM said there was and in this case the Local Authority was providing funds to assist discharge. A&E was funded by Hounslow PCT on a block charge basis, although this might changes in the future with Payment by Results legislation. JH asked about younger patients in need of rehabilitation. AM said that younger disabled patients were not covered by the changes, but work was in progress to help them. PD said that there were often 28 patients who needed to go home and were delayed due to reasons which were not their fault. This blocked beds for acute patients. GW said that patients with chronic conditions needed to be managed differently in the community, with the right support in the community with primary care. Hospital was for acute patients. NL said that elderly people changed each day in regard to the moods and health. Years ago there were more staff in the community. AM asked if the Forum could identify what minimum data they required on a monthly basis. This information would allow that Trust to collect the necessary data on a regular basis and not have to rework data collected for other agencies. JD said that she had been contacted by a member of the public who had gone in to the hospital for treatment in Lampton ward and found it closed with all the beds stripped. He had been told there was not bed for him, but after a lengthy discussion involving the bed manager a bed had been found for him in another ward. JD felt that this was not acceptable. JJ said he would look into the matter, in general terms as he did not have the patient’s details. There have been occasions where the consultant has called patients in and instead of reporting to the admissions office have gone straight to the ward, and staff there are not aware of their arriving as other arrangements had been made. It was agreed that there was no further business. JD agreed to send out the revised information as soon as possible and JH said that the Forum would go away and look at the information and come back to the Trust.

64


App . 24. Enqu iry ema i led to Yvonne Franks re Wa it ing L ists , 3 rd Oct . 2005

Date: Mon, 03 Oct 2005 23:20:22 +0100 To: [email protected], Joe.Johnson@wmuh-

tr.nthames.nhs.uk, [email protected], [email protected]

From: John Hunt <[email protected]> Subject: Re: bed model information Cc: [email protected]

Dear Yvonne, At 16:30 2005.09.30, you wrote:

Simon and Alison have met to discuss the figures for patient waiting times and reason for

cancellations. On Monday this work will be progressed to provide you with up to date and

accurate data. We are looking forward to receiving these. Please could you also circulate the Impact Study that Patricia Davies said the Trust had conducted?

[Study on impact of bed closures, mentioned during meeting on 29th Sep..]

Alison would also like to reiterate her request that you suggest a data set of information that

you would like us to be able to provide on a regular basis. This will allow us to collect it in a

format that makes this possible. Members have been asked to consider what might be useful. ====================================================== With regard to the Forum's public meeting on 8th Nov., I asked on 23rd Sep. whether the Trust can supply a speaker on Heart Disease, Cancer, or Palliative Care. If you could let me know by Thursday evening, (6th), it would be greatly appreciated. Best wishes, John H.

[ Reminders sent on 7th Oct., 27th Oct., 31st Oct., and 4th November. As the PPI Forum announced on 17th Oct. the decision to refer the hospital to Overview & Scrutiny not only for failure to consult but also for fai lure to supply information, we were surprised that the Trust delayed responding to the enquiry of 3rd Oct. until 4th Nov.: four reminders and 24 working days later, (exceeding the statutory l imit of twenty working days). The Forum is unable to reconcile the eventual reply of 4th Nov. EITHER with the statement made by Patric ia Davies on 29th Sep., OR with the reasonable expectation that any Trust planning the closure of an entire ward would, in accordance with standard business practice, first assess the impact on service users, viz., the patients.]

65


App . 25 . WMUHT Press Re lease , 3 rd October 2005

Twickenham Road

Isleworth Middlesex TW7 6AF

3 October 2005

Reorganisation of wards will improve patient care and efficiency

West Middlesex Hospital is reorganising its wards and increasing the provision of

rehabilitation care for elderly patients once they no longer need intensive nursing in

an acute ward. This will reduce the number of patients unnecessarily in acute

hospital beds, which is better for patients, reduces their time in hospital and frees up

hospital resources for patients with different needs.

A number of changes are proposed, including a new ward for patients needing

rehabilitation before they leave hospital, bringing together nursing, therapies and

discharge planning within a dedicated area. In parallel there will be a reduction in

acute bed numbers and reorganisation of the wards to provide services that better

suit the needs of the patients currently being admitted. As well as improving the

patient experience and delivering better clinical care, the changes will make the

hospital more efficient. The resulting savings will help to bring the Trust more into line

with the expected running costs of NHS hospitals of its type.

The changes have been planned for many months in consultation with doctors and

senior nurses and options under consideration have been communicated widely via

public board papers. The selected option will lead to new roles for some staff with

whom the proposals are being discussed. As the vast majority of the hospital’s

patients are elderly, the roles will not change significantly other than some staff

working in a new ward configuration. This will make best use of the skills of our

permanent nursing staff for the benefits of patients and further reduce our

dependence on temporary staff. In turn this is better for nurses who will work in more

stable teams.

-ENDS-

For information please contact

Jane Brennan 020 8321 2555 or Andrew Butcher 07850 366077

Press Information

66


App . 26 . WMUHT Beds Mode l 10 and 11-b , ema i led 10 th October 2005

Bed Mode l 10

Bed Mode l 11-b

67


App . 27 . Trust "S ITREP" report , ema i led 10 th October 2005

SITREP For Period 26/09/2005 - 02/10/2005

Collected Awaiting Collection

Type

Weekly Period

26/09/2005

Organisation

West Middlesex University

NHS Trust Organisation

Code

RFW

SHA

North West London SHA (Code)

Q04

This collection has been approved by the Review of Central Returns Steering

Committee (ROCR).

ROCR ref: ROCR/OR/0067/004

Gateway ref: 1865

SECTION A - A & E

Total no in

reporting

period

Average of

last four

weeks (to

nearest

whole

number)

A1. A and E

attendances

i.). Type I 1621 1637

ii). Type II 0 0

iii). Type III 0 0

iv). Total

(Computed) 1621 1637

A2. Total time in A&E – number of patients spending over 4 hours in A&E from

arrival to discharge, transfer or admission

Calculated % spending <4

hours in A&E

i.). in Type I

A&E 13 35 99.20

%

68


ii). in Type II

A&E 0 0 0.00

%

iii). in Type III

A&E 0 0 0.00

%

iv). Total

(Computed) 13 35 99.20

%

A3. Total number patients who have waited > 4 hours but < 12 hours in A&E

from decision to admit to admission

i.). in Type I

A&E 1 2

ii). in Type II

A&E 0 0

iii). in Type III

A&E 0 0

iv). Total

(Computed) 1 2

A4. Total number of patients who have waited > 12 hours from decision to

admit to admission

i.). in Type I

A&E 0 0

ii). in Type II

A&E 0 0

iii). in Type III

A&E 0 0

iv). Total

(Computed) 0 0

A5. Total number of A

& E Closures during

the reporting

period

0 0

SECTION B - Emergency & Elective Activity

Total no in

reporting

period

Average of last

four weeks

B1. Emergency admissions in the reporting period.

i.). Via A&E Type I 294 298

ii). Via A&E Type II 0 0

iii). Via A&E Type III 0 0

iv). Via A&E Total

(Computed) 294 298

v). Other (i.e not via

A&E) 9 11

69


B2. Total number of elective

ordinary admissions

(voluntary item)

58 54

B3. Total number of elective

day case admissions

(voluntary item)

143 128

SECTION C - Cancelled Operations

Total no in

reporting

period

Average of last

four weeks

C1. Cancellations of Elective

surgery

1 2

C2. Urgent cancellations

i. Total number of

urgent operations

cancelled.

0 0

ii. Number of urgent

operations cancelled for

the 2nd or more time

0 0

SECTION D - Delayed Transfers of Care

Delayed Transfers on Thursday of Reporting Period

Use the "create delayed transfer" button to record your delayed transfers by local authority. Create a new form for each local authority you have delays for.

Create delayed transfer Postcode Lookup

D1. Total number of patients occupying an acute bed whose transfer of care is delayed

Council a) No. of patients whose transfer is delayed

b) Numbers of days delayed within the week

c) Number of 'reimbursable' days

Actions

Hounslow 5 7 0 edit

Richmond upon Thames 0 0 0 edit

Total for West Middlesex University NHS Trust:

5 7 0

Responsibility of NHS (ie includes patients making

Attributable to Social Care. Note that these delays

Attributable to Both

70


own arrangements) qualify for reimbursement

Key to columns:

a) Number of patients whose transfer is delayed b) Number of days delayed within the week

Reasons for delay - awaiting a) b) a) b) a) b)

A) Completion of assessment 0 0 0 0 0 0

B) Public Funding 0 0 0 0 0 0

C) Further non acute NHS care (including intermediate care, rehabilitation etc)

5 7 n/a n/a n/a n/a

D) Care Home placement i) Residential Home

0 0 0 0 n/a n/a

ii) Nursing Home 0 0 0 0 0 0

E) Care package in own home 0 0 0 0 0 0

F) Community Equipment/Adaptations 0 0 0 0 0 0

G) Patient or family choice 0 0 0 0 n/a n/a

H) Disputes 0 0 0 0 n/a n/a

I) Housing - patients not covered by NHS and Community Care Act

0 0 n/a n/a n/a n/a

Total 5 7 0 0 0 0

Total no in

reporting

period

Average of

last four

weeks

As % of occupied

acute beds (item E1ii)

D1. Total number of patients

occupying an acute bed

whose transfer of care is

delayed

5 4 0.00%

D2. Numbers of days delayed

in the period

7 7

D3. Number of 'reimbursable'

days in the period

0 0

SECTION E - Beds

E1. Acute beds

i. Total number of

acute hospital beds

at midnight on the

Thursday of the

reporting period

338

71


ii. total number of

patients occupying

an acute hospital

bed on midnight on

Thursday of the

reporting period.

316

iii. Bed occupancy

rate 0.00

%93%

E2. Medical beds (voluntary data item)

i. total number of

beds designated

as medical beds on

midnight on the

Thursday of the

reporting period.

0

ii. Medical outliers

- total at midnight

on Thursday of the

reporting period

0

iii. Medical outliers

as % of total acute

beds

0.00%

0%

SECTION F - Critical Care

F1. Adults

i) The total number of

adult critical care beds

open at midnight on the

Thursday of the

reporting period.

10

ii) The total number of

occupied adult critical

care beds at midnight

on the Thursday of the

reporting period.

10

iii) The total number of

adult critical care beds

available at midnight on

the Thursday of the

reporting period. (i.e.

(i) - (ii))

0

F2. Paediatric


paediatric critical care

beds open at midnight

on the Thursday of the

reporting period.

0


occupied paediatric

critical care beds at

midnight on the

0

72


Thursday of the

reporting period.


paediatric critical care

beds available at

midnight on the

Thursday of the


(i) - (ii))

0

F3. Neonatal Intensive Care


neonatal intensive care

cots (or beds) open at

midnight on the

Thursday of the

reporting period.

2


occupied neonatal

intensive care cots (or

beds) at midnight on

the Thursday of the

reporting period.

1


neonatal intensive care

cots (or beds) available

at midnight on the

Thursday of the


(i) - (ii))

1

F4. Critical Care Transfers


non medical critical care

transfers during the

reporting period.

0


non medical critical care

transfers out of an

approved critical care

transfer group during

the reporting period.

0

Trust Commentary

Overview of Pressures in reporting period

73


If there are current issues relating to the topics below comments should be made in the appropriate box. A comment is if the topic is not currently an issue.

Staffing

Ward Closures (please give reasons).

Critical Care

Social Services (to be completed with Social Services Departments):

Please comment on any significant change in capacity/level of delayed transfers.

74


Others (this should include any recent/forthcoming potentially newsworthy issues).

Modified Date and Time

By Action

03/10/2005 15:40 03/10/2005 15:41 03/10/2005 15:44 03/10/2005 16:31 04/10/2005 09:49

SRFW SRFW SRFW SRFW SRFW

Browser edit Browser edit Browser edit Browser edit Browser edit

75


App . 28 . WMUHT Press Re lease , 12 th October 2005

Twickenham Road

Isleworth Middlesex TW7 6AF

12 October 2005

Statement on ward reconfiguration

A reorganisation of some of the hospital’s wards was carried out last week to improve patient care and reduce unnecessary stays.

Although most of the changes have taken place, due to unpredictably high numbers of emergency admissions over the past week, the closure of one ward has not yet been possible. We are reviewing the situation on a daily basis with the aim of closing the ward as soon as we can. This ward will remain available for escalation purposes and we are fortunate to have this extra capacity and flexibility should the need arise.

Staffing levels are being maintained through a combination of our own staff and temporary staff.

-ends-

For information, please contact:

Richard Elliott – 020 8321 6342

Press Information

76


App . 29. Request for comments on Better Health Draft Declaration , received 13 th Oct . 2005

Subject: FW: West Middlesex University Hospital NHS Trust - Standards

for Better Health Draft Declaration Date: Thu, 13 Oct 2005 08:57:28 +0100 From: "ForumSupport.Inhouse2" <[email protected]> To: <[email protected]>, <[email protected]>

-----Original Message----- From: Stephen Piper [mailto:[email protected]] Sent: Tue 10/11/2005 11:54 AM To: ForumSupport.Inhouse2 Cc: Subject: RE: West Middlesex University Hospital NHS Trust - Standards for Better Health Draft Declaration Dear Colleagues, This email is a reminder that we are expecting final responses to the West Middlesex University Hospital NHS Trust draft declaration of compliance to the annual health check core standards by this Friday, 14th October. I would be grateful if you could send all responses to myself, preferably by email, to [email protected] or by post. Please would you clearly mark your email as draft declaration response including your organisation name. Please do not hesitate to contact me should you have any questions or require additional clarification. Many thanks for your assistance. Regards, Stephen Piper Associate Director of Finance and Performance Finance Dept, Level 2, East Wing West Middlesex University Hospital NHS Trust Tel: 020 8321 2551 Fax: 020 8321 2509 email : [email protected]

…

<< File: West Middx SfBH Draft Declaration 23.09.05.xls >>

77


App . 30 . Excerpt from ema i l to PPIF members , 13 th October 2005 Date: Mon, 24 Oct 2005 11:56:59 +0100 To: <[email protected]>, <[email protected]>,

<[email protected]>, <[email protected]>, <[email protected]>, <[email protected]>, <[email protected]>, <[email protected]>, [email protected]

From: John Hunt <[email protected]> Subject: Escalation wards + Inspections meeting + OSC briefing

Bob, Please can you copy this to Norman -- and to Basil, if he still has email trouble? Thanks, John.

Informa l Inspection V is i t , Esca lation Wards Thursday, 13th October, 11:30 - 12:30

Jean & John were met by Joe Johnson, and taken round by Jackie Hardy and Modern Matron Cathy Sanafianos.

Crane Esca lat ion Ward ( lower leve l) 26 escalation beds open at time of our visit. We were told patients were mostly from A&E via MAU, and mostly elderly, awaiting transfer to nursing homes for long-term care. The staff on duty were:

� 1 H-grade duty matron. � 1 F-grade ("Bank", from Osterley ward) � 1 E-grade sister � 1 A-grade (health care assistant)

We were told that an extra member of staff would be "ideal". Staff reported that the level of staffing was an issue -- and that a patient's relative had complained about the level of care being provided. A team of doctors (headed by a Dr. X) visited both wards during our visit. Team members complained of several problems with the new escalation wards. -- Patients under the team are now scattered over several wards -- Lack of staff permanently assigned to the wards resulted in

� ward staff not familiar with patients � lack of continuity � information more easily lost at hand-over between shifts � lower levels of supplies are stocked on these wards � staff not familiar with ward had difficulty finding supplies

Once Dr. X heard that the PPIF had been approached by local journalists, they stated that an "acceptable level of care" IS being provided, and that the current system is better than a couple of years ago, when patients awaiting discharge were kept in operating theatres, with no shower facilities

78


Lamp ton Esca lat ion Ward (upper leve l) 22 escalation beds open at time of visit. We were told these were mostly ambulant, expected to be discharged home, (sooner than patients on Crane). Staff on duty were:

� 2 D-grades (one Bank and one Agency) � 2 HCA's (both Bank)

One of these HCAs was being required to float this morning between the escalation wards: so effectively 3 - 4 staff on Lampton, and 4 - 5 on Crane. One of the D-grade nurses said that he was on duty the whole week, as were (some of) the others on Crane, so that there is some continuity. However, these are all taken from the "Bank" -- which almost certainly means that they are working there in addition to their normal shifts on

other wards. [Lack of] Continuity -- and severe overwork / overload / ... ! [Overwork means that patient safety is being compromised both on the escalation wards and on the ward where staff usually work. The physical and mental health of the staff is also at risk: as is their registration to practise with the Nursing and Midwifery Council.] Two duty matrons, Karen Phillips and Rob Breen were overseeing the booking of staff on these two escalation wards. We asked what level of staffing was typical on the other wards, and were told 7 staff (including HCA's) for 32 patients: a "standard" W.Mx. ratio of 4.6 patients per member of ward staff, compared with 5.8 on Lampton + Crane. We spoke to an ambulant cardiac patient who had been transferred from CC1 a couple of days previously. He had been very happy with the standard of care on CC1, but felt the standard of organisation was not of a similar standard on the escalation ward. He had been told he would go home the previous day -- but at 17:30 was told no (blood test not good), test would be repeated in morning, could go home if satisfactory. The blood sample was not taken till almost midday, so he was still waiting, unable to find out when or if results would be back that day. He wanted to go home -- and the hospital need the bed. He described the NHS as a behemoth, complaining that things take so long to happen. He had also witnessed bed-bound patients waiting 10 - 15 minutes for a response when they pressed their bell. At the end of our visit, a drug trolley went past. It looked filthy. On asking where equipment came from, we were told that all equipment was serviceable, and that all electrical equipment had been tested for electrical safety by the hospital's electricians. Public Meetings, 2006 … Progress since Meeting on Inspections, Monday, 17th Oct. …

Brief ing by North Wes t London Strateg ic Hea lth Au thor ity , 20 th October given to Hounslow's Adult Health & Social Care Overview & Scrutiny Panel

Jean, Gursh, and John attended this briefing by Barbara Gill, "Acting Executive Director of Strategy" at the NWL-SHA: an initial step in the consultation for a "patient-led NHS". Although members of other NW London Health Overview & Scrutiny Committees had been invited, attendance was poor. We were told at the beginning of the presentation that "it will take at least another 12 months to evolve strategy". At the end Sunita Sharma told us that the OSC will invite the NWL-SHA for another session, once they have some more detail.

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I requested (though have not yet obtained) an electronic copy of the Powerpoint presentation

given, which I shall be happy to forward to CPPIH and Bob HK for distribution to other PPIFs. [The SHA appear to be no better in supplying information than the West Middlesex. An updated version of the presentation was eventually suppl ied, with a request not to distribute it widely, as an improved version would be suppl ied the fol lowing week. Despite several requests, no further communication has been received! ] Incredibly, we were told that one of the "local" reasons for reorganisation is that "we have more beds than we need". Another reason given was "excess length of bed stays compared to national average" -- though my experience on "placement" since August is that a number of patients are already being readmitted after premature discharge. (While this placement is at another hospital, I have no reason to believe that it is significantly different from others.) The announced "vision" of "bigger & better" local services, including GP centres with 25 GP's suggests that services will cease to be truly local, becoming inaccessible to many patients who are elderly or impoverished, or have mobility problems. Consultation with BME community groups was promised: but there was no mention of consultation with other groups such as the elderly, the young, people with physical or mental disabilities, the unemployed, those with unsocial working hours, or LGBT (lesbian, gay, bisexual, & transgender). A throw-away remark that no decisions had yet been taken on Charing Cross or Ealing hospitals suggested that at least one of these is likely to be closed in the not-too-distant future.

http : / /news . independent .co .uk /uk /po l i t ics/art ic le320599 .ece 19th October

Senior Labour MPs will protest to Tony Blair today about being "railroaded" over changes to primary care trusts. Officials of the parliamentary Labour Party circulated a confidential note to MPs last night promising they would raise with the Prime Minister the "unprecedented" concern among backbenchers at the changes. It follows an angry meeting of the parliamentary party with Patricia Hewitt, the Health Secretary, on Monday over the changes. They took up the case again yesterday at a meeting with a Labour backbench health committee. "I think Patricia Hewitt was taken aback by the depth of the feeling among Labour MPs," said one senior Labour MP who was at the meeting. "They felt railroaded and angry that there had been a complete lack of consultation."

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App . 31. Forum 's response to Draft Dec larat ion on "Standards for Better Health" , 19 th October 2005

Date: Wed, 19 Oct 2005 12:10:16 +0100 To: [email protected], Stephen.Piper@wmuh-

tr.nthames.nhs.uk From: John Hunt <[email protected]> Subject: Re: Standards for Better Health Draft Declaration Cc: <[email protected]>, <[email protected]>,

<[email protected]>, <[email protected]>, <[email protected]>, <[email protected]>, <[email protected]>, <[email protected]>, [email protected], [email protected], [email protected], [email protected]

To: West Middlesex Hospital -- Yvonne Franks + Stephen Piper CC: CPPIH: Rosie Newbigging L.B. Hounslow Overview & Scrutiny: Joan Conlon + Isabelle Granet PPIF members + Forum Support Dear Yvonne, At 13:46 2005.10.14, you wrote:

2. I have spoken to Gail about the deadline for your comments. Due to the timing of our

Trust Board we can receive comment up to 5pm on Wednesday 19th October. Apologies

for this tight timescale but we were unaware of your difficulties in this respect. Here are some brief comments on the WMUHT's Standards for Better Health Draft Declaration [which] I hope will be useful to the WMUHT, to CPPIH, and to the Healthcare Commission. (Bob and Rosie: please can you forward, as appropriate?) Best wishes, John. Timescale The PPI Forum was informed verbally on 15th Sep. 2005 that we would shortly be receiving the Draft Declaration for comment. This was emailed to PPIF members on 10th Oct.: as an Excel file, which most members are unable to read. On 13th Oct. we were notified that a response was required by 14th Oct.. On the afternoon of 14th Oct. the deadline was extended to 19th Oct.. Printed copies were received on 15th and 17th Oct.: together with a 12-page document from CPPIH, dated 19th July, outlining how PPIFs are expected to respond; stating (p.2,sec.4,para.6): "Forums may want to encourage their Trusts to work with them as early as possible ..."; and promising future advice (p.3,sec.6,para.s 3+4) and training (p.3,sec.7) on coordinating inspections by PPIF and the Healthcare Commission. CPPIH and the WMUHT must both realise that such a timescale is totally unrealistic -- and must also appreciate that PPIF members are volunteers who devote time and energy to PPIF activities in addition to all the other commitments of our daily lives. Presentation The initial authorship of the Draft Declaration is not stated.

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(From the CPPIH covering document one might infer that this is the Healthcare Commission or the Dept. of Health.) It is a scrappy document, which has patently not been proof-read. It contains many references to DoH standards, Acts of Parliament, EU directives, and documents by NHS organisations and other bodies. It would be very helpful if the electronic version included hyperlinks to each of these documents. General Reaction to WMUHT Declarations We note with surprise that there is just one level 2 (Partly Met) and 18 level 3 (Nearly / Almost Met) responses, while all other items (apart from Domain5/C19, which has no declaration) are described as "Fully Met", suggesting an uncommon degree of perfection. This is not the impression gained from last year's Picker Survey. As our work over the past year has been hampered by a number of factors, some of which are now beginning to improve, and our work plan has not specifically addressed many of the points listed in the Draft Declaration, the comments below relate just to the ones mentioned in the CPPIH guidance document. Domain 4/C13 -- Dignity, respect, consent, & confidentiality This is not something we have explicitly addressed. An incident in Dec. 2004 experienced by one of our members demonstrated that not all staff treat consent seriously. We also heard of unwarranted force being used to restrain a frail and elderly patient. Domain 4/C14 -- Complaints We are pleased to hear the hospital report that the introduction of PALS "surgeries" in wards is making the PALS service more widely known, which is believed to underlie a reduction in formal complaints. On the other hand, regular reports in local newspapers indicate that further progress is required. Domain 4/C15 -- Food We plan to include this in a survey early in 2006. Domain 4/C16 -- Informing patients The hospital gives this section the lowest score, including their only Level 2 rating. This is mentioned by respondents in our (not yet completed) survey of Outpatient Clinics. Domain 5/C17 -- Consultation As the WMUHT Board is well aware, the PPI Forum complained in September 2004 that the Trust had not adhered to the requirements of Section 11 by not consulting the Forum when ward Lampton 1 was closed. On that occasion the Forum raised the matter at Hounslow's Overview and Scrutiny panel, but neglected to request an enquiry. The Forum remains deeply unhappy about the continued lack of meaningful consultation -- most recently over the further bed closures in October 2005. At a PPIF meeting on 11th Oct. attended by seven of our ten members, there was a unanimous vote to refer the WMUHT for investigation by the London Borough of Hounslow's Overview & Scrutiny Panel "for persistent refusal to consult, and for the abysmal quality of the inconsistent, inaccurate, unclear and misleading information that we have been drip-fed". Although the press release issued on 17th October (recommended and approved by CPPIH) used milder language, our members and Commission representatives are greatly disappointed and frustrated by experiences over the past year.

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Domain 7/C22 -- Local partnerships We are not aware of any work being done in this area. Domain 7/C23 -- Disease prevention & health promotion In addition to the areas mentioned, we are aware that the prevalence of tuberculosis in this area is a matter of concern. Domain 7/C24 -- Emergencies During the bomb attacks in Central London this summer the hospital was put "on alert" and turned regular patients away. We trust that the hospital has learnt from this unplanned exercise -- but are acutely aware that our proximity to the ever expanding Heathrow Airport and crowded skies put us at risk of larger incidents which have not yet been tested.

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App . 32. Extract from WMUHT Chief Execut ive 's Report , Ga i l Wanne l l , 27 th October 2005

Meeting Trust Board

Date Thursday 27 October 2005

Agenda Item 5

Author/Exec Lead Gail Wannell

Title of Paper Chief Executive’s report

Summary

This report updates the Board on various issues which includes the following:

Formal action required

The Board is asked to note the report.

Executives and Assistant Directors to cascade through the directorates and CEO briefings.

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Agenda No: 5

WEST MIDDLESEX UNIVERSITY HOSPITAL NHS TRUST

CHIEF EXECUTIVE’S REPORT

Trust Board Meeting – Thursday 27 October 2005

…………

Bed reconfigurations and IARDs ward At the beginning of October we undertook a major reconfiguration of our bed base to facilitate the closure of acute beds and at the same time opened a 14-place rehabilitation ward on the ground floor of the Marjorie Warren Unit. These changes were planned with military precision and thanks and praise goes to all staff for their help and support during this process. The rehabilitation service is now located on Kew ward, ground floor Marjorie Warren unit. This is a modern facility with more individual rooms than the standard Marjorie Warren ward areas. A&E and the 4 hour Wait We continue to perform well against the 98% 4 hour standard in spite of seeing record numbers of attendances over the past few months.

…………

Gail Wannell October 2005

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App . 33 . Extract from WMUHT M inutes from 21s t July, Jane Brennan , 27 th October 2005

Meeting Trust Board

Date 27th

October 2005

Agenda Item Item 2

Author/Exec Lead Jane Brennan, Trust Board Secretary

Title of Paper Minutes from 21st

July 2005

Summary Attached are the minutes from the last Trust Board Meeting which was held on the 21

st July 2005


The Board is asked to approve the minutes

Minutes of the Trust Board meeting held on 21st July 2005 at 10.00 hours

Present: Mrs Sue Ellen, Chairman

Mrs Gail Wannell, Chief Executive Miss Janet Baldwin, Medical Director Mr Stephen Clark, Non Executive Director

Mrs Celia Golden, Non Executive Director Mr Andrew Daws, Non Executive Director Mrs Yvonne Franks, Director of Nursing

Mr Peter Gill, Director of Information Technology Professor Sean Hughes, Non Executive Director Ms Shan Jones, Director of Family & Sexual Health & Ambulatory Care Mr Simon Marshall, Director of Finance & Performance

Mrs Alison McIntosh, Director of Acute Care Mrs Nina Singh, Director of Human Resources Dr Salim Vohra, Non Executive Director

Apologies None received

In attendance: Ms Jane Brennan, Trust Board Secretary Mrs Cherna Crome, WMUH PPI Forum

…………

TB05.86.07 Proposed bed reductions – Mrs Wannell advised the Board that the executive team had met with the PPI Forum on 19

th July 2005 to continue discussions

regarding the Trust’s savings plan. Details of the plan, including the proposed bed reductions had been reported in the Board papers since January. The Forum were advised formally of the proposals at a Forum meeting held on 18

th February. This

week’s meeting detailed the plans the Trust has to relocate 28 beds to a rehabilitation ward in addition to reducing bed numbers by 30, following a reduction in length of stay.

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All the actions are designed to improved the quality of patient care. Mrs Wannell will ensure that developments are communicated to the Forum in a timely manner. TB05.86.08 Financial Recovery Plan – This item was taken under agenda item 8.3. TB05.86.09 Infection Control – This item was taken under agenda item 9.3. TB05.86.10 Clinical Excellence Committee – This item was taken under agenda item 9.5. TB05.86.11 Nurse Turnover – This item was taken under agenda item 10.1. TB05.86.12 Agenda for Change – This item was taken under agenda item 10.2. TB05.86.13 Patient Experience Panel - This item was taken under agenda item 6.4.

TB05.87 Chairman’s report

Mrs Ellen reported that the Trust Board had met in private prior to the meeting and discussed confidential commercial issues. In addition, confidential issues relating to staff and patients had also been discussed.

…………

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App . 34. Extract from WMUHT Remunerat ion/HR Committee , Nina S ingh , 27 th October 2005

Meeting Trust Board

Date 27th

October 2005

Agenda Item 6.2

Author/Exec Lead

Nina Singh, Director of Workforce and Development

Title of Paper Remuneration/HR Committee

Summary The attached are notes from the HR Committee held on the 18th

July 2005 and the 12

th October 2005 as well as a summary of

discussions from the last meeting of the Remuneration Committee on 18

th July 2005.


Board to note content

…………

HR Committee Meeting

Notes of the Meeting held on 12th October 2005

Present:

Stephen Clark

Sue Ellen Nina Singh Larraine Howard-Jones Julia Ryan Alison McIntosh Yvonne Franks Sue Daw Richard Ingrey John Wilkinson Lie Wah Johnson Celia Golden Sharon de Silva

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…………

10. Workforce Data

Nina Singh presented a summary of the staffing costs to date, confirming that costs and percentage staffing compared to last year had reduced. Sue Ellen stated that the bed closures and staffing reductions should have resulted in greater savings than those demonstrated by the figures and that savings must be realised even when including inflation and Agenda for Change. Stephen Clark suggested that it would be useful to have comparative data on substantive post numbers, as we need to be reducing staffing levels. Larraine Howard-Jones read the workforce data report, and pointed out that the HR department are now recording more ER information in a database, which should result in more detailed figures in the next report, and that vacancy data should be more accurate by November, once the Agenda for Change work is complete. Action: Nina Singh to provide information at next meeting on staffing numbers and expenditure in liaison with Finance.

11. Policies for Ratification The Capability Policy and Sickness Absence Policy were both ratified.

12. Any Other Business a) It was agreed that all papers presented at the committee have a section on finance. Action: Nina Singh to amend front cover sheet to include a section on finance b) Disciplinary procedure for doctors - it was noted that there is a new national framework for disciplining doctors, which will need to be brought back to the Committee for consultation and ratification. Action: Mary Smith and Larraine Howard-Jones

13. Date of Next Meeting - 17th November 2005

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App . 35 . Extract from WMUHT Pat ient Exper ience Committee M inutes , 27 th October 2005

Meeting TRUST BOARD

Date 27th October 2005

Agenda Item 7.4

Author/Exec Lead Joe Johnson, PPI Manager

Yvonne Franks, Director of Nursing & Midwifery

Title of Paper Patient Experience committee minutes

Summary These minutes are a record of the first meeting of this Trust board sub group.

Terms of reference and committee membership were agreed.

It was agreed that standard agenda items included;

• Relationships with stakeholders

• Patient feedback

• Complaints and PALS service

• Outpatient improvement work

• Reputation management

Meetings will be held bi-monthly


To note.

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Minutes of the Patient Experience Sub-Committee held on 22nd July 2005

Present Jane Brennan Jean Doherty Sue Ellen Yvonne Franks Celia Golden Shân Jones Joe Johnson Salim Vohra

…………

3. Relationships with stakeholders 3.1 Consultation with patient forum YF explained that in February 2005 the Trust had arranged a joint workshop at the hospital with a view to discussing and agreeing a local protocol on the consultation process. The overarching aim was to produce some simple guidance that could be shared with Trust staff so that they understood when it was appropriate to consult with the Forum. The workshop was attended by Forum representatives from WMUH, Hounslow PCT and the local mental health Trust. She said that the workshop had explored a number of scenarios to test when it was and when it was not appropriate to arrange formal consultation. A written protocol was subsequently produced and circulated to the Forum for consideration but the Trust had not received a reply.

JD said that the workshop had not been attended by all of the Forum members and whilst she recognized that the written protocol provided some suggestions it could never replace the legal requirements on consultation set out by Section 11 of the Health & Care Social Act. She said that from the Forum’s perspective they appeared to be continually ‘playing catch up’ and were only finding out about changes after the event. She was concerned that the Forum was not being involved at the planning stage when they could actually contribute something. CG agreed that the protocol could only provide a framework and the Trust needed to work within the Act. However, the Committee agreed that this was something that needed to be resolved quickly. As the Trust had not received a response from the Forum about the draft protocol, JD agreed to raise this matter at the next Forum meeting as a matter of priority.

3.2 Consultation discussion with Overview & Scrutiny Committee The Committee discussed wherever it was appropriate for reports to and from the OSC to be tabled and considered by this Committee. CG noted that some of the more clinical issues (such as Infection Control) which had already been the subject of OSC work were already being considered by other sub-committees and she said that it was important to avoid any duplication. However, it was agreed that issues such staff attitude and behaviour could be considered by this group. SE said that it was important that this was a two-way process

…………

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App . 36 . WMUHT Performance Report , Stephen P iper , 27 th October 2005

Meeting Trust Board

Date 27th

October 2005

Agenda Item 8.1

Author Stephen Piper, Associate Director of Finance and Performance

Exec Lead Simon Marshall, Director of Finance and Performance

Title of Paper Performance Report

Summary This paper updates the Trust Board on the current performance against existing and new national key targets for 2005-06. These will be formally assessed under Healthcheck Standard C19.


The Committee is asked to note the current position.

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Performance Report – Key Targets

INTRODUCTION This paper sets out the current performance of the Trust in relation to existing and new national targets. KEY TARGETS Key targets remain an important element under Standards for Better Health and will be part of the overall Healthcheck assessment. At present, they do not form part of the draft declaration of compliance, which is to be submitted to the Healthcare Commission by the 31

st October. However, for

the formal submission in Spring 2006, these will be taken into account in deciding the overall rating for the Trust. The attached appendix reports the current performance against each key target. The main points are as follows: 1. Cancer

Performance against the 2 week and 31 day target remains as 100% compliant. However, the 62 day target remains as more of a challenge given the issue of timely access to specialist hospital services. The overall assessment reflects this, in that this is jointly measured across the respective organisations. In terms of the sector we are currently joint top in terms of percentage compliance.

2. Cancelled Operations Further validation of the data submitted is required to provide complete assurance of good performance against this target and this is currently being undertaken. On the information we currently have it would suggest that we are in the middle band of performance, raising the issue that we need to remain vigilant in terms of cancelled operations. We need to ensure that performance does not further deteriorate, especially with potentially extra pressures arising from the recent reduction in bed capacity, the onset of Winter and the impact from February of the Ashford emergency services reconfiguration.

…………

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App . 37 . WMUHT F inancia l Update Report , S imon Marsha l l , 27 th October 2005

Meeting Trust Board


Agenda Item 9.1

TITLE Financial Update Report

Exec Lead / Author

Simon Marshall, Director of Finance & Performance

Summary This paper sets out full details of the Trust’s latest financial position, progress against our recovery plan, SLA activity, efficiency indicators and our key financial risks.

Revenue

There is a requirement for the Trust to repay £3.6m of prior year support in the current financial year. Although the Trust continues to work on identifying this through the ten high impact changes, the challenges facing the Trust focus on clinical practice and cannot be immediately resolved. The unidentified actions and slippage within the Trust’s savings plans currently total £3.1m.

At the end of September, the Trust is reporting an in year overspend of £734k, (excluding the above £3.6m debt contribution), with a risk that without further action this will escalate to £2m. Further actions have been identified to reverse this, but we remain unable to demonstrate a significant contribution towards the expected deficit repayments. The Trust is therefore likely to breech the revenue control total by at least £3.4m.

Capital

The proposed CRL for the Trust in 05/06 is £3,016k. We are required to undershoot this by £834k to reverse the 2004/05 CRL overshoot associated with the Northside land sale adjustments.

Cash

We are still in discussions with the Strategic Health Authority over our cash position, where to live within the required cash limits and achieve the better payments requirements we are likely to have to run out our creditors from their current position by c£9m. This is not deliverable, as it would involve deferring payments on a wide range of SLA agreements and our PFI contract. The Trust therefore requires significant brokerage to avoid a major breach of our EFL. This has been requested and to date £4m of in year brokerage has been received but any brokerage remains subject to the

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sectors wider cash difficulties.

Action required The Board is asked to note this report.

…………

Emergency Care The position on the month has improved on the month, despite continuing overspends in a

number of budgets. The main variances are as follows:

• Escalation costs were £30k for September. Escalation has been used predominantly for surgical admissions. There has been an increase in admissions which is being investigated.

• The A&E overspending on the month was £17k on nursing and £27k on medical budgets, which is consistent with the pattern in previous months. Overspending on pay is reducing and will further reduce with the removal of three posts – 2 nursing and 1 A&C. On the medical side, a review of rotas is being undertaken, and will be completed by mid November. At the same time a proposal to ‘turn away primary care related attendees is being worked through.

• Osterley, Crane and Lampton wards are all showing under spends on their pay budgets totalling £14k for September.

• There was a one-off benefit in the month as a previous year’s accrual for £20k was written off.

…………

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App . 38 . WMUHT F inance Subcommittee M inutes , Andrew Daws , 27 th October 2005

Meeting Trust Board

Date 27th

October 2005

Agenda Item 9.2

TITLE Finance sub committee minutes

Exec Lead / Author

Andrew Daws

Summary The finance sub-committee met on the 29th September to discuss the month 5 financial position. Minutes from this meeting are attached. A verbal update on any significant issues arising from the meeting on the 20th October to discuss the month 6 figures will be given at the Board meeting.

Action required

The Board is asked to note the attached minutes.

Finance Sub-Committee Meeting 29

th September 2005

Present: Stephen Clark (SC)) Chair Sue Ellen (SE)

Gail Wannell (GW) Alison McIntosh (AM)

Simon Marshall (SM) Shan Jones (SJ)

In Attendance: Stephen Piper (SP)

Satvinder Matharu (SSM)

…………

Item No.

Title Minutes

Action by

4.

2005/06 Financial Position – Month 5

…………

Recovery Plans

SE said that the report on the position to date was helpful but that she is not comfortable with the delivery of targets. GW confirmed that the Trust will deliver on bed reductions from October and will slow down expenditure on training, development and other non-pay areas. SE advocated being robust with the PCT on work that is being done but not being paid for. Action: SM to produce plan which details measures to be taken to claw back potential overspend of £1.5m.

SM

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App . 39. WMUHT Nurs ing Acu ity & Dependency, Yvonne Franks , 27 th October 2005

Meeting TRUST BOARD


Agenda Item 10.1

Author/Exec Lead Yvonne Franks, Director of Nursing & Midwifery

Title of Paper Nursing Acuity & Dependency

Summary This report provides the most comprehensive review of nurse staffing undertaken at West Middlesex University Hospital. This diagnostic has been welcomed by senior nurses who consider the findings to corroborate professional judgement in respect of the complexity and heaviness of current workload and doubts about the appropriateness of nursing establishments.

This initial diagnostic phase of the project to benchmark two very different ward areas has provided valuable data. These indicators are invaluable to future efficient management of staff and therefore serve to ensure the deployment of staff is optimum for patient need but also vital for financial control and understanding. The introduction of the nurse pooling initiative (currently under development) would provide the flexible workforce which could be deployed to meet demand.

Nursing hours may be calculated in various ways, many of which do not accommodate the variables of individual patient need and complexity. Likewise, the number of nursing hours available is not the only critical determinant in the pursuit of the delivery of quality and safe nursing care. Skill mix and leadership, workload and the environment in which care is delivered are as important.


To note the report and support the continued programme for nurse rostering and associated systems

Patient Dependency, Nursing Workload, Nursing Activity, Care Quality and

Establishments Benchmarked Against UK Best Practice Wards

…………

4.0 Benchmarking results – Syon & Crane Wards 4.1 The draft report (Appendix 1.) was received from Leeds University on 12th October 2005

and is currently being distributed and discussed with ward staff and nurse managers.

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4.2 The data from the two wards is compared with average scores from ‘best practice wards’ throughout the UK.

4.3 Patient numbers and dependency – the greater proportion of medium dependency

patients on Syon ward supports the evidence of nurses over the past year who have highlighted the significant number of rehabilitation category patients on the ward. This also supports the already identified need for the Rehab ward development.

4.4 Crane Ward had proportionally more high dependency patients than other wards of this

type. Other nursing indicators used to highlight nursing need, including the Bartel scoring system, also support this finding.

4.5 Nursing workload - calculated from the amount of direct (face-to-face) nursing care each

patient receives and the number and mix of inpatients. Syon had a higher ward workload as a result of the high number of medium dependency patients.

4.6 Crane’s ward workload was significantly higher than UK comparisons due to the higher

proportion of highly dependent patients. 4.7 Nursing Activity – the data from the observation of nursing activities provides useful

information from which priorities for action may be identified. 4.8 Whilst it is pleasing that our nurses in both wards are ‘extraordinarily patient centred’, it

appears that important indirect care activities like communication and reporting are not given adequate time. This has potential serious medico-legal consequences with nurses failing to assess, plan and evaluate their care. These core-nursing activities have a direct impact on quality of provision and must not be ignored.

4.9 This indicator supports the results of the national patient survey where communication

with patients scored the Trust in the bottom 20%. Further support of this finding is found in the quality of nursing documentation when scrutinised as a result of investigation or complaint. This work is being addressed through the Essence of Care work.

4.10 Inappropriate working by nurses was assessed to be low, suggesting that housekeeper

and ward clerk roles are helping to deliver non nursing workload as intended in the new nursing structure introduced in 2004.

4.11 That nurses routinely relinquish breaks will be no surprise to ward staff but this warning

must not be ignored in respect of retention, sickness and job satisfaction. Anecdotally it is recognised that front line staff are frequently exhausted by increasing workload demand and as a result of the complexity of the patients.

4.12 The direct patient activities, which predominate in Crane Ward are stated to be the

‘heaviest’ nursing workload. The unusually high amount of time helping patients move around the ward is a feature that could be further investigated on a number of our wards to determine whether more therapists could impact on nursing time. This result supports the establishment changes in New Kew where there is increased therapy involvement.

4.13 Nursing quality – the quality scores for this indicator are derived from 5 categories

including patient assessment, care planning, interventions, evaluations and ward resources.

4.14 Notably, patient assessment and care planning are poor in comparison with UK best

practice wards, however interventional activity is slightly higher than comparators and Crane ward also delivered favourable evaluation of care. This corroborates the previous section, which highlighted the exceptionally high percentage of time spent ‘doing’ to the

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detriment of equally important assessment and planning – e.g. indirect care record keeping activities.

4.15 The author of the report warns ‘This problem is usually a symptom of excessive

workload and grade-mix imbalance as corners are cut. Medico-legally this is dangerous practice since tribunals view unrecorded care negatively.’ Discussion has taken place with Associate Directors of nursing relating to the provision of evidence based standardised care plans.

4.16 Time out – below average scores on both wards will be investigated. This may indicate

low sickness levels, which would be good news. 4.17 Nurse Staffing and Grade mix – the report outlines actual, temporary and

recommended staffing, based on each ward’s dependency mix superimposed onto best practice wards.

4.18 Both wards were assessed to be understaffed, Crane ward more so than Syon, the

establishment of which was enhanced slightly last year in response to concerns about complaints and patient falls. Temporary staffing was minimal on both wards during the study despite the heavy workloads, testimony to the staffing commitment to continue to reduce requests for temporary staffing. This also undoubtedly contributes to the references to staff missing breaks and to the greater emphasis on doing rather than record keeping.

4.19 Crane ward’s understaffing is further compromised by an inappropriate grade mix. The

recommendation to consider the conversion of some support posts to therapy assistants should be explored.

4.20 The data shows that our F & G grade posts represent a higher % of the total

establishment than UK comparators. However the deficit in the middle grades would require those seniors to be predominantly patient centred and therefore forced to relinquish their leadership roles, which would have been recorded in the study under the indirect care category.

4.21 It would appear that despite our success at appointing to all key leadership roles on the

wards, these senior staff are unable to provide the supervision of others, teaching and management elements so essential to raising and maintaining the standards of care on their wards. On most shifts they are ‘doing’ rather than assessing need and evaluating outcomes.

4.22 Recommended staffing costs would require an increase of 19 & 25% respectively. 5. Issues which should not be ignored 5.1 This report provides the most comprehensive review of nurse staffing undertaken at

West Middlesex University Hospital. This diagnostic has been welcomed by senior nurses who consider the findings to corroborate professional judgement in respect of the complexity and heaviness of current workload and doubts about the appropriateness of nursing establishments.

5.2 Professional concerns regarding the standard of record keeping and time to address

fundamental non-direct care activities are heightened and continue to pose a risk of litigation for the Trust.

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5.3 There is concern about the lack of breaks taken by nurses on shift – not only is this a potential patient safety issue with tiredness, particularly with the heavy workload, but in the longer term, retention of staff and ‘burnout’ / sickness absence is high risk.

5.4 Both ward areas have changed in character since the study was performed. Crane has

become New Kew Ward, a mix of Stroke and Rehabilitation. Syon has split orthopaedics from surgery onto each of its wards.

5.5 Crane ward had an actual wte per patient of 0.88. It should be noted that for a ward of

this type, national data recommends 1.19 wte. Although improved, the budgeted establishment currently on New Kew is 1.1 wte per bed. The remaining Crane ward has 0.97 wte.

…………

APPENDIX 1

Strictly Confidential: Draft Report: West Middlesex Hospital Patient Dependency, Nursing Workload, Nursing Activity, Care Quality and Establishments Benchmarked Against UK Best Practice Wards Summary 1. The orthopaedic/surgical Syon 2 ward, compared to best practice wards in the same care

group, had more patients but a greater number were low to medium dependency. The stroke/elderly care Crane ward also housed more patients than its compatriots but proportionally more were high dependency. Crane’s outcomes may reflect the elderly inpatients unable to move into care and residential homes owing to poor local provision.

2. Workloads mimic occupancy and dependency. Syon 2 ward’s acuity, compared to compatriots in the database, was unremarkable. Crane ward, on the other hand, had a workload that was well above average at the time of the study.

3. Compared to nursing activity in best practice wards from the same care groups, the two wards’ nurses were considerably more ‘patient centred’. Consequently, there are fewer undesirable nursing activities. These outcomes, no doubt, are a feature of the housekeeper and ward clerks that work singly or in combination in these wards. Worryingly, on the other hand, staff have little ‘breathing time’, which may be unsustainable.

4. The wards’ quality scores are a curate’s egg. Lower quality scores seem to be grade-mix and workload related. That is, nurses consistently give high quality care but the medico-legal implications surrounding poor record keeping need attention. Not wishing to be alarmist but this situation may be a disaster waiting to happen. Care Systems’ software, on the other hand, may make a significant difference to the poor recording keeping scores, although underlying staffing problems can’t be ignored.

5. Both Syon 2 and Crane ward were understaffed compared to ‘actual staffing’ in comparable wards elsewhere in the UK. Moreover, based on workload at the time of the study, both wards were understaffed. Syon 2’s staff mix is close to the ideal. Crane’s mix, on the other hand, needs careful thought since therapy assistants could have a catalytic effect on nursing activity.

6. Temporary staffing was minimal at the time of the study so converting bank, agency, etc., time into substantive would have a negligible effect.

7. Recommended staffing adjustments, therefore, raise the wards’ nursing costs between 19% and 25%.

…………

Keith Hurst, Leeds University 0113 343 6985, [email protected] Oct 05

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101

App . 40 . Extract from WMUHT Service Improvement Journey – Progress Report , 27 th Oct . 2005

Meeting Trust Board

Date Thursday October 27th

Agenda Item 10.4 Service Improvement

Author/Exec Lead Peter Gill

Amanda Fegan

Patricia Davies

Jacqui Hardy

Cathy Hill

Bennie Tilbury

Title of Paper Service Improvement Journey-Progress Report

Summary Progress in the last 6 months


To note

SERVICE IMPROVEMENT JOURNEY PrOGRESS REPORT

1. INTRODUCTION 3

2. PROGRESS IN FIRST 12 MONTHS (APRIL-MARCH 2004/5) 3

2.1 Initial Diagnostic 3

2.2 Key Achievements during first 12 months (April 04-March 05) 4

3. PROGRESS IN THE NEXT SIX MONTHS (MARCH 05-OCTOBER 05) 7

3.1 Acute Care 7

….i) Diagnostic 7

….ii) Building on the improvement work started in the previous 12 months 9

….iii) Reducing LOS in 'top 5' HRGs 15

….iv) Reducing LOS for 'complex' patients -Lead Patricia Davies/Ranjit Kooner 21

….v) Day case conversion -Lead Bennie Tilbury 21

….vi) Structure to Support Improvement 23

….vii) Summary of Progress to date in Acute Care 24

….viii) Bed Base Reductions 24

….ix) Theatres Utilisation -Lead Janet Henry Clinical Lead Janet Baldwin 26

3.2 Ambulatory care 28

….i) Diagnostic 28

4. LEARNING IMPROVEMENT TOOLS AND TECHNIQUES 32

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102

5. SUMMARY 33

…………

By reducing Length of Stay and improving the flow of emergency patients through beds along with indefatigable efforts of front line staff within A&E examining and re-examining their processes, the 98% A&E performance to the 4 hour target is now being achieved consistently.

…………

PROGRESS IN THE NEXT SIX MONTHS (MArch 05-OCTOBER 05)

Significant success has been achieved in the first 12 months of the improvement journey. However, much still remained to be improved within our organisational processes to achieve the necessary improvements to ensure WMUH delivers an efficient, safe healthcare service to the local population. The challenge in this next phase was not only to consolidate and sustain the improvements already achieved, but, to build on them. The improvement work focused on two main areas, Acute and Ambulatory care.

…………

i) Bed Base Reductions

In line with the further reductions in emergency LOS described in section 3.1, the trust plans to remove a further 30 beds in October 2005 to save another £1.2M (full year effect).

Figure 23 - Bed base reduction in 2004/5

…………

102

103

App . 41. Rep ly from Al ison Mc Intosh re Hea lth Impact Assessment , 4 th Nov. 2005

Subject: Information requests Date: Fri, 4 Nov 2005 17:34:43 -0000 From: "Alison McIntosh" <[email protected]> To: <[email protected]>, <[email protected]>, <[email protected]>, <[email protected]>, <[email protected]>, <[email protected]>, <[email protected]>, <[email protected]>, <[email protected]>, <[email protected]> Cc: "Yvonne Franks" <[email protected]>, "Joe Johnson" <[email protected]>, "Amanda Fegan" <[email protected]>, "Andrew Caunce" <[email protected]>, "Annette Funai" <[email protected]>, "Bennie Tilbury" <[email protected]>, "Cathy Hill" <[email protected]>, "Jacqueline Hardy" <[email protected]>, "Patricia Davies" <[email protected]>, "Ranjit Kooner" <[email protected]>

Dear colleague Yvonne has passed to me some outstanding information requests from you: 1. Bed Model impact assessment. The bed model impact assessment that we referred to is infact what we do on a daily basis. (We have not closed the ward yet as you already know. ) We assess the impact of any operational issues including any bed closures for whatever reasons on a daily basis. I meet with the operational team where we assess the activity in the hospital, review our elective programme for the forthcoming days, check what the bed situation is like, what our staffing is like in all clinical areas and where we have particular delays in patients discharge. We make decisions based on this information. On a weekly basis we review the waiting list position and our cancellations to make sure that we are rescheduling cancelled patients and keeping to our waiting time targets. I have already sent you ( 10/10 by email with attachments) a detailed report for last month on our SITREP return and waiting lists ( including removals from the list)and asked for your comments on this. I will await these before sending you anything further. I will send you our cancellation graph under a separate email for October. Waiting list I sent you a profile of additions and removals from the list yesterday. You have not advised me if you wish the other detail I provided you with on 10/10. Please let me know if you want this.. Cancelled ops. I have covered above. Escalation ward We monitor all bed usage in the hospital on a hour by hour basis. As you will appreciate this is a moving feast. This morning we reported "We currently have 18 patients in the Escalation area (12 medical & 6 surgical)" . Tonight I am leaving the hospital with up to 20 empty beds. If the weekend is stable we should be able to start to reduce the number of patients in our escalation ward. If the forum would find it useful, I can give you a weekly update on admissions and discharges including escalation usage. I will instruct a bed manager to pull this together on Monday for the past week and get this to you before your meeting on Tuesday. Best wishes and have a good weekend. Alison Alison McIntosh Director of Acute Care Direct Line: 0208 321 6802 Mobile: 07990521283

103

104

App . 42. Invitat ion from Al ison Mc Intosh re Cessat ion of GP service in A&E, 4 th Nov. 2005

West Middlesex University Hospital NHS Trust

Primary care clients attending Accident and Emergency

Introduction For the past year up until July 2005, the PCT has funded (with a small

contribution from WMUH) a GP service in A&E, to see approximately 70% of patients attending A&E who have primary care needs. While this contributed

to reducing waiting times for patients in A&E, it was considered very expensive with the GP’s seeing a relatively small number of patients. Earlier this year, therefore, a decision was made by the PCT to cease this scheme.

There is a need to replace the scheme with something more effective to ensure

that we continued to meet our target of seeing , treating, discharging or admitting patients who attend A&E within 4 hours and manage the increasing number of patients who are attending A&E within the resources available to us.

A considerable proportion of people attending A&E do not need to be seen

immediately and could be sent back to their GP for treatment or advice or to the Walk in Centres within the community. We anticipate that 30% of all new attendances (patients) are Primary care in nature. However, simply sending

people away from A&E would not be accepted or acceptable.

So how can we try to reduce the number of patients who attend A&E and who do not need immediate or emergency treatment? We can;

o Try to dissuade the public from using A&E as a primary care facility before

they get there

o redirect them to more appropriate healthcare services when they do o a combination of both.

The national policy on Urgent Care is driving the development of urgent care centres and we are starting to look at possibilities within Hounslow. However,

this will take time and will not address our immediate requirements.

Evidence has shown that simply trying to educate the public about the right treatment, right place etc has had no effect on the numbers of patients attending A&E departments. It is still important that we provide this education, however we

think that more has to be done to change behaviour.

One suggestion that we have discussed with the PCT is to employ a senior A&E nurse to triage all patients arriving at A&E and a PALS officer to advise and guide patients to the appropriate place e.g. GP appointment, pharmacy etc.

Such a system could work where after triage, patients could be passed on to four

possible routes;

� A&E majors

� A&E minors (e.g. fractures)

104

105

� Primary care – problem that should be seen that day � back to A&E

minors after education and help from PALS � Primary care - problem that can wait until following day � to PALS for

sending home with advice, pharmacy, help and a GP appointment if appropriate

The PALS officer role would be to see the patients referred to primary care

and could

� Confirm that the patient is registered with a GP

� If they are not, advise them how to register with a GP and help them

make an appointment to do so

� Provide the patient with information about self care and use of NHS facilities

� Help them make an appointment to see a primary care professional within 24 hours at their practice/out of hours service

Clearly this would be quite a radical change, which could meet with resistance from patients and GP’s. The PCT PEC has discussed the concept and is supportive

of an approach such as this. There are a number of issues to be addressed;

• The legality of such an approach. We have checked with the DoH and it

would appear there are no legal barriers to such an approach.

• A major communications exercise would be required for the public and

GP’s.

• There will be a cost associated with developing such an approach. However at present we are seeing an ever increasing number of patients

through A&E who have primary care needs. This is stretching resources to the extreme.

Proposal

We would like to run with a project such as that described above as soon as possible. We would establish a project group with representation from Primary care and the Patients Forum.

The Patient Forum is asked to consider this proposal and respond to

Alison McIntosh by 14 November 2005. We welcome comment on the suggested approach above or alternatives which will help us address the problem.

Alison McIntosh Director of Acute Care 4 November 2005

105

106

App . 43 . Rep ly to Al ison Mc Intosh re Cessat ion of GP service in A&E, 14 th Nov. 2005

Dear Alison, At 12:40 2005.11.04, you wrote:

The Patient Forum is asked to consider this proposal and respond to Alison McIntosh by 14

November 2005. We welcome comment on the suggested approach above or alternatives

which will help us address the problem. Following consultation with PPIF members, Jean and I would like to meet you to find out in more detail what your proposal entails. We suggest any time after 4:00, either Thursday, 24th Nov., or Friday, 25th. Our questions include the following. -- 1) How long has the GP service been running?

2) How many patients does it see?

3) What "inappropriate referrals" do you get (numbers and categories)?

4) What public education has been performed?

5) How will PALS staffing be increased to support the proposal?

6) What type of criteria will be used for referral?

7) What safeguards will ensure that referrals are appropriate?

8) How will success (clinical and financial) be monitored?

Best wishes, John H.

106

107

App . 44. Excerpt from Papers for Pat ient Exper ience Committee , 8 th Dec . 2005, Scanned

107

- 1 -

23rd February 2006 CHIEF EXECUTIVE’S OFFICE

020 8321 5604

020 8321 5562

E MAIL [email protected]

Councillor Felicity Barwoood Chair Adult Health & Social Care Committee London Borough of Hounslow Civic Centre, Lampton Road, Hounslow, Middlesex, TW3 4DN

Dear Councillor Barwood

Re: Referral to Hounslow Adult Health & Scrutiny Committee of the West Middlesex University Hospital Trust (WMUH) by the Patient & Public Involvement Forum (PPIF)

Thank you for giving the Trust the opportunity to respond to the referral the OSC received from the WMUH PPI Forum.

I am conscious that the referral document is a very detailed paper with several appendices. For the sake of clarity and ease of reference, I thought it might be helpful to start by outlining how our reply to this referral has been structured. Our response is detailed in three separate documents.

• This covering letter which sets out the Trust’s general comments on the referral; • A tabular response (with embedded attachments) which addresses each of the PPIF

concerns which relate specifically to alleged non-consultation; and • A tabular response (also with embedded attachments) which addresses each of the

PPIF concerns about poor data quality and delays in supplying information.

Please note that in some instances, where the issues raised by the PPIF are effectively duplicated in different parts of their written submission, we have grouped our responses under a single heading.

You will see from their referral that the PPI Forum has quoted from a number of documents. In some instances, the Trust considers that these quotes are selective, do not provide the full picture and offer a distorted view of events. In our response, we have therefore consciously reproduced several of the quoted documents in full, so that OSC members can better understand the context of the information provided.

108

2

I note too, that some of the points raised by the Forum are not about failures in consultation but instead pass comment on the operational management of the hospital. I have not commented on these but would be happy to do so, if the OSC felt that that was appropriate. Additionally, one of the issues raised actually falls outside the Trust’s jurisdiction and appears to be the responsibility of Hounslow PCT. Again, I have not commented on that point.

I hope you find this comprehensive response informative and I would be happy to supply any further information and to discuss how we take this forward, prior to the public meeting in March. PPIF complaints about alleged non-consultation

I was personally very disappointed and saddened to read that the PPI Forum considers that the Trust has persistently refused to consult with them in accordance with the statutory requirement under Section 11 of the Health & Social Care Act (2001). I do not believe that to be the case and I feel that our response to this referral clearly demonstrates our commitment to developing a mature relationship with the Forum in which consultation is an integral part. You will see from the attached papers that the Trust has actively engaged with the Forum over the last 18 months with a view to establishing a better understanding of how our statutory obligations should be implemented locally. In addition, we have consciously tried to develop a better working relationship with the Forum and generally improve the flow of information. This is demonstrated by the regular information updates that Yvonne Franks, our Director of Nursing & Midwifery provides at PPI Forum meetings. During the period in question the Trust has invited the Forum members to sit on several of our local committees including our Governance Committee, Patient Experience Committee, Patient Environment Action Group (PEAT) and various other hospital groups and committees. It is my strong belief that this approach demonstrates a genuine desire on the part of the Trust to develop a partnership from the inception of the PPI Forum. The Trust enjoyed an effective working relationship with the former Forum Chair, Cherna Crome. Since her resignation in the summer of 2005, we have found that our relationship with the Forum has become increasingly strained and difficult. At the PPI Forum meeting held in Council Chambers in January 2005, I gave a personal promise that the Trust would work with the Forum to develop a joint written protocol to help improve the local consultation process. I made this commitment as a direct response to earlier complaints from the Forum about alleged non-consultation. I kept my word and a successful multi-agency workshop was hosted by the Trust in February 2005. The aim of this event was to help facilitate the production of a jointly agreed protocol. Following the workshop, a draft protocol was circulated to the PPI Forum in March 2005 for their comment. The subsequent sequence of events is outlined in our response. It is interesting to note that subsequent to our attempts to gain a greater understanding of our respective responsibilities, a North West London SHA wide protocol has been developed which mirrors the outputs from our workshop in February 2005.

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3

Given that one of the central issues raised by PPIF in this referral relates to alleged non-consultation, I find it quite astonishing that their submission includes absolutely no mention of the joint workshop. PPI forum members attended this event and contributed to the positive outcomes, which unfortunately were later overruled and never adopted. I would ask the OSC as part of their consideration of this referral, to give careful consideration to the evidence and attachments relating to the February 2005 joint workshop, which are presented by the Trust in pages 2-4 of our attached response.

Whilst I categorically reject the allegation that the Trust has persistently or deliberately refused to consult with the PPI Forum, I recognise that the Trust has not always presented information to the Forum in the form of an overt invitation to help us determine options or as an opportunity to influence the final outcome. You will see from our response that there are several examples where the PPI Forum’s input was sought when our plans were still at the proposal stage. I acknowledge, however, that in some instances we have informed the PPI Forum of preferred options or decisions already taken, but often only as a temporary reaction to operational events.

Our fundamental problem appears to be a difference in the interpretation of what reasonably constitutes the need for consultation, as opposed to communication or information on what is happening in the hospital. I still strongly believe that there is a fundamental need to develop a jointly agreed local protocol. That protocol should set out clearly the obligations of when and how all the respective parties are to be involved in the local consultation process. Simply referring to Section 11 of the Act is not in my view a satisfactory answer to this complex issue and I feel that the lack of a locally agreed approach with PPI Forum is a weakness in our current system that has ultimately resulted in a breakdown of our relationship and has contributed to this referral. I believe that this should be remedied urgently. The offer that I made in January 2005 still stands and the Trust would welcome the opportunity to work in partnership with both the PPIF and the OSC to take this piece of work forward again and develop a long-term solution.

You will see from the attachments that the tone and content of some of our communication exchanges with the PPI Forum have not been easy. Indeed some of the PPI Forum members have apologised privately to the Trust about the behaviour and actions of some of their Forum colleagues towards Trust staff. PPI Forum members have also spoken to us privately about division within their own membership. The Forum's own national handbook suggests that they should act as the Trust's Independent Critical Friend. The Trust would welcome that kind of approach. I am sad to report, however, that our working relationship with the Forum has taken the definition of ‘critical friend’ to mean an adversarial relationship.

Despite the difficulties with the relationship and to help improve our Trust staff awareness of the PPI Forum and their role, we have arranged for Trust staff to attend PPIF public meetings to provide information about specific topics such as Stroke, Cancer, Accident & Emergency and the role of the Modern Matron. We have also invited the Forum to have their own information stall at the public events held in the hospital’s main Atrium. In addition, we have been developing a local guide for staff which explains the role of the PPI Forum and need for consultation.

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4

Despite these efforts to engage and develop an effective working relationship, we find ourselves no further forward than we were in February 2005, particularly with regard to a locally agreed approach on the consultation process.

PPI Forum complaints about poor data quality and delays in supplying information. During the last 18 months the Trust has received numerous requests for information. The PPI Forum is not the only organisation seeking data from the Trust. In some instances we do not routinely collect or hold the requested information. That has sometimes contributed to the delay in meeting these requests. Where information is routinely available in the format requested, we supply this promptly.

I accept that the information we have provided in the past has not always been readily accessible to some individual Forum members, because of the different IT formats used. I recognise that this has contributed to their perception of poor data quality. The Trust uses commonly available software and we would hope that the Forum support services to assist them to access the data provided.

I am pleased to report that since writing to the OSC, the PPI Forum has met with Trust staff and we have agreed to improve the management of data. The PPI Forum has chosen a data set which meets their needs and this information will routinely be sent to them in order that they may monitor performance on the agreed list. To help improve the management of requests for information we have also implemented an internal database for recording requests from all stakeholders. This methodology will allow better monitoring of our response times which we will be able to share with the PPI Forum and the OSC.

In conclusion, the Trust would like to work in partnership with the OSC and the PPI Forum to develop an agreed and constructive outcome to this referral. As I mentioned earlier in this letter, I feel that the lack of a locally agreed protocol on consultation is one of the fundamental flaws in our local arrangements. The Trust remains willing and ready to revisit this issue and to work with the OSC and the PPI Forum to develop such a protocol. We believe, in light of our experiences, this will only succeed if the approach and attitude of some members of the Forum changes. I know that the North West London Strategic Health Authority has recently circulated some good practice that has been developed by other PPIFs and their respective Acute Hospitals. That might be a good starting point when we come to discuss this issue.

Once again, I hope that the information in this covering letter and the attached documents are helpful to the OSC in considering this referral.

Kind regards

Yours sincerely

Gail Wannell Chief Executive

111

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112

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ls a

nd th

eref

ore

the

stan

dard

s of

fund

amen

tal c

are

on th

e w

ard

wer

e be

ing

clos

ely

mon

itore

d fro

m A

pril

of th

at y

ear a

nd ro

bust

edu

catio

n an

d tra

inin

g pr

ogra

mm

es fo

r sta

ff w

ere

unde

rway

. The

num

ber o

f nu

rsin

g va

canc

ies

on th

is w

ard

rose

sig

nific

antly

in s

ubse

quen

t mon

ths,

lead

ing

to th

e re

mov

al o

f stu

dent

nur

ses

from

the

area

due

to la

ck o

f app

ropr

iate

men

tors

hip.

In a

dditi

on, t

he n

umbe

r of c

ompl

aint

s &

PA

LS e

nqui

ries

incr

ease

d an

d th

eref

ore

Yvo

nne

Fran

ks, D

irect

or o

f Nur

sing

& M

idw

ifery

, mad

e th

e re

com

men

datio

n th

at p

atie

nt

care

was

pot

entia

lly b

eing

com

prom

ised

. Ja

cqui

Har

dy, A

ssoc

iate

Dire

ctor

of N

ursi

ng, A

lison

McI

ntos

h, D

irect

or o

f Em

erge

ncy

Car

e at

this

tim

e an

d Jo

e Jo

hnso

n, P

PI m

anag

er m

et C

hern

a C

rom

e an

d an

othe

r for

um m

embe

r as

desc

ribed

in th

e re

ferr

al re

port

to

upda

te o

n th

e ci

rcum

stan

ces.

W

e w

ere

awar

e of

the

OS

C d

iscu

ssio

ns b

ut w

e w

ere

not a

ppro

ache

d fo

r fur

ther

info

rmat

ion

at th

is ti

me.

W

e re

fute

the

com

men

t tha

t no

furth

er a

ctio

n w

as ta

ken.

Thi

s ep

isod

e ac

ted

as a

cat

alys

t for

the

Trus

t to

inst

igat

e fu

rther

deb

ate

with

the

obje

ctiv

e of

reac

hing

a jo

int u

nder

stan

ding

of t

he d

efin

ition

of c

onsu

ltatio

n to

sat

isfy

our

re

spec

tive

stat

utor

y re

spon

sibi

litie

s.

This

issu

e w

as d

iscu

ssed

at t

he P

PIF

mee

ting

that

was

hel

d on

13th

Jan

uary

200

5 in

the

Cou

ncil

Cha

mbe

rs.

Som

e of

the

PP

IF m

embe

rs m

ade

repr

esen

tatio

ns th

at th

e Tr

ust h

ad n

ot c

onsu

lted

with

them

rela

ting

to th

e re

cent

cha

nges

. At t

he s

ame

mee

ting,

Pau

l Con

rath

(a s

olic

itor)

gav

e a

talk

on

Sec

tion

11 o

f the

Hea

lth &

Soc

ial

Car

e A

ct a

nd th

e du

ty to

con

sult.

Dur

ing

the

disc

ussi

on th

at fo

llow

ed, i

t was

agr

eed

by a

ll pr

esen

t tha

t the

re w

as

a ne

ed to

dev

elop

a c

lear

writ

ten

prot

ocol

.

To

take

this

forw

ard

the

Trus

t offe

red

to o

rgan

ize

and

host

a w

orks

hop

invi

ting

the

mem

bers

of t

he lo

cal P

CT,

M

enta

l Hea

lth T

rust

and

the

WM

UH

For

ums.

Bob

Har

dy-K

ing

from

the

Foru

m S

uppo

rt te

am o

ffere

d to

sup

ply

cons

ulta

tion

prot

ocol

s fro

m o

ther

Tru

sts

to a

id th

e de

bate

and

circ

ulat

ed tw

o ex

ampl

es (1

B) o

n th

e da

y be

fore

the

mee

ting.

A s

ucce

ssfu

l and

wel

l atte

nded

wor

ksho

p w

as h

eld

on 2

5th F

ebru

ary

and

the

min

utes

and

out

com

es a

re

Atta

chm

ents

1A

– P

PI m

eetin

g m

ins

PPIF

ia

l+m

eetin

g 13

.1.0

5 1B

- S

peci

men

pro

toco

ls

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orks

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113

Issu

e nu

mbe

rs a

nd n

umer

ical

app

endi

ces r

efer

to th

ose

in th

e PP

IF d

ocum

ent

App

endi

ces u

sed

in th

e Tr

ust r

espo

nse

sect

ion

use

the

PPIF

issu

e nu

mbe

r fol

low

ed b

y a

lette

r e.g

. 1A

, 5B

3

atta

ched

. (1C

) Jo

hn H

unt e

mai

led

the

Trus

t (1D

) ask

ing

for t

he w

orks

hop

to b

e re

sche

dule

d, d

espi

te th

e da

te c

hose

n be

ing

one

sugg

este

d by

the

foru

m c

hair

(1E)

afte

r con

sulta

tion

with

mem

bers

. He

com

plai

ned

also

that

spe

cim

en p

roto

cols

fro

m o

ther

Tru

sts

had

not b

een

sent

(a ta

sk th

at w

as o

ffere

d by

the

foru

m s

uppo

rt te

am a

nd n

ot th

e Tr

ust)

and

also

that

the

cont

ent o

f the

wor

ksho

p di

d no

t mee

t his

exp

ecta

tions

. The

follo

win

g ex

tract

from

his

em

ail c

lear

ly

dem

onst

rate

s hi

s ne

gativ

e pr

edis

posi

tion

prio

r to

the

wor

ksho

p. T

he re

fere

nce

to n

on-c

onsu

ltatio

n re

gard

ing

the

wor

ksho

p ag

enda

is fl

awed

giv

en th

e pr

ogra

mm

e w

as p

lann

ed w

ith b

oth

Che

rna

Cro

me

and

Bob

Har

dy-K

ing.

‘

I hav

e al

so d

iscu

ssed

the

Prov

isio

nal A

gend

a

with

For

um c

olle

ague

s Fr

anci

s B

row

n an

d Je

an D

oher

ty.

(C

hern

a C

rom

e is

not

ava

ilabl

e th

is e

veni

ng,

and

I sh

all b

e un

obta

inab

le a

ll da

y Th

ursd

ay.)

We

are

all i

ncen

sed

that

the

"exp

erie

nce"

has

inex

plic

ably

bee

n re

duce

d

(

with

out c

onsu

ltatio

n w

ith P

PIF

mem

bers

)

t

o a

set o

f pon

cy p

rese

ntat

ions

follo

wed

by

lunc

h,

ins

tead

of t

he d

iscu

ssio

n fo

rmat

agr

eed

at th

e m

eetin

g on

22n

d D

ec.

Thi

s is

NO

T w

hat w

e ex

pect

ed.

We

do N

OT

belie

ve th

at it

will

add

any

val

ue’.

(1D

) H

owev

er 4

oth

er fo

rum

mem

bers

, inc

ludi

ng th

e ch

air,

two

repr

esen

tativ

es fr

om th

e P

CT

foru

m a

nd o

ne fr

om th

e m

enta

l hea

lth tr

ust f

orum

wer

e at

tend

ing

and

Che

rna

Cro

me

was

hap

py to

pro

ceed

. The

em

ail e

xcha

nge

from

Jo

hn H

unt i

s at

tach

ed –

(1F)

Th

e ou

tput

s fro

m th

e w

orks

hop

wer

e dr

awn

toge

ther

by

the

faci

litat

or o

f the

eve

nt A

ndre

w B

utch

er a

nd s

ent t

o th

e fo

rum

cha

ir an

d th

ose

who

cou

ld n

ot a

ttend

on

4th M

arch

. (1

C) T

he F

orum

was

ask

ed fo

r the

ir co

mm

ent o

n th

e dr

aft p

roto

col b

y 25

th M

arch

. Th

e Tr

ust r

ecei

ved

lette

rs o

f tha

nks

from

Joh

n M

urph

y, (1

G) H

ouns

low

PC

T P

PIF

and

the

repr

esen

tativ

e fro

m th

e M

enta

l Hea

lth T

rust

. D

espi

te re

ques

ts to

resp

ond

in A

pril

and

June

200

5 at

priv

ate

PP

IF /

WM

UH

mee

tings

(see

atta

ched

bul

letin

s 1H

&

1I)

no c

omm

ents

wer

e re

ceiv

ed fr

om th

e W

MU

H F

orum

on

the

draf

t Con

sulta

tion

Pro

toco

l.

1E -

Wor

ksho

p or

gani

satio

n w

ith P

PIF

ch

air

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n 06

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unt

H:\

OSC

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Con

sulta

tion

Wor

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ks fr

om P

CT

PP

IF

H:\

OSC

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n M

urph

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anks

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1H

- A

pril

bulle

tin

H:\

YVO

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ENTS

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1I -

June

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letin

H:\

YVO

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114

Issu

e nu

mbe

rs a

nd n

umer

ical

app

endi

ces r

efer

to th

ose

in th

e PP

IF d

ocum

ent

App

endi

ces u

sed

in th

e Tr

ust r

espo

nse

sect

ion

use

the

PPIF

issu

e nu

mbe

r fol

low

ed b

y a

lette

r e.g

. 1A

, 5B

4

On

22nd

Jun

e 20

05 G

ail W

anne

ll an

d Y

vonn

e Fr

anks

atte

nded

the

Thre

e B

orou

ghs

Eve

nt in

Ham

mer

smith

whe

re

they

gav

e fu

rther

com

mitm

ent t

o be

tter u

nder

stan

ding

this

issu

e an

d im

prov

ing

our p

erfo

rman

ce in

this

are

a.

In a

nsw

er to

Issu

e 13

: Mon

ths

late

r, on

18th

Jul

y, th

e Tr

ust r

ecei

ved

an e

mai

l fro

m th

e W

MU

H F

orum

whi

ch is

at

tach

ed (1

J). T

hey

faile

d to

com

men

t on

the

draf

t con

sulta

tion

prot

ocol

that

had

bee

n de

velo

ped

in p

artn

ersh

ip

at th

e Fe

brua

ry W

orks

hop

and

had

draw

n up

a n

ew d

ocum

ent.

This

doc

umen

t sta

ted

the

term

s on

whi

ch th

ey

had

agre

ed to

wor

k w

ith th

e Tr

ust.

It re

itera

ted

Sec

tion

11 o

f the

Act

but

faile

d to

offe

r fur

ther

und

erst

andi

ng o

r gu

idan

ce o

n in

terp

reta

tion

of th

e le

gisl

atio

n w

hich

has

bee

n th

e ke

y ob

ject

ive

of d

evel

opin

g a

join

t pro

toco

l on

the

cons

ulta

tion

proc

ess.

In s

umm

ary

ther

efor

e th

is p

aper

was

not

dev

elop

ed in

par

tner

ship

. The

Tru

st w

as n

ot

aske

d ab

out o

ur v

iew

s an

d th

e co

nten

t – it

cle

arly

sta

tes

in th

e fir

st li

ne; ‘

Ple

ase

find

belo

w th

e te

rms

on w

hich

th

e P

PI F

orum

hav

e ag

reed

to w

ork

with

the

Trus

t’.

At a

mee

ting

the

follo

win

g da

y (o

rgan

ised

to u

pdat

e th

e fo

rum

abo

ut th

e la

test

fina

ncia

l situ

atio

n) th

e Tr

ust d

id

inde

ed v

oice

its

disa

ppoi

ntm

ent t

hat a

pro

toco

l had

not

bee

n jo

intly

agr

eed.

It is

reco

rded

in th

e m

inut

es th

at

furth

er d

iscu

ssio

ns b

etw

een

both

par

ties

shou

ld a

ttem

pt to

reac

h ‘c

onse

nsus

at t

he e

arlie

st o

ppor

tuni

ty’.

Fo

llow

ing

the

PP

I for

um m

eetin

g in

Aug

ust 0

5, th

e fo

rum

mad

e no

furth

er a

men

dmen

ts to

thei

r doc

umen

t des

pite

th

e Tr

ust h

ighl

ight

ing

that

the

deba

te h

ad n

ot m

oved

forw

ard.

The

Tru

st w

as in

form

ed o

f thi

s in

a le

tter o

f 3rd

A

ugus

t 200

5. (1

J)

.

1J –

PP

IF re

spon

se to

co

nsul

tatio

n w

orks

hop

outp

uts

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115

Issu

e nu

mbe

rs a

nd n

umer

ical

app

endi

ces r

efer

to th

ose

in th

e PP

IF d

ocum

ent

App

endi

ces u

sed

in th

e Tr

ust r

espo

nse

sect

ion

use

the

PPIF

issu

e nu

mbe

r fol

low

ed b

y a

lette

r e.g

. 1A

, 5B

5

Issu

e 2.

Vet

ting

patie

nt re

ferr

als

Com

men

tary

from

PPI

foru

m

In N

ovem

ber 2

004

the

PC

T's

new

sch

eme

for r

efer

ral o

f pat

ient

s by

GP

s to

the

hosp

ital w

as o

utlin

ed a

t a p

ublic

mee

ting

of th

e Fo

rum

by

Cat

h A

ttlee

from

Hou

nslo

w P

CT,

who

sta

ted

that

this

cha

nge

was

bei

ng in

trodu

ced

with

out c

onsu

lting

pat

ient

s, a

s it

alle

gedl

y di

d no

t affe

ct th

e se

rvic

e pa

tient

s re

ceiv

ed. [

App

. 6]

Trus

t res

pons

e Th

is is

sue

was

rais

ed b

y a

mem

ber o

f the

pub

lic a

t a p

ublic

WM

UH

PP

I mee

ting

durin

g th

e op

en fo

rum

dis

cuss

ion.

Cat

h A

tlee

from

the

PC

T w

as a

mem

ber o

f the

aud

ienc

e on

this

occ

asio

n an

d th

eref

ore

was

abl

e to

ans

wer

this

que

stio

n.

This

issu

e is

an

oper

atio

nal c

hang

e in

stig

ated

and

man

aged

by

the

PC

T an

d th

eref

ore

it is

unc

lear

why

this

is b

eing

pre

sent

ed a

s an

exa

mpl

e of

non

-con

sulta

tion

by W

MU

H T

rust

.

116

Issu

e nu

mbe

rs a

nd n

umer

ical

app

endi

ces r

efer

to th

ose

in th

e PP

IF d

ocum

ent

App

endi

ces u

sed

in th

e Tr

ust r

espo

nse

sect

ion

use

the

PPIF

issu

e nu

mbe

r fol

low

ed b

y a

lette

r e.g

. 1A

, 5B

6

Issu

e 3.

Red

uctio

n in

sur

gery

& c

losu

re o

f car

diac

dro

p-in

faci

lity

Com

men

tary

from

PPI

foru

m

On

8th

Dec

embe

r 200

4 th

e Tr

ust w

rote

to th

e P

PIF

, ann

ounc

ing

that

the

hosp

ital h

ad "a

lread

y st

arte

d to

redu

ce e

lect

ive

surg

ical

wor

k", h

ad

ceas

ed th

e "o

pen-

acce

ss d

rop-

in fa

cilit

y" fo

r car

diac

pat

ient

s, a

nd h

ad "i

mpl

emen

ted

thes

e ch

ange

s th

is w

eek"

. [A

pp. 7

] Tr

ust r

espo

nse

The

Trus

t bel

ieve

s th

at th

is is

sue

is a

goo

d ex

ampl

e of

our

sta

ff en

gagi

ng w

ith th

e fo

rum

bef

ore

a pr

opos

ed c

hang

e is

intro

duce

d.

The

extra

cts

used

her

e fo

rm p

art o

f a le

tter o

utlin

ing

plan

ned

oper

atio

nal c

hang

es fi

rst d

iscu

ssed

on

1st D

ecem

ber 2

004

with

the

PP

IF c

hair.

Th

e le

tter d

ated

8th D

ecem

ber a

nd s

ent e

lect

roni

cally

to a

ll fo

rum

mem

bers

, pro

vide

s fu

rther

det

ail o

f pro

posa

ls o

n 3

issu

es in

ord

er th

at it

cou

ld

info

rm d

iscu

ssio

n at

the

plan

ned

PP

IF m

eetin

g on

14th

Dec

embe

r 200

4 . M

rs M

cInt

osh

offe

red

to a

ttend

that

mee

ting.

The

lette

r con

clud

es ‘

I ho

pe I

have

pro

vide

d yo

u w

ith s

uffic

ient

info

rmat

ion

to a

llow

dis

cuss

ion

on th

e 3

prop

osed

cha

nges

. If y

ou re

quire

any

furth

er in

form

atio

n pl

ease

do

not h

esita

te to

con

tact

me.

I lo

ok fo

rwar

d to

rece

ivin

g fe

edba

ck o

n th

ese

prop

osal

s fro

m th

e fo

rum

’. S

peci

fic c

omm

ent f

ollo

ws:

R

educ

ing

elec

tive

wor

k –

The

sele

cted

ext

ract

(PP

I App

.7) f

rom

the

lette

r ref

ers

to o

ur p

lann

ing

to a

ccom

mod

ate

the

expe

cted

em

erge

ncy

wor

kloa

d ov

er th

e C

hris

tmas

and

New

Yea

r hol

iday

per

iod

– an

act

ivity

whi

ch o

ccur

s ev

ery

year

, in

resp

onse

to w

inte

r pre

ssur

es.

The

prop

osal

on

whi

ch fo

rum

feed

back

was

requ

este

d, re

late

d to

our

man

agem

ent o

f pla

nned

sur

gica

l wor

k in

the

follo

win

g 3

mon

ths,

bet

wee

n Ja

nuar

y an

d M

arch

200

5. It

sta

ted

our c

omm

itmen

t to

mee

t our

nat

iona

l tar

gets

for w

aitin

g tim

es a

nd e

xpla

ined

our

ove

r per

form

ance

of

elec

tive

wor

k in

rela

tion

to th

e co

ntra

ct w

ith th

e P

CT.

C

ardi

ac d

rop-

in fa

cilit

y Th

e se

lect

ed e

xtra

ct is

take

n fro

m a

det

aile

d ex

plan

atio

n of

impr

ovem

ents

to a

cces

s m

edic

al a

nd n

ursi

ng e

xper

tise

for c

ardi

ac p

atie

nts.

W

e ac

know

ledg

e th

at th

is c

hang

e w

as im

plem

ente

d as

a te

mpo

rary

mea

sure

, prio

r to

any

feed

back

, due

to s

ever

e st

affin

g de

ficits

but

was

su

ppor

ted

by c

linic

ians

in h

ospi

tal a

nd p

rimar

y ca

re, t

o en

sure

pat

ient

saf

ety.

The

lette

r exp

lain

s th

at th

is w

as a

tem

pora

ry c

hang

e in

ligh

t of t

he

abov

e ris

ks a

nd w

ould

be

revi

ewed

in o

ne m

onth

allo

win

g tim

e fo

r fee

dbac

k fro

m th

e fo

rum

, GP

s an

d ot

her c

linic

al s

taff.

117

Issu

e nu

mbe

rs a

nd n

umer

ical

app

endi

ces r

efer

to th

ose

in th

e PP

IF d

ocum

ent

App

endi

ces u

sed

in th

e Tr

ust r

espo

nse

sect

ion

use

the

PPIF

issu

e nu

mbe

r fol

low

ed b

y a

lette

r e.g

. 1A

, 5B

7

Issu

e 4.

Red

uctio

n of

Med

ical

Day

Uni

t C

omm

enta

ry fr

om P

PI fo

rum

O

n 10

th D

ecem

ber 2

004

the

Trus

t wro

te a

gain

to th

e P

PIF

, ann

ounc

ing

that

the

hosp

ital h

ad “a

gree

d to

redu

ce th

e se

rvic

e to

two

days

per

w

eek

and

to re

loca

te th

e se

rvic

e”. [

App

. 8]

Trus

t res

pons

e A

ppen

dix

8 is

ano

ther

exa

mpl

e of

the

Trus

t see

king

the

view

s of

the

foru

m p

rior t

o th

e im

plem

enta

tion

of a

cha

nge,

nam

ely

that

of r

educ

ing

the

func

tion

of th

e M

edic

al D

ay U

nit f

rom

5 d

ays

a w

eek

to 2

day

s a

wee

k. H

owev

er, i

t is

ackn

owle

dged

that

the

Trus

t quo

te ‘h

as a

gree

d’ d

oes

not

over

tly d

epic

t to

the

foru

m th

at it

is a

pro

posa

l for

con

sulta

tion.

Thi

s is

sue

rela

tes

to a

n in

tern

al a

gree

men

t of a

pot

entia

l way

forw

ard,

not

, tha

t it

had

been

agr

eed

with

any

oth

er b

ody.

Thi

s ha

s hi

ghlig

hted

that

the

Trus

t nee

ds to

giv

e du

e re

gard

to th

e te

rmin

olog

y us

ed in

futu

re

docu

men

ts to

ens

ure

clar

ity o

n th

e pu

rpos

e of

its

com

mun

icat

ions

. Th

e tim

ely

com

mun

icat

ion

with

the

foru

m a

nd it

s in

tent

to p

rovi

de th

e fo

rum

with

the

oppo

rtuni

ty to

see

k fu

rther

info

rmat

ion

is a

ppar

ent.

How

ever

the

foru

m w

as n

ot p

arty

to a

ny d

iscu

ssio

ns o

n op

tions

for c

hang

e.

Dat

ed 1

0th D

ecem

ber t

he p

ropo

sed

chan

ge w

as to

be

effe

ctiv

e fro

m J

anua

ry 0

6. T

his

info

rmat

ion

was

sen

t in

time

for t

he fo

rum

to d

iscu

ss th

e is

sue

at th

eir m

eetin

g on

14th

. It i

nvite

d th

eir f

eedb

ack.

Th

e le

tter c

lear

ly o

utlin

es th

e ra

tiona

le fo

r the

pro

posa

l. Th

e re

loca

tion

of th

e de

partm

ent w

ould

not

be

detri

men

tal t

o pa

tient

s, th

ey w

ere

to b

e se

en o

n th

e sa

me

site

, in

the

sam

e bu

ildin

g.

The

redu

ctio

n of

the

serv

ice

from

five

to tw

o da

ys a

wee

k w

as b

ased

on

the

fact

that

we

coul

d ac

com

mod

ate

the

sam

e nu

mbe

r of p

atie

nts

(8 a

w

eek)

in tw

o da

ys m

ore

effic

ient

ly a

nd w

ithou

t det

rimen

t to

patie

nts

or th

eir t

reat

men

t pla

ns.

118

Issu

e nu

mbe

rs a

nd n

umer

ical

app

endi

ces r

efer

to th

ose

in th

e PP

IF d

ocum

ent

App

endi

ces u

sed

in th

e Tr

ust r

espo

nse

sect

ion

use

the

PPIF

issu

e nu

mbe

r fol

low

ed b

y a

lette

r e.g

. 1A

, 5B

8

Issu

e 5.

Dec

. 200

4 –

Con

tinue

d re

fusa

l to

cons

ult

Com

men

tary

from

PPI

foru

m

Just

bef

ore

Chr

istm

as 2

004

the

Trus

t sum

mon

ed th

e P

PIF

to h

ear t

wo

com

plai

nts,

(one

of w

hich

was

with

draw

n be

fore

the

mee

ting)

. PP

IF

mem

bers

bel

ieve

d th

at th

e Tr

ust w

as s

till r

efus

ing

to c

onsu

lt. T

he T

rust

rest

ated

its

view

that

"ope

ratio

nal d

ecis

ions

had

to b

e m

ade

quic

kly"

: al

thou

gh th

e vi

ew o

f the

For

um re

mai

ns th

at, w

hile

this

may

app

ly to

cris

is m

anag

emen

t, it

ough

t not

to a

pply

to th

e m

ajor

ity o

f dec

isio

ns m

ade

abou

t the

runn

ing

of th

e ho

spita

l. [A

pp. 9

] Tr

ust r

espo

nse

Th

e Tr

ust e

xecu

tive

invi

ted

foru

m m

embe

rs to

a m

eetin

g on

22nd

Dec

embe

r 200

4 (5

A) –

not

abo

ut

cons

ulta

tion

– bu

t abo

ut th

eir b

ehav

iour

tow

ards

a m

embe

r of W

est M

id’s

sta

ff, fo

llow

ing

a co

mpl

aint

lodg

ed b

y th

at s

taff

mem

ber w

ho a

llege

d in

appr

opria

te a

nd a

ggre

ssiv

e be

havi

our

tow

ards

her

whe

n sh

e at

tend

ed a

mee

ting

on th

e Tr

ust’s

beh

alf.

The

com

plai

nt w

as d

iscu

ssed

with

th

e P

PI f

orum

cha

ir w

ho a

gree

d th

at th

e Tr

ust s

houl

d in

vite

mem

bers

of t

he fo

rum

to a

mee

ting

with

the

obje

ctiv

e of

dis

cuss

ing

beha

viou

rs a

nd im

prov

ing

wor

king

rela

tions

hips

. Th

is is

sue

high

light

s th

e ch

alle

nges

the

Trus

t has

exp

erie

nced

in it

s re

latio

nshi

p w

ith s

ome

mem

bers

of t

he fo

rum

and

its

cont

inua

l atte

mpt

s at

impr

ovin

g it.

The

atta

ched

em

ail f

rom

J H

unt

(5B

), de

mon

stra

tes

his

view

of t

he in

cide

nt –

how

ever

we

are

awar

e of

the

conv

erse

opi

nion

of

othe

rs in

the

grou

p. M

inut

es fr

om th

is m

eetin

g on

22nd

Dec

embe

r 200

4 ar

e at

tach

ed (5

C)

For y

our i

nfor

mat

ion,

the

issu

e un

der d

iscu

ssio

n at

the

time,

rela

ted

to th

e bu

sine

ss c

ase

for H

igh

Dep

ende

ncy

beds

and

an

outre

ach

serv

ice

of In

tens

ive

Ther

apy

Uni

t nur

ses

to s

uppo

rt th

e ca

re o

f ac

utel

y ill

pat

ient

s on

all

war

ds. T

he T

rust

bel

ieve

s th

is p

ropo

sal r

epre

sent

s a

subs

tant

ial

impr

ovem

ent i

n pa

tient

car

e an

d sa

fety

, and

dem

onst

rate

s th

e Tr

ust B

oard

’s c

omm

itmen

t to

inve

st

in s

ervi

ces,

des

pite

our

fina

ncia

l pre

ssur

es.

Atta

chm

ents

5A

- In

vita

tion

to m

eetin

g re

con

duct

to

war

d tru

st s

taff

G:\

OSC

\invi

te t

o m

eetin

g on

con

duct

d

5B -

Em

ail f

rom

J H

unt

G:\

OSC

\__

new

ton_

vol_

user

s_

5C -

mee

ting

min

s 22

.12.

04

G:\

OSC

\BH

K m

ins

of

dec

04 m

eetin

g.do

c

119

Issu

e nu

mbe

rs a

nd n

umer

ical

app

endi

ces r

efer

to th

ose

in th

e PP

IF d

ocum

ent

App

endi

ces u

sed

in th

e Tr

ust r

espo

nse

sect

ion

use

the

PPIF

issu

e nu

mbe

r fol

low

ed b

y a

lette

r e.g

. 1A

, 5B

9

Issu

e 6.

Ces

satio

n of

blo

od te

sts

for c

hild

ren

over

six

C

omm

enta

ry fr

om P

PI fo

rum

In

Jan

uary

200

5, F

orum

mem

bers

lear

nt th

at th

e pr

ovis

ion

of b

lood

test

s fo

r chi

ldre

n w

as a

bout

to c

ease

. [A

pp. 1

0] W

e ha

ve n

ot h

eard

any

m

ore

abou

t thi

s.

Trus

t res

pons

e Th

e Tr

ust h

ad in

itiat

ed d

ialo

gue

with

PC

T co

lleag

ues

on 6

th J

anua

ry 0

5 pr

opos

ing

an o

ptio

n to

cha

nge

som

e ph

lebo

tom

y se

rvic

es. A

s a

resu

lt of

diff

icul

ties

in m

aint

aini

ng th

e cu

rren

t lev

el o

f ser

vice

, due

to s

taff

resi

gnat

ions

w

ith th

e sk

ills

requ

ired,

a p

ropo

sal t

o th

e P

rofe

ssio

nal E

xecu

tive

Com

mitt

ee (P

EC

) cha

ir w

as s

ent b

y ou

r Hea

d of

C

hild

ren’

s se

rvic

es a

mon

th p

rior t

o th

e po

tent

ial d

ate

of th

e ch

ange

. On

rece

ipt o

f thi

s le

tter t

he m

atte

r was

di

scus

sed

at th

e P

EC

at t

he P

CT.

The

ir re

spon

se ra

ised

con

cern

s re

gard

ing

thei

r abi

lity

to re

spon

d to

this

su

gges

tion

and

spec

ified

this

cha

nge

coul

d no

t be

prog

ress

ed. A

s a

resu

lt, th

e Tr

ust m

ade

alte

rnat

ive

arra

ngem

ents

with

in th

e ho

spita

l and

no

chan

ges

wer

e th

eref

ore

mad

e to

pat

ient

acc

ess

or tr

eatm

ents

.

The

Trus

t con

side

rs th

at it

is re

ason

able

to e

xplo

re o

ptio

ns fo

r ope

ratio

nal p

robl

ems

with

clin

ical

col

leag

ues

at th

e P

CT,

to a

scer

tain

whe

ther

a s

olut

ion

is fe

asib

le. I

n th

is in

stan

ce, d

ue to

trai

ning

requ

irem

ents

in th

e P

CT

the

prop

osal

was

not

a s

afe

and

viab

le o

ptio

n an

d th

eref

ore

othe

r sol

utio

ns w

ere

foun

d w

ithou

t the

nee

d to

cha

nge

the

venu

e fo

r par

t of t

his

serv

ice.

We

unde

rsta

nd th

at v

ia re

pres

enta

tions

from

foru

m m

embe

rs a

t the

PC

T, th

e W

MU

H fo

rum

wer

e m

ade

awar

e of

thes

e op

erat

iona

l dis

cuss

ions

and

con

clud

ed th

at a

cha

nge

was

to h

appe

n w

ithou

t the

ir kn

owle

dge.

In th

is in

stan

ce, t

he tw

o tru

sts

wer

e en

gagi

ng in

pre

limin

ary

disc

ussi

ons

– a

nece

ssar

y re

quire

men

t prio

r to

the

deve

lopm

ent o

f any

opt

ions

for c

hang

e. S

houl

d it

have

bee

n an

opt

ion

for 6

yea

r old

s to

ha

ve th

is s

ervi

ce in

the

com

mun

ity, t

his

wou

ld h

ave

been

a te

mpo

rary

cha

nge

due

to th

e st

affin

g is

sues

unt

il fu

ll an

alys

is o

f opt

ions

was

con

side

red.

Thi

s w

as c

onfir

med

by

the

Chi

ef E

xecu

tive

at th

e P

PI f

orum

mee

ting

on 1

3th

Janu

ary

2005

. See

PP

IF m

inut

es o

n th

eir w

eb s

ite. T

here

was

no

inte

nt to

exc

lude

the

foru

m. T

his

prop

osal

was

st

ill a

t the

ear

ly s

tage

of d

evel

opm

ent a

nd u

ltim

atel

y pr

oved

not

to re

quire

con

sulta

tion

beca

use

a ch

ange

was

no

t to

be in

trodu

ced.

In re

spon

se to

the

Foru

m c

omm

ent t

hat t

hey

not h

eard

any

mor

e ab

out t

his,

an

upda

te o

n th

is is

sue

was

pr

esen

ted

at th

e jo

int H

PC

T &

WM

UH

pub

lic P

PI f

orum

mee

ting

at th

e C

ivic

Cen

tre o

n 17

th F

ebru

ary

2005

(6A

). Th

e B

ulle

tin o

verv

iew

det

ailin

g th

e co

nten

t of t

his

pres

enta

tion

is a

ttach

ed a

nd c

onfir

mat

ion

of th

is a

ppea

rs in

the

min

utes

of t

his

mee

ting

avai

labl

e on

the

PP

IF w

ebsi

te.

Atta

chm

ents

6A

– F

ebru

ary

bulle

tin

2005

\\ne

wto

n\vo

l\use

rs\

yfra

nks\

YVO

NN

E\PP

I\

120

Issu

e nu

mbe

rs a

nd n

umer

ical

app

endi

ces r

efer

to th

ose

in th

e PP

IF d

ocum

ent

App

endi

ces u

sed

in th

e Tr

ust r

espo

nse

sect

ion

use

the

PPIF

issu

e nu

mbe

r fol

low

ed b

y a

lette

r e.g

. 1A

, 5B

10

Issu

e 7.

Dut

y to

con

sult

expl

aine

d at

Civ

ic C

entr

e.

Com

men

tary

from

PPI

foru

m

In J

anua

ry 2

005,

at a

mee

ting

atte

nded

by

mem

bers

of t

he P

PIF

for t

he W

est M

iddl

esex

Hos

pita

l, by

mem

bers

of t

he P

PIF

for H

ouns

low

PC

T,

by s

taff

from

the

Wes

t Mid

dles

ex H

ospi

tal,

by s

taff

from

Hou

nslo

w P

CT,

and

by

staf

f sup

porti

ng O

verv

iew

& S

crut

iny,

a s

olic

itor,

Pau

l Con

rath

, ga

ve a

n in

vite

d pr

esen

tatio

n on

the

stat

utor

y du

ty o

f NH

S T

rust

s to

con

sult,

exp

lain

ing

that

for a

ny c

onsu

ltatio

n to

be

mea

ning

ful i

t had

to b

e co

nduc

ted

at s

uch

a tim

e an

d in

suc

h a

man

ner t

hat i

t cou

ld in

fluen

ce th

e ev

entu

al o

utco

me.

Gai

l Wan

nell

repe

ated

her

adm

issi

on th

at th

e Tr

ust h

ad n

ot y

et g

ot ri

ght t

he le

vel o

f deb

ate

need

ed w

hen

face

d w

ith th

e ne

ed to

mak

e em

erge

ncy

deci

sion

s. P

aul C

onra

th n

oted

that

pl

eadi

ng la

ck o

f fun

ds o

r oth

er re

sour

ces

was

not

a v

alid

exc

use

for t

he T

rust

to a

void

pro

vidi

ng a

ser

vice

or t

o av

oid

cons

ultin

g, [A

pp. 1

0].

Trus

t res

pons

e It

has

alre

ady

been

ack

now

ledg

ed th

at th

e Tr

ust t

akes

its

resp

onsi

bilit

ies

on c

onsu

ltatio

n ve

ry s

erio

usly

and

this

was

pub

licly

ack

now

ledg

ed b

y th

e C

hief

Exe

cutiv

e at

this

mee

ting.

She

reco

gnis

ed th

e ch

alle

nges

and

unc

erta

intie

s th

at th

e Tr

ust f

aced

in a

chie

ving

its

stat

utor

y ob

ligat

ions

in

the

man

agem

ent o

f its

ser

vice

s w

hils

t at t

he s

ame

time

mee

ting

the

requ

irem

ents

of S

ectio

n 11

.

She

out

lined

the

need

for f

urth

er c

larif

icat

ion

and

impl

emen

tatio

n lo

cally

, and

com

mitt

ed to

eng

age

fully

to d

evel

op b

ette

r und

erst

andi

ng o

f the

is

sues

, with

a v

iew

to d

evel

opin

g a

join

t wor

king

pro

toco

l with

PP

IF.

Th

e Tr

usts

effo

rts to

faci

litat

e th

is a

re o

utlin

ed in

det

ail i

n an

swer

to is

sue

1 ab

ove.

121

Issu

e nu

mbe

rs a

nd n

umer

ical

app

endi

ces r

efer

to th

ose

in th

e PP

IF d

ocum

ent

App

endi

ces u

sed

in th

e Tr

ust r

espo

nse

sect

ion

use

the

PPIF

issu

e nu

mbe

r fol

low

ed b

y a

lette

r e.g

. 1A

, 5B

11

Issu

e 9.

Red

uctio

n in

cor

onar

y ca

re s

taff.

C

omm

enta

ry fr

om P

PI fo

rum

A

lso

in M

ay 2

005,

Che

rna

Cro

me

wro

te to

the

Trus

t, co

mpl

aini

ng th

at in

form

atio

n ab

out a

noth

er c

hang

e m

ade

with

out c

onsu

ltatio

n, (p

uttin

g on

ho

ld "t

he a

ppoi

ntm

ent o

f a re

plac

emen

t for

the

Cor

onar

y C

are

lead

") h

ad n

ot b

een

forth

com

ing.

[App

. 12]

In

Sep

tem

ber t

his

was

rais

ed a

gain

, [A

pp. 2

0]: b

ut n

o in

form

atio

n w

as a

vaila

ble.

On

24th O

ctob

er a

four

-pag

e pr

opos

al w

as e

mai

led

by th

e Tr

ust:

pepp

ered

with

une

xpla

ined

initi

als

and

abbr

evia

tions

, rai

sing

mor

e qu

estio

ns th

an it

ans

wer

ed, a

nd d

evoi

d of

any

tim

esca

les,

(apa

rt fro

m

the

dead

line

for r

eply

). H

ad w

e re

spon

ded,

we

shou

ld h

ave

need

ed to

sch

edul

e a

mee

ting

to o

btai

n cl

arifi

catio

n: b

ut w

e w

ere

unab

le to

do

this

w

ithin

the

dead

line.

The

follo

win

g br

ief e

xtra

ct in

dica

tes

that

this

ser

vice

has

not

bee

n pr

ovid

ed a

s re

quire

d un

der t

he N

SF

(Nat

iona

l Ser

vice

Fr

amew

ork)

. It h

as ta

ken

from

May

to O

ctob

er to

obt

ain

this

info

rmat

ion:

dur

ing

whi

ch p

erio

d it

appe

ars

that

the

situ

atio

n ha

s de

terio

rate

d.

�Ph

ase

3 –

Cur

rent

ly th

e on

ly o

ptio

n fo

r pha

se th

ree

is to

com

e in

to W

MU

H to

hav

e ex

erci

se. T

he c

ardi

ac p

hysi

othe

rapi

st w

ho re

turn

ed fr

om

leav

e in

May

200

5 an

d a

nurs

e fro

m th

e ca

rdio

logy

war

d ar

ea c

urre

ntly

pro

vide

Pha

se 3

. The

re h

as b

een

an in

term

itten

t pro

blem

of p

hysi

o co

ver o

ver t

he p

ast y

ear d

ue to

mat

erni

ty a

nd s

ubse

quen

tly s

ick

leav

e of

the

post

hol

der.

This

pos

t is

man

aged

and

fund

ed b

y th

e PC

T w

ho

wer

e un

able

to c

over

this

pos

t for

som

e of

this

tim

e.

Dur

ing

this

per

iod

the

exer

cise

com

pone

nt o

f thi

s ph

ase

was

not

cov

ered

and

has

resu

lted

in a

wai

ting

list f

or th

is s

ervi

ce. I

n ad

ditio

n th

e nu

rsin

g po

st h

olde

r res

igne

d in

Sep

tem

ber 2

004

and

desp

ite a

dver

tisin

g at

a n

umbe

r of g

rade

s W

MU

H w

ere

unab

le to

recr

uit.

Dur

ing

this

tim

e th

e nu

rsin

g el

emen

t of p

hase

3 h

as b

een

cove

red

by n

ursi

ng s

taff

from

the

card

iolo

gy w

ard

– ei

ther

by

perm

anen

t or b

ank

card

iolo

gy s

taff

who

ha

ve a

ppro

pria

te s

kills

requ

ired

to ru

n th

is s

ervi

ce s

afel

y.

Trus

t res

pons

e C

hern

a C

rom

e’s

lette

r of 1

8th M

ay [P

PI A

pp.1

2 ] a

sked

for a

n up

date

on

this

issu

e pr

evio

usly

dis

cuss

ed a

nd w

as

not a

com

plai

nt a

bout

non

-con

sulta

tion.

In a

dditi

on, t

he T

rust

doe

s no

t agr

ee th

at it

took

from

May

to O

ctob

er to

obt

ain

info

rmat

ion

on th

is is

sue.

It is

un

deni

able

that

this

ver

y co

mpl

ex p

athw

ay o

f car

e, d

eliv

ered

join

tly b

y st

aff f

rom

WM

UH

and

the

PC

T, w

as

affe

cted

by

a se

ries

of o

pera

tiona

l sta

ffing

issu

es w

hich

took

som

e tim

e to

reso

lve.

All

elem

ents

in th

e us

ual

path

way

wer

e no

t who

lly c

over

ed th

roug

hout

this

per

iod.

How

ever

this

was

com

mun

icat

ed to

the

foru

m v

ery

regu

larly

as

outli

ned

belo

w. I

n ad

ditio

n, th

e fo

rum

opi

nion

that

the

outc

ome

for p

atie

nts

has

dete

riora

ted

is

unfo

unde

d.

O

n 14

th A

pril

at a

PP

I for

um m

eetin

g he

ld a

t WM

UH

the

issu

es o

f car

diac

reha

b w

ere

rais

ed b

y th

e Tr

ust i

n th

e se

ctio

n w

here

we

high

light

‘adv

ance

war

ning

’ of i

ssue

s of

inte

rest

to th

e fo

rum

. Thi

s is

reco

rded

on

the

bulle

tin fo

r

Atta

chm

ents

9A

- Adv

ance

war

ning

- ca

rdia

c re

hab

Bul

letin

Apr

il 05

H:\

YVO

NNE\

PPI\

PATI

ENTS

FO

RU

M\f

or

122

Issu

e nu

mbe

rs a

nd n

umer

ical

app

endi

ces r

efer

to th

ose

in th

e PP

IF d

ocum

ent

App

endi

ces u

sed

in th

e Tr

ust r

espo

nse

sect

ion

use

the

PPIF

issu

e nu

mbe

r fol

low

ed b

y a

lette

r e.g

. 1A

, 5B

12

Apr

il 05

atta

ched

. (9A

)

At t

he J

une

PP

I mee

ting

– bu

lletin

atta

ched

(9B

), a

n up

date

pap

er (9

C) w

as p

rese

nted

to th

e fo

rum

pro

vidi

ng

deta

ils o

f the

cur

rent

pos

ition

and

act

ions

the

Trus

t and

PC

T w

ere

taki

ng to

ens

ure

serv

ice

cont

inui

ty. T

he g

aps

in

the

serv

ice

wer

e ac

know

ledg

ed a

t thi

s tim

e.

In S

epte

mbe

r Yvo

nne

Fran

ks w

as a

sked

if th

e pe

rman

ent n

ursi

ng p

ost h

ad b

een

fille

d. S

he d

id n

ot h

ave

that

in

form

atio

n at

that

mee

ting.

How

ever

in th

e fo

llow

ing

mon

th, O

ctob

er, a

det

aile

d pr

opos

al (9

D) –

out

linin

g bo

th

curr

ent a

nd p

ropo

sed

serv

ices

was

sen

t to

the

foru

m in

vitin

g co

mm

ent.

W

e ac

know

ledg

e th

at in

som

e in

stan

ces

abbr

evia

tions

wer

e us

ed to

des

crib

e di

agno

stic

test

s an

d ca

rdia

c pr

oced

ures

.

We

did

not r

ecei

ve fe

edba

ck, r

eque

sts

for c

larit

y or

a re

ques

t for

a m

eetin

g to

furth

er d

iscu

ss –

whi

ch w

ould

hav

e be

en a

ccom

mod

ated

.

9B -F

orum

bul

letin

Jun

e 05

H:\

YVO

NNE\

PPI\

PATI

ENTS

FO

RU

M\f

or

9C -

Writ

ten

upda

te to

fo

rum

Jun

e 05

D:\

PPI\

evid

ence

for

sc

rutin

y re

f ja

n 06

\Ca

9D -

Ser

vice

dev

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men

t pr

opos

al O

ct 0

5

\\ne

wto

n\vo

l\use

rs\

yfra

nks\

CA

RDIA

C R

E

123

Issu

e nu

mbe

rs a

nd n

umer

ical

app

endi

ces r

efer

to th

ose

in th

e PP

IF d

ocum

ent

App

endi

ces u

sed

in th

e Tr

ust r

espo

nse

sect

ion

use

the

PPIF

issu

e nu

mbe

r fol

low

ed b

y a

lette

r e.g

. 1A

, 5B

13

Issu

e 12

. Bus

ines

s ca

se fo

r war

d cl

osur

e in

pre

para

tion

Com

men

tary

from

PPI

foru

m

Alth

ough

the

PP

IF w

as in

form

ed th

at p

lans

to c

lose

ano

ther

war

d w

ere

bein

g m

ade,

at n

o st

age

wer

e w

e ev

er c

onsu

lted

abou

t thi

s. A

few

PP

IF

mem

bers

atte

nded

a d

aytim

e m

eetin

g at

the

hosp

ital o

n 19

th J

uly,

and

wer

e to

ld th

at a

bus

ines

s ca

se fo

r the

cha

nges

was

stil

l bei

ng p

repa

red,

(th

ough

not

a H

ealth

Impa

ct A

sses

smen

t), a

nd th

at th

e Tr

ust w

as "a

imin

g to

pre

clud

e th

e us

e of

esc

alat

ion

war

ds".

[App

. 13]

Tr

ust r

espo

nse

This

issu

e re

turn

s to

the

defin

ition

of c

onsu

ltatio

n. A

lthou

gh w

e be

lieve

that

mee

tings

we

orga

nise

d an

d pa

pers

se

nt to

the

foru

m d

emon

stra

te a

dequ

ate

oppo

rtuni

ty fo

r the

ir co

mm

ent o

n th

e fin

anci

al n

eed

to c

lose

bed

s by

O

ctob

er 2

005,

we

acce

pt th

at th

ese

com

mun

icat

ions

wer

e no

t pre

sent

ed a

s ov

ert c

onsu

ltatio

n op

portu

nitie

s. T

he

deta

il of

whi

ch b

eds

wou

ld b

e in

volv

ed w

as n

ot fi

nalis

ed u

ntil

late

sum

mer

200

5 w

hen

the

foru

m w

ere

appr

aise

d of

the

deta

il.

A

t the

initi

al s

tage

our

pro

posa

ls w

ere

still

in d

evel

opm

ent,

but m

indf

ul o

f con

cern

s th

e fo

rum

had

rais

ed in

the

past

abo

ut la

ck o

f con

sulta

tion,

we

wer

e ke

en to

giv

e th

em a

s m

uch

adva

nce

war

ning

as

poss

ible

. We

ther

efor

e as

ked

to m

eet w

ith th

em d

espi

te n

ot h

avin

g sp

ecifi

c an

d de

taile

d pl

ans

for t

he fu

ture

.

Prio

r to

the

begi

nnin

g of

the

new

fina

ncia

l yea

r, A

pril

2005

, the

Tru

st e

ngag

ed in

a s

erie

s of

mee

tings

with

the

PP

I fo

rum

to in

form

and

upd

ate

them

abo

ut th

e fin

anci

al s

ituat

ion

and

the

pote

ntia

l act

ions

requ

ired

to m

eet o

ur

oblig

atio

ns.

A

t a m

eetin

g in

Feb

ruar

y 20

05 th

e C

hief

Exe

cutiv

e an

d M

edic

al D

irect

or o

utlin

ed T

rust

per

form

ance

in re

latio

n to

re

duct

ions

in le

ngth

of s

tay

and

the

pote

ntia

l to

redu

ce b

ed c

apac

ity a

s a

resu

lt. T

rust

boa

rd re

ports

thro

ugho

ut

the

year

hav

e re

gula

rly re

porte

d pr

ogre

ss to

war

d th

is a

im. I

t sho

uld

be n

oted

that

PP

I for

um m

embe

rs re

ceiv

e Tr

ust B

oard

pap

ers

and

Foru

m re

pres

enta

tives

had

bee

n at

eac

h Tr

ust B

oard

. A ‘r

oad

map

’ out

linin

g se

quen

tial

plan

ning

was

giv

en to

the

foru

m o

n 19

th J

uly

2005

. (12

A).

At t

his

mee

ting

it is

reco

rded

that

Che

rna

Cro

me

stat

ed (1

2B) t

hat ‘

the

foru

m a

ren’

t dis

putin

g th

e pr

inci

ples

of t

he p

lan

but r

athe

r how

it’s

del

iver

ed in

the

cont

ext o

f th

e co

mm

unity

infra

stru

ctur

e or

lack

of i

t’. I

n ad

ditio

n th

e H

ealth

Scr

utin

y P

anel

rece

ived

a p

rese

ntat

ion

at th

eir

mee

ting

on 1

1th J

uly

2005

(12C

) abo

ut b

ed c

apac

ity a

nd th

e pa

per (

12D

) was

cop

ied

to a

ll fo

rum

mem

bers

. S

ever

al m

embe

rs o

f the

foru

m w

ere

pres

ent a

nd th

eir q

uest

ions

on

the

subj

ect a

re m

inut

ed. I

t als

o re

cord

s th

e Tr

usts

inte

ntio

n to

mee

t with

the

foru

m o

n 19

th J

uly

2005

to p

rese

nt s

peci

fic d

etai

ls o

f thi

s is

sue.

Atta

chm

ents

12

A -

road

map

& J

uly

mee

ting

min

s

H:\

OSC

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\M

inut

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f an

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12B

Mee

ting

min

s 19

.7.0

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\\ne

wto

n\vo

l\use

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yfra

nks\

OSC

\19.

2.06

12

C -

OS

C m

inut

es J

uly

05

G:\

OSC

\OSC

Min

utes

ju

ly 0

5.do

c.pd

f

12D

- B

ed u

tilis

atio

n pa

per

July

05 G:\

OSC

\$B

edut

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iona

ndLe

n

124

Issu

e nu

mbe

rs a

nd n

umer

ical

app

endi

ces r

efer

to th

ose

in th

e PP

IF d

ocum

ent

App

endi

ces u

sed

in th

e Tr

ust r

espo

nse

sect

ion

use

the

PPIF

issu

e nu

mbe

r fol

low

ed b

y a

lette

r e.g

. 1A

, 5B

14

Issu

e 14

. Not

ifica

tion

afte

r eve

nt in

stea

d of

prio

r con

sulta

tion.

C

omm

enta

ry fr

om P

PI fo

rum

A

pap

er o

n a

prop

osed

con

sulta

tion

plan

dat

ed 1

5th

Aug

ust m

arks

the

19th

Aug

ust t

o "in

form

PP

I of b

ed m

odel

cha

nges

" (no

t "co

nsul

t"), w

ith

the

cons

ulta

tion

perio

d to

end

on

9th

Sep

tem

ber.

[App

. 19]

How

ever

, thi

s di

d no

t hap

pen.

At a

PP

IF m

eetin

g on

15t

h S

epte

mbe

r, th

e Tr

ust

info

rmed

the

PP

IF th

at th

e Tr

ust "

had

deve

lope

d th

e B

ed M

odel

and

wou

ld li

ke to

dis

cuss

it w

ith m

embe

rs in

the

very

nea

r fut

ure"

, [A

pp. 2

0].

We

wer

e la

ter o

ffere

d fiv

e sl

ots

in th

e w

eek

of th

e Tr

ust's

Ann

ual G

ener

al M

eetin

g: tw

o be

fore

, and

thre

e af

ter,

[App

. 21]

. A m

ajor

ity o

f PP

IF

mem

bers

foun

d th

e th

ird s

lot m

ost c

onve

nien

t: an

d di

scov

ered

that

the

chan

ges

had

been

ann

ounc

ed th

e da

y be

fore

, at t

he A

GM

, with

out a

ny

cons

ulta

tion

havi

ng ta

ken

plac

e. G

ail W

anne

ll st

ated

that

"the

pro

posa

l was

dev

elop

ed e

nd o

f Aug

ust /

ear

ly S

epte

mbe

r” a

nd th

at th

e pu

rpos

e of

the

mee

ting

was

"to

give

the

ratio

nale

beh

ind

the

mod

el",

[App

. 23]

. The

war

d ha

d be

en c

lose

d at

the

begi

nnin

g of

the

wee

k: a

s nu

rsin

g st

aff

disc

over

ed w

hen

they

arr

ived

for w

ork!

Tr

ust r

espo

nse

(Th

is is

sue

is c

lose

ly li

nked

to p

oint

12)

Th

e Tr

ust’s

fina

ncia

l situ

atio

n an

d ou

r int

entio

n to

redu

ce o

ur b

ed c

apac

ity in

Oct

ober

200

5 w

as c

lear

ly

com

mun

icat

ed to

the

Foru

m a

t var

ious

Boa

rd m

eetin

gs (e

.g. 3

0th J

une

2005

ava

ilabl

e on

Tru

st w

ebsi

te).

It w

as

disc

usse

d w

ith th

e Fo

rum

at a

spe

cial

mee

ting

held

on

19th J

uly

2005

whe

re th

e R

oadm

ap w

ork

was

pre

sent

ed.

(see

12B

for m

inut

es o

f tha

t mee

ting)

. Whi

lst t

he d

etai

l of t

he p

lann

ed O

ctob

er c

hang

es h

ad n

ot b

een

final

ised

, th

ese

mee

tings

, non

ethe

less

, pro

vide

d an

opp

ortu

nity

for t

he F

orum

to ra

ise

any

conc

erns

. Th

e ex

tract

refe

rred

to h

ere

is fr

om a

pap

er c

lear

ly ti

tled

‘con

sulta

tion

plan

’ sta

ting

the

over

t int

entio

n to

con

sult

with

bot

h fo

rum

and

sta

ff. O

ne o

f the

act

ion

poin

ts s

tate

s to

‘inf

orm

the

foru

m’ –

wor

ding

that

onc

e ag

ain

has

been

hig

hlig

hted

by

the

foru

m a

s an

exa

mpl

e of

non

-con

sulta

tion

whe

n th

e co

nten

t and

tone

of t

he e

ntire

pap

er is

ab

out c

onsu

ltatio

n. T

his

agai

n hi

ghlig

hts

the

need

for t

he T

rust

to e

nsur

e th

e la

ngua

ge u

sed

in p

ublic

doc

umen

ts

is c

onsi

sten

t and

acc

urat

e.

The

Trus

t had

hop

ed to

be

in a

pos

ition

to p

rovi

de th

e Fo

rum

with

a p

aper

set

ting

out t

he d

etai

ls o

f the

pro

pose

d ch

ange

s by

19th

Aug

ust f

or c

omm

ent b

y 9th

Sep

tem

ber,

but i

n th

e ev

ent t

his

targ

et o

n th

e ac

tion

plan

slip

ped,

it

took

long

er th

an e

xpec

ted

to fi

nalis

e th

e pa

pers

. The

use

of d

ata

to d

eter

min

e th

e id

eal u

tilis

atio

n of

the

bed

stoc

k an

d th

e su

bseq

uent

dis

cuss

ions

with

clin

ical

sta

ff to

ope

ratio

nalis

e a

clin

ical

ly s

ound

pla

n, w

as im

pera

tive.

Atta

chm

ents

14

A -

chro

nolo

gy o

f eve

nts

H:\

OSC

\19.

2.06

\C

hron

olog

y Pa

tric

ia D

125

Issu

e nu

mbe

rs a

nd n

umer

ical

app

endi

ces r

efer

to th

ose

in th

e PP

IF d

ocum

ent

App

endi

ces u

sed

in th

e Tr

ust r

espo

nse

sect

ion

use

the

PPIF

issu

e nu

mbe

r fol

low

ed b

y a

lette

r e.g

. 1A

, 5B

15

At t

he P

PIF

mee

ting

on 1

5th S

epte

mbe

r 200

5, Y

vonn

e Fr

anks

invi

ted

the

Foru

m to

a m

eetin

g at

the

hosp

ital

whe

re th

e pr

opos

ed c

hang

es c

ould

be

expl

aine

d an

d sa

id th

at th

e Tr

ust w

ould

wel

com

e th

e Fo

rum

’s v

iew

s. F

ive

optio

ns w

ere

give

n fo

r the

mee

ting

– th

e ch

osen

opt

ion;

afte

r the

AG

M.

It is

com

plet

ely

untru

e th

at a

ll st

aff w

ere

unaw

are

of th

e ch

ange

s ‘w

hen

they

arr

ived

for w

ork’

. Our

man

agem

ent

of c

hang

e po

licy

was

follo

wed

in re

spec

t of b

oth

grou

p, u

nion

and

indi

vidu

al re

spon

sibi

litie

s.

The

staf

f on

the

affe

cted

are

as m

ade

choi

ces

as to

thei

r pre

fere

nces

for r

edep

loym

ent a

nd th

e m

ajor

ity re

mai

ned

with

in e

xist

ing

staf

f gro

ups,

one

war

d te

am re

loca

ted

rath

er th

an s

plit

up. T

he c

hron

olog

y of

eve

nts

is a

ttach

ed. (

14A

)

126

Issu

e nu

mbe

rs a

nd n

umer

ical

app

endi

ces r

efer

to th

ose

in th

e PP

IF d

ocum

ent

App

endi

ces u

sed

in th

e Tr

ust r

espo

nse

sect

ion

use

the

PPIF

issu

e nu

mbe

r fol

low

ed b

y a

lette

r e.g

. 1A

, 5B

16

Issu

e 17

. Esc

alat

ion

war

ds

Com

men

tary

from

PPI

foru

m

One

wee

k af

ter t

he T

rust

's a

nnou

ncem

ent o

f bed

clo

sure

s, th

e P

PIF

dis

cove

red

that

two

esca

latio

n w

ards

wer

e in

ope

ratio

n, w

ith o

ver f

orty

pa

tient

s, d

espi

te th

e at

tem

pt to

clo

se o

ver 3

0 be

ds w

ith n

o ad

vers

e im

pact

on

patie

nt c

are.

A h

ospi

tal p

ress

rele

ase

on 1

2th

Oct

ober

sta

tes

that

th

is is

"due

to u

npre

dict

ably

hig

h nu

mbe

rs o

f em

erge

ncy

adm

issi

ons

over

the

past

wee

k". I

t exp

lain

s: "t

he c

losu

re o

f one

war

d ha

s no

t yet

bee

n po

ssib

le. W

e ar

e re

view

ing

the

situ

atio

n on

a d

aily

bas

is w

ith th

e ai

m o

f clo

sing

the

war

d as

soo

n as

we

can.

Thi

s w

ard

will

rem

ain

avai

labl

e fo

r es

cala

tion

purp

oses

and

we

are

fortu

nate

to h

ave

this

ext

ra c

apac

ity a

nd fl

exib

ility

sho

uld

the

need

aris

e". [

App

. 28]

It

ther

efor

e ap

pear

s th

at w

hate

ver p

lann

ing

of th

e be

d cl

osur

es m

ay h

ave

been

per

form

ed, (

whe

ther

bus

ines

s ca

se o

r Hea

lth Im

pact

A

sses

smen

t), w

as w

oefu

lly in

adeq

uate

. We

won

der h

ow th

e ho

spita

l will

resp

ond

durin

g w

inte

r pea

ks; w

heth

er it

has

any

dev

elop

ed a

ny ro

bust

pl

ans

in th

is re

gard

; and

wha

t may

hap

pen

shou

ld a

vian

'flu

stri

ke. (

In M

ay 2

005

Joe

John

son

info

rmed

And

ris V

anag

s, th

en a

For

um m

embe

r, th

at w

ard

Lam

pton

1, c

lose

d in

Aug

ust 2

004,

had

bee

n re

open

ed a

s an

esc

alat

ion

war

d to

take

"the

ove

rflow

of p

atie

nts

from

oth

er w

ards

". Y

et

at th

e sa

me

time

the

Trus

t was

alre

ady

plan

ning

the

clos

ures

ann

ounc

ed in

Sep

tem

ber 2

005.

– F

or a

ll th

e re

ports

that

are

pro

duce

d by

Tru

st

staf

f at m

eetin

gs, a

re d

ecis

ion

mak

ers

in p

osse

ssio

n of

a s

uita

ble

pers

pect

ive

and

appr

opria

te in

tern

ally

-ava

ilabl

e fa

cts

in s

uffic

ient

tim

e to

m

ake

good

dec

isio

ns?

They

are

cer

tain

ly n

ot in

pos

sess

ion

of e

xter

nally

-ava

ilabl

e fa

cts,

for t

he s

impl

e re

ason

that

they

do

not c

onsu

lt.)

Trus

t res

pons

e Th

is is

a c

omm

ent r

athe

r tha

n an

exa

mpl

e of

non

-con

sulta

tion.

It

shou

ld b

e no

ted

that

our

pro

posa

ls a

lway

s st

ated

that

cha

nge

wou

ld ta

ke ti

me

to ‘b

ed in

’ and

we

expe

cted

to re

quire

esc

alat

ion

for a

per

iod

of ti

me.

127

Issu

e nu

mbe

rs a

nd n

umer

ical

app

endi

ces r

efer

to th

ose

in th

e PP

IF d

ocum

ent

App

endi

ces u

sed

in th

e Tr

ust r

espo

nse

sect

ion

use

the

PPIF

issu

e nu

mbe

r fol

low

ed b

y a

lette

r e.g

. 1A

, 5B

17

Issu

e 19

. Im

poss

ible

dea

dlin

es a

nd d

ata

acce

ssib

ility

C

omm

enta

ry fr

om P

PI fo

rum

A

t the

For

um's

pub

lic m

eetin

g on

15t

h S

epte

mbe

r we

wer

e in

form

ed th

at th

e Tr

ust "

wou

ld b

e se

ndin

g th

eir d

raft

decl

arat

ion

on S

tand

ards

for

Bet

ter H

ealth

to th

e fo

rum

in th

e ne

ar fu

ture

", [A

pp. 2

0]. W

e w

ere

ther

efor

e su

rpris

ed to

rece

ive

on 1

3th O

ctob

er a

rem

inde

r tha

t our

resp

onse

w

as e

xpec

ted

by 1

4th

Oct

ober

, [A

pp. 2

9]. T

he D

raft

had

been

em

aile

d to

mem

bers

on

10th

Oct

ober

: but

as

an E

xcel

file

, (w

hich

mos

t mem

bers

ar

e un

able

to o

pen)

, and

form

atte

d to

prin

t in

an in

cred

ibly

sm

all f

ont s

ize.

We

wer

e gr

ante

d a

brie

f ext

ensi

on to

sub

mit

our r

espo

nse.

Dur

ing

this

per

iod

we

obta

ined

har

d co

pies

of t

he D

raft,

in a

read

able

font

: tog

ethe

r with

a 1

2-pa

ge d

ocum

ent f

rom

CP

PIH

, dat

ed 1

9th J

uly,

con

tain

ing

guid

ance

on

how

to re

spon

d. W

e re

plie

d on

19t

h O

ctob

er, [

App

. 31]

.b 2

1.10

.05

Trus

t res

pons

e Th

is is

not

an

issu

e of

non

-con

sulta

tion

on b

ehal

f of t

he T

rust

, rat

her o

ne o

f int

erna

l for

um c

omm

unic

atio

n an

d IT

co

mpa

tibili

ty. W

e ac

know

ledg

e th

at d

eadl

ines

wer

e tig

ht fo

r res

pond

ing

to th

is d

ocum

ent b

ut w

ere

date

s th

at

wer

e ag

reed

in a

dvan

ce a

t an

OS

C m

eetin

g on

6th S

epte

mbe

r 200

5 w

here

the

foru

m w

ere

pres

ent.

No

obje

ctio

n to

this

tim

esca

le w

as ra

ised

. The

Tru

st s

ent t

he in

vita

tion

to re

spon

d an

d th

e lin

k to

acc

ess

the

docu

men

t, to

the

OS

C, f

orum

and

SH

A o

n 23

rd S

epte

mbe

r 200

5 (1

9A).

As

arra

nged

at t

he la

st P

PI f

orum

mee

ting

on 1

5th

Sep

tem

ber 2

005,

this

was

sen

t ele

ctro

nica

lly to

the

‘foru

m s

uppo

rt’ te

am fo

r dis

sem

inat

ion.

We

cann

ot th

eref

ore

com

men

t on

the

date

it re

ache

d in

divi

dual

foru

m m

embe

rs.

It is

als

o no

t app

ropr

iate

for t

he T

rust

to c

omm

ent a

bout

the

avai

labi

lity

to th

e fo

rum

of i

ts o

wn

inte

rnal

gui

danc

e on

how

to re

spon

d to

the

draf

t dec

lara

tion.

Th

e tru

st w

as u

naw

are

that

foru

m m

embe

rs h

ad d

iffic

ulty

in o

peni

ng th

e fil

e un

til th

e re

min

der u

rged

a re

spon

se

on 1

3th O

ctob

er, h

avin

g al

read

y re

ceiv

ed re

spon

ses

from

the

othe

r age

ncie

s. (1

9B)

The

foru

m s

uppo

rt te

am a

ppea

red

equa

lly s

urpr

ised

by

this

and

Bob

Har

dy-K

ing

imm

edia

tely

prin

ted

hard

cop

ies

in re

spon

se, i

nfor

min

g Y

vonn

e Fr

anks

that

this

was

in h

and.

In re

spon

se to

a re

ques

t for

an

exte

nsio

n to

the

dead

line

in li

ght o

f the

se a

dmin

istra

tive

diffi

culti

es, t

his

was

gra

nted

and

we

rece

ived

the

com

men

ts o

n 19

th

Oct

ober

in ti

me

for t

he b

oard

mee

ting

of 2

7th O

ctob

er. W

e th

eref

ore

belie

ve th

e Tr

ust m

anag

ed it

s pr

oces

ses

reas

onab

ly.

Atta

chm

ents

19

A -

Dra

ft de

clar

atio

n to

st

akeh

olde

rs 2

3.9.

05

H

:\FW

Wes

t M

iddl

esex

Uni

vers

ity H

19B

– J

Hun

t em

ail

- pr

oble

ms

acce

ssin

g S

tand

ards

for B

ette

r Hea

lth

docu

men

t 13.

10.0

5

H:\

UR

GEN

T

Stan

dard

s fo

r Be

tter

128

Issu

e nu

mbe

rs a

nd n

umer

ical

app

endi

ces r

efer

to th

ose

in th

e PP

IF d

ocum

ent

App

endi

ces u

sed

in th

e Tr

ust r

espo

nse

sect

ion

use

the

PPIF

issu

e nu

mbe

r fol

low

ed b

y a

lette

r e.g

. 1A

, 5B

18

Issu

e 20

. Ins

pect

ion

of e

scal

atio

n w

ards

C

omm

enta

ry fr

om P

PI fo

rum

O

n 13

th O

ctob

er th

e Fo

rum

's tw

o co

chai

rs c

ondu

cted

an

info

rmal

vis

it to

insp

ect t

he tw

o es

cala

tion

war

ds, g

ivin

g 90

min

utes

' not

ice,

(in

exce

ss

of th

e on

e ho

ur re

quire

d by

the

CP

PIH

Han

dboo

k). T

here

wer

e 48

pat

ient

s in

the

two

war

ds a

t the

tim

e of

our

vis

it, b

eing

car

ed fo

r by

just

eig

ht

staf

f (nu

rses

and

hea

lth c

are

assi

stan

ts).

[App

. 30]

A te

am o

f doc

tors

vis

ited

both

war

ds d

urin

g ou

r vis

it, a

nd v

oice

d th

e fo

llow

ing

conc

erns

. –

A c

onsu

ltant

's p

atie

nts

are

now

sca

ttere

d ov

er s

ever

al w

ards

, Low

er le

vels

of s

uppl

ies

are

stoc

ked

on th

ese

war

ds, L

ack

of s

taff

perm

anen

tly

assi

gned

to e

scal

atio

n w

ards

, hen

ce: w

ard

staf

f are

not

fam

iliar

with

the

patie

nts,

lack

of c

ontin

uity

, inf

orm

atio

n is

lost

mor

e ea

sily

at h

ando

ver

betw

een

shift

s, s

taff

not f

amili

ar w

ith th

e w

ard

have

diff

icul

ty in

loca

ting

supp

lies

Dur

ing

an u

nrel

ated

vis

it to

che

ck th

e av

aila

bilit

y of

hot

wat

er, F

ranc

is B

row

n, a

For

um m

embe

r, w

as to

ld b

y th

e en

gine

er fr

om E

cove

rt (th

e m

aint

enan

ce s

ubco

ntra

ctor

) tha

t it w

as c

onsi

dere

d si

gnifi

cant

that

pre

viou

s pr

oble

ms

with

hot

wat

er (i

n th

e ne

w b

uild

ing)

had

coi

ncid

ed w

ith th

e re

cent

reco

mm

issi

onin

g of

an

esca

latio

n w

ard

(in th

e ol

d M

arjo

rie W

arre

n bu

ildin

g). [

Em

ail d

ated

28th

Oct

ober

.]

The

open

ing

of th

ese

two

esca

latio

n w

ards

so

soon

afte

r the

ann

ounc

ed b

ed c

losu

re, a

nd th

e co

mm

ents

offe

red

by s

taff

indi

cate

that

in

form

atio

n ga

ther

ing,

pla

nnin

g, a

nd c

onsu

ltatio

n w

ith th

e Tr

ust's

ow

n st

aff w

ere

inad

equa

te.

Trus

t res

pons

e W

e do

not

bel

ieve

the

com

men

tary

her

e is

indi

cativ

e or

dem

onst

ratio

n of

poo

r inf

orm

atio

n ga

ther

ing,

pla

nnin

g, o

r co

nsul

tatio

n w

ith o

ur o

wn

staf

f. D

espi

te a

chie

ving

leng

th o

f sta

y re

duct

ion

the

corr

espo

ndin

g in

crea

se in

em

erge

ncy

adm

issi

ons

has

cont

ribut

ed to

the

use

of a

n E

scal

atio

n w

ard.

The

atta

ched

gra

phs

(20A

) illu

stra

te

this

. E

scal

atio

n ar

eas

are

used

to a

ccom

mod

ate

extra

act

ivity

. At t

imes

of e

xtre

me

pres

sure

pat

ient

s ar

e pl

aced

in

avai

labl

e be

ds. D

ue to

the

way

we

allo

cate

pat

ient

s to

the

med

ical

team

s w

hen

they

eac

h ha

ve re

spon

sibi

lity

for

emer

genc

y ad

mis

sion

s, th

eir p

atie

nts

may

be

disp

erse

d th

roug

hout

the

hosp

ital.

Any

clin

icia

n w

ill c

ompl

ain

abou

t th

e in

conv

enie

nce

of th

is.

In th

is e

vent

, the

esc

alat

ion

war

d ar

ea w

as a

ctua

lly o

ne th

at, a

lthou

gh ta

rget

ed to

clo

se, h

as n

ever

don

e so

. It i

s tru

e th

at te

mpo

rary

sta

ff ar

e us

ed in

this

are

a, h

owev

er 9

0% o

f tem

pora

ry s

hifts

are

fille

d by

our

ow

n st

aff.

The

nega

tive

impa

ct o

f thi

s, h

owev

er is

that

ther

e is

redu

ced

cont

inui

ty o

f sta

ffing

from

one

day

to th

e ne

xt a

nd

ther

efor

e a

core

gro

up o

f per

man

ent s

taff

wer

e ro

ster

ed to

this

are

a in

clud

ing

a S

iste

r. Th

is s

trate

gy h

elps

to li

mit

the

effe

cts

of u

nfam

iliar

ity w

ith th

e w

ard

envi

ronm

ent a

nd w

ith th

e lo

catio

n of

sup

plie

s.

For y

our i

nfor

mat

ion

the

repo

rt by

Fra

ncis

Bro

wn

rega

rdin

g ho

t wat

er c

heck

s is

atta

ched

. (20

B)

Atta

chm

ents

20

A –

dat

a on

leng

th o

f st

ay a

nd e

mer

genc

y ad

mis

sion

s

\\ne

wto

n\vo

l\use

rs\

yfra

nks\

OSC

\19.

2.06

20

B w

ater

repo

rt

G:\

OSC

\wat

er

tem

pera

ture

_11

0213

129

Issu

e nu

mbe

rs a

nd n

umer

ical

app

endi

ces r

efer

to th

ose

in th

e PP

IF d

ocum

ent

App

endi

ces u

sed

in th

e Tr

ust r

espo

nse

sect

ion

use

the

PPIF

issu

e nu

mbe

r fol

low

ed b

y a

lette

r e.g

. 1A

, 5B

19

Issu

e 24

. Tru

st B

oard

pap

ers

Com

men

tary

from

PPI

foru

m

Thes

e pa

pers

from

the

boar

d m

eetin

g on

27t

h O

ctob

er 2

005

dem

onst

rate

.

• C

hief

Exe

cutiv

e's

Rep

ort [

App

. 32]

Sec

tion

2 ("

Bed

reco

nfig

urat

ions

and

IAR

DS

war

d") d

ism

isse

s th

ese

two

item

s in

just

four

brie

f se

nten

ces,

cro

win

g "w

e un

derto

ok a

maj

or c

onfig

urat

ion

of o

ur b

ed b

ase

… a

nd a

t the

sam

e tim

e op

ened

a 1

4-pl

ace

reha

bilit

atio

n w

ard

…pl

anne

d w

ith m

ilita

ry p

reci

sion

…".

Ther

e is

no

men

tion

of th

e un

sche

dule

d op

enin

g of

two

esca

latio

n w

ards

with

ove

r for

ty b

eds

whi

ch h

ad o

ccur

red

just

two

wee

ks la

ter.

The

cove

r pag

e sp

ecifi

es th

e fo

rmal

act

ion

requ

ired

as "c

asca

de th

roug

h th

e di

rect

orat

es a

nd

CE

O b

riefin

gs".

Doe

s "c

asca

de" m

ean

anyt

hing

mor

e th

an "j

ust f

lick

thro

ugh

the

page

s"?

•

Min

utes

from

21s

t Jul

y [A

pp. 3

3] It

em "T

B05

.86.

07 P

ropo

sed

bed

redu

ctio

ns" r

epor

ts m

eetin

gs w

ith th

e Fo

rum

on

18th

Feb

. and

19t

h Ju

ly. T

here

was

a p

ublic

mee

ting

of th

e Fo

rum

on

17th

Feb

., an

d a

few

mem

bers

atte

nded

mee

tings

at t

he h

ospi

tal o

n 25

th F

eb. a

nd

19th

Jul

y. W

e ar

e no

t aw

are

of a

ny m

eetin

g on

18t

h Fe

b.

•

The

min

utes

of t

he m

eetin

g on

29t

h S

ep. r

ecor

d: "T

he p

ropo

sal w

as d

evel

oped

end

of A

ugus

t ear

ly S

epte

mbe

r". A

s ex

plai

ned

abov

e, it

w

as o

nly

on 2

9th

Sep

. tha

t det

ails

wer

e gi

ven

to F

orum

mem

bers

: afte

r the

pub

lic a

nnou

ncem

ent t

he d

ay b

efor

e. T

here

is n

o w

ay th

at

this

can

be

cons

ider

ed c

onsu

ltatio

n.

•

Rem

uner

atio

n/H

R C

omm

ittee

[App

. 34]

"Sue

Elle

n st

ated

that

the

bed

clos

ures

and

sta

ffing

redu

ctio

ns s

houl

d ha

ve re

sulte

d in

gre

ater

sa

ving

s". S

teph

en C

lark

sai

d: "w

e ne

ed to

be

redu

cing

sta

ffing

leve

ls".

Thes

e st

atem

ents

app

ear t

o co

ntra

dict

Gai

l Wan

nell's

"pla

nned

w

ith m

ilita

ry p

reci

sion

": un

less

, of c

ours

e, s

he w

as th

inki

ng o

f fam

ous

mili

tary

dis

aste

rs.

•

Pat

ient

Exp

erie

nce

com

mitt

ee m

inut

es [A

pp. 3

5] T

he F

orum

's re

pres

enta

tive

stat

ed th

e P

PIF

vie

w th

at "t

hey

appe

ared

to b

e co

ntin

ually

‘p

layi

ng c

atch

up’

and

wer

e on

ly fi

ndin

g ou

t abo

ut c

hang

es a

fter t

he e

vent

… th

e Fo

rum

was

not

bei

ng in

volv

ed a

t the

pla

nnin

g st

age

whe

n th

ey c

ould

act

ually

con

tribu

te s

omet

hing

". A

Tru

st d

irect

or a

gree

d th

at "t

he T

rust

nee

ded

to w

ork

with

in th

e A

ct".

•

Per

form

ance

Rep

ort [

App

. 36]

"We

need

to e

nsur

e th

at p

erfo

rman

ce d

oes

not f

urth

er d

eter

iora

te, e

spec

ially

with

pot

entia

lly e

xtra

pr

essu

res

aris

ing

from

the

rece

nt re

duct

ion

in b

ed c

apac

ity, t

he o

nset

of W

inte

r and

the

impa

ct fr

om F

ebru

ary

of th

e A

shfo

rd e

mer

genc

y se

rvic

es re

conf

igur

atio

n." Y

et th

e Fo

rum

was

ass

ured

that

the

bed

redu

ctio

n w

ould

not

impa

ct o

n pa

tient

car

e. If

the

Foru

m is

bei

ng to

ld

one

stor

y an

d th

e Tr

ust B

oard

ano

ther

, thi

s su

gges

ts a

t bes

t bad

pla

nnin

g, (m

ilita

ry p

reci

sion

?), o

r at w

orst

del

iber

ate

dece

it. In

the

latte

r cas

e, a

ny c

onsu

ltatio

n is

tota

lly m

eani

ngle

ss.

130

Issu

e nu

mbe

rs a

nd n

umer

ical

app

endi

ces r

efer

to th

ose

in th

e PP

IF d

ocum

ent

App

endi

ces u

sed

in th

e Tr

ust r

espo

nse

sect

ion

use

the

PPIF

issu

e nu

mbe

r fol

low

ed b

y a

lette

r e.g

. 1A

, 5B

20

•

Fina

ncia

l upd

ate

[App

. 37]

Thi

s re

ports

"At t

he s

ame

time

a pr

opos

al to

‘tur

n aw

ay p

rimar

y ca

re re

late

d at

tend

ees

is b

eing

wor

ked

thro

ugh"

: alth

ough

this

was

not

men

tione

d to

the

PP

IF u

ntil

4th

Nov

embe

r, [A

pp. 4

2].

•

Fina

nce

sub

com

mitt

ee m

inut

es [A

pp. 3

8] "G

W c

onfir

med

that

the

Trus

t will

del

iver

on

bed

redu

ctio

ns fr

om O

ctob

er a

nd w

ill s

low

dow

n ex

pend

iture

on

train

ing,

dev

elop

men

t and

oth

er n

on-p

ay a

reas

" Opt

ions

men

tion

incl

ude

"Dow

nsiz

ing

outp

atie

nts"

and

"Tur

ning

aw

ay

prim

ary

care

pat

ient

s fro

m A

&E

, or c

appi

ng th

e le

vel a

t 04/

05 le

vels

". Th

ere

is n

o m

entio

n of

con

sulta

tion.

• N

ursi

ng A

cuity

& D

epen

denc

y [A

pp. 3

9] It

em 4

refe

rs to

a re

port

by L

eeds

Uni

vers

ity o

n S

yon

and

Cra

ne w

ards

. "4.

8 W

hils

t it i

s pl

easi

ng th

at o

ur n

urse

s in

bot

h w

ards

are

‘ext

raor

dina

rily

patie

nt c

entre

d’, i

t app

ears

that

impo

rtant

indi

rect

car

e ac

tiviti

es li

ke

com

mun

icat

ion

and

repo

rting

are

not

giv

en a

dequ

ate

time.

Thi

s ha

s po

tent

ial s

erio

us m

edic

o-le

gal c

onse

quen

ces

with

nur

ses

faili

ng to

as

sess

, pla

n an

d ev

alua

te th

eir c

are.

The

se c

ore-

nurs

ing

activ

ities

hav

e a

dire

ct im

pact

on

qual

ity o

f pro

visi

on a

nd m

ust n

ot b

e ig

nore

d."

"

4.11

… A

necd

otal

ly it

is re

cogn

ised

that

fron

t lin

e st

aff a

re fr

eque

ntly

exh

aust

ed b

y in

crea

sing

wor

kloa

d de

man

d an

d as

a re

sult

of th

e

co

mpl

exity

of t

he p

atie

nts"

"4.

15 T

he a

utho

r of t

he re

port

war

ns ‘T

his

prob

lem

is u

sual

ly a

sym

ptom

of e

xces

sive

wor

kloa

d an

d gr

ade-

mix

imba

lanc

e as

cor

ners

are

cu

t. M

edic

o-le

gally

this

is d

ange

rous

pra

ctic

e si

nce

tribu

nals

vie

w u

nrec

orde

d ca

re n

egat

ivel

y.’ …

"

B

oth

Cra

ne a

nd S

yon

unde

rsta

ffed.

No

men

tion

of th

is in

rela

tion

to th

e tw

o es

cala

tion

war

ds a

nd th

e pr

oble

m o

f sta

ffing

them

on

an a

d-

hoc

basi

s. Y

ou w

ould

hav

e to

que

stio

n S

C c

omm

ent o

n th

e ne

ed to

furth

er re

duce

sta

ffing

leve

ls.

Trus

t res

pons

e Th

e ex

tract

s ta

ken

from

var

ious

Tru

st p

aper

s in

this

sec

tion

clea

rly d

emon

stra

te a

n op

en a

nd a

cces

sibl

e et

hos

whi

ch p

uts

Trus

t bus

ines

s in

the

publ

ic d

omai

n. T

hese

exa

mpl

es a

nd e

xtra

cts

are

used

to:

a) c

ritic

ise

the

term

inol

ogy

used

to d

escr

ibe

the

oper

atio

nal p

roce

sses

with

in th

e Tr

ust

• B

oard

mee

ting

min

utes

are

by

nece

ssity

brie

f and

form

an

over

view

of p

roce

edin

gs.

• C

asca

ding

info

rmat

ion

thro

ugh

lines

of m

anag

emen

t is

the

rout

ine

met

hod

of d

isse

min

atin

g in

form

atio

n th

roug

hout

a la

rge

orga

nisa

tion.

•

Bei

ng ‘w

orke

d th

roug

h’ in

dica

tes

that

idea

s ar

e be

ing

form

ulat

ed. I

t is

not p

ract

ical

or r

easo

nabl

e to

exp

ect t

he tr

ust t

o ex

pose

the

foru

m

to a

ll po

tent

ial s

ubje

ct m

atte

r. In

the

inst

ance

quo

ted,

a p

aper

on

27th O

ctob

er s

tate

d an

issu

e w

as ‘b

eing

wor

ked

thro

ugh’

and

the

foru

m

rece

ived

a p

aper

the

follo

win

g w

eek

on 4

th N

ovem

ber w

ith a

pro

posa

l tha

t cle

arly

ask

ed fo

r com

men

ts o

r alte

rnat

ive

sugg

estio

ns. W

e co

nsid

er th

is to

be

an e

xam

ple

of c

onsu

ltatio

n.

• Th

e fin

ance

sub

com

mitt

ee is

an

exam

ple

of a

n op

erat

iona

l gro

up w

ithin

the

Trus

t whe

re id

eas

are

gene

rate

d an

d hi

gh le

vel d

iscu

ssio

n

131

Issu

e nu

mbe

rs a

nd n

umer

ical

app

endi

ces r

efer

to th

ose

in th

e PP

IF d

ocum

ent

App

endi

ces u

sed

in th

e Tr

ust r

espo

nse

sect

ion

use

the

PPIF

issu

e nu

mbe

r fol

low

ed b

y a

lette

r e.g

. 1A

, 5B

21

take

s pl

ace.

The

exa

mpl

es g

iven

, onc

e de

term

ined

to b

e an

are

a of

pot

entia

l cha

nge

wou

ld th

en b

e re

ason

able

to d

iscu

ss w

ith th

e fo

rum

– s

ee p

oint

abo

ve.

• H

R c

omm

ittee

min

utes

– th

e ex

tract

is ta

ken

out o

f con

text

– th

e p

lann

ed b

ed re

duct

ions

wer

e in

deed

inte

nded

to re

sult

in re

duce

d co

sts

– du

e to

incr

ease

d ac

tivity

this

had

not

mat

eria

lised

as

we

cont

inue

to s

taff

this

war

d. T

he e

xtra

ct a

ccur

atel

y re

cord

s th

e vi

ews

of

non-

exec

utiv

es c

halle

ngin

g m

anag

ers

to fi

nd a

ltern

ativ

e w

ays

to re

duce

cos

ts to

ach

ieve

sta

tuto

ry fi

nanc

ial t

arge

ts.

b)

dem

onst

rate

a m

istru

st o

f inf

orm

atio

n su

pplie

d.

• Th

e fo

rum

and

the

boar

d ar

e ex

pose

d to

the

sam

e in

form

atio

n as

is d

emon

stra

ted

by th

e fo

rum

s ab

ility

to q

uote

from

thes

e do

cum

ents

c)

Lan

guag

e us

ed is

indi

cativ

e of

the

poor

rela

tions

hip

with

the

Trus

t •

The

Trus

t tak

es o

bjec

tion

to th

e ac

cusa

tion

of d

elib

erat

e de

ceit

and

wou

ld p

oint

to th

e ex

trem

e le

ngth

s to

whi

ch T

rust

sta

ff ha

ve g

one

to

keep

foru

m m

embe

rs a

ppra

ised

of t

he e

ver c

hang

ing

situ

atio

n.

• Th

e su

bjec

tive

com

men

ts a

bout

the

Chi

ef E

xecu

tive’

s de

scrip

tion

are

unne

cess

ary.

132

Issu

e nu

mbe

rs a

nd n

umer

ical

app

endi

ces r

efer

to th

ose

in th

e PP

IF d

ocum

ent

App

endi

ces u

sed

in th

e Tr

ust r

espo

nse

sect

ion

use

the

PPIF

issu

e nu

mbe

r fol

low

ed b

y a

lette

r e.g

. 1A

, 5B

22

Issu

e 26

. Con

sulta

tion

on re

duct

ion

in A

&E

Serv

ice

Com

men

tary

from

PPI

foru

m

On

4th

Nov

embe

r Alis

on M

cInt

osh

emai

led

PP

IF m

embe

rs a

n at

tach

men

t with

no

cove

r not

e. A

t the

end

of t

he a

ttach

men

t was

a b

rief a

nd

vagu

e pr

opos

al w

ith a

requ

est t

o re

spon

d by

14t

h N

ovem

ber,

[App

. 42]

. The

two

coch

airs

ther

efor

e re

ques

ted

a m

eetin

g to

obt

ain

mor

e de

tail,

an

d in

clud

ed a

list

of q

uest

ions

, [A

pp. 4

3]. N

o re

ply

was

forth

com

ing,

des

pite

a re

min

der:

but J

oe J

ohns

on e

vent

ually

sch

edul

ed th

e m

eetin

g fo

r 24

th N

ovem

ber.

Thre

e ho

urs

befo

re th

e m

eetin

g, a

mes

sage

was

left

for o

ne o

f the

coc

hairs

, can

celli

ng th

e m

eetin

g. It

was

rece

ived

just

one

hou

r bef

ore

the

mee

ting.

No

mes

sage

had

bee

n le

ft fo

r the

oth

er c

ocha

ir, w

ho a

t tha

t poi

nt w

as ju

st a

bout

to le

ave

hom

e to

bra

ve th

e dr

ivin

g sl

eet a

nd fa

ce a

on

e ho

ur jo

urne

y to

atte

nd th

e m

eetin

g. W

e w

ere

stag

gere

d at

this

unp

rofe

ssio

nal a

ttitu

de. T

he m

eetin

g w

as re

sche

dule

d fo

r 6th

Dec

embe

r. H

owev

er, t

his

was

als

o ca

ncel

led

on th

e af

tern

oon

of th

e m

eetin

g. O

n th

is o

ccas

ion

mes

sage

s w

ere

left

for b

oth

coch

airs

, exp

lain

ing

that

the

Trus

t has

now

put

its

plan

s fo

r A&

E o

n ho

ld, a

nd e

xpec

ts to

con

sult

the

Foru

m "e

arly

in th

e N

ew Y

ear"

. W

e w

onde

r whe

ther

it is

coi

ncid

ence

that

the

plan

s sh

ould

sud

denl

y be

put

on

hold

just

a fe

w h

ours

bef

ore

the

resc

hedu

led

mee

ting.

Non

e of

th

e qu

estio

ns h

as y

et b

een

answ

ered

. Tr

ust r

espo

nse

The

pape

r sen

t by

Alis

on M

cInt

osh

prov

ided

a c

onci

se re

sum

e of

the

issu

e w

ith id

eas

for a

pro

posa

l to

addr

ess

the

prob

lem

of i

ncre

asin

g de

man

ds o

n ou

r A&

E d

epar

tmen

t.

The

pro

posa

l end

ed ‘t

he p

atie

nt fo

rum

is a

sked

to c

onsi

der t

his

prop

osal

and

resp

ond

to A

lison

McI

ntos

h by

14th

Nov

embe

r 200

5. W

e w

elco

me

com

men

t on

the

sugg

este

d ap

proa

ch a

bove

or a

ltern

ativ

es w

hich

will

help

us

addr

ess

the

prob

lem

’.

On

the

14th a

requ

est f

or a

mee

ting

was

rece

ived

and

fina

lly a

rran

ged

for o

ne o

f the

ir su

gges

ted

date

s. A

t lun

ch ti

me

on th

e af

tern

oon

in

ques

tion

Alis

on w

as re

ques

ted

to a

ddre

ss u

rgen

t mat

ters

at a

mee

ting

at th

e S

HA

and

ther

efor

e ha

d to

can

cel.

We

are

sorry

that

bot

h vi

sito

rs

wer

e no

t con

tact

ed p

erso

nally

. O

n th

e se

cond

occ

asio

n, c

ance

llatio

n by

Alis

on w

as fo

r per

sona

l rea

sons

; her

inte

nt w

as to

hol

d th

e m

eetin

g an

d th

ey w

ould

hav

e be

en

info

rmed

that

this

pro

posa

l was

no

long

er a

cur

rent

opt

ion

and

that

sho

uld

the

idea

be

mut

ed a

gain

, the

foru

m w

ould

be

cons

ulte

d at

that

tim

e.

This

is th

e re

ason

that

a fo

llow

up

mee

ting

was

not

requ

ired

on th

is s

ubje

ct. A

ll th

e qu

estio

ns re

late

d to

the

prop

osal

and

ther

efor

e w

ere

not

atte

nded

to in

ligh

t of t

his

proj

ect b

eing

put

on

the

back

bur

ner.

This

can

be

reso

lved

.

133

Issu

e nu

mbe

rs a

nd n

umer

ical

app

endi

ces r

efer

to th

ose

in th

e PP

IF d

ocum

ent

App

endi

ces u

sed

in th

e Tr

ust r

espo

nse

sect

ion

use

the

PPIF

issu

e nu

mbe

r fol

low

ed b

y a

lette

r e.g

. 1A

, 5B

23

Issu

e 27

. Pa

per f

or P

atie

nt E

xper

ienc

e C

omm

ittee

C

omm

enta

ry fr

om P

PI fo

rum

A

pap

er o

n co

nsul

tatio

n w

ith th

e P

PI F

orum

con

tain

ing

seve

ral g

larin

g er

rors

, for

pre

sent

atio

n to

the

Pat

ient

Exp

erie

nce

Com

mitt

ee o

n 8th

D

ecem

ber,

[App

. 44]

, was

han

ded

to a

For

um m

embe

r the

eve

ning

bef

ore

the

PE

C m

eetin

g. W

e do

not

kno

w w

heth

er th

is w

as a

n ac

t of

obst

inac

y or

one

of i

ncom

pete

nce.

A re

spon

se w

as e

mai

led

the

sam

e ni

ght,

reca

lling

the

prev

ious

ly n

otifi

ed c

onsu

ltatio

n cr

iteria

and

co

nsul

tatio

n pr

oces

s. W

e do

not

yet

kno

w w

heth

er th

e pa

per w

as w

ithdr

awn,

or w

heth

er it

was

pre

sent

ed w

ith e

rror

s or

with

(val

id) c

orre

ctio

ns.

Trus

t res

pons

e O

ur s

taff

are

not o

bstin

ate

nor i

ncom

pete

nt a

nd th

ese

wor

ds d

emon

stra

te o

nce

agai

n th

e di

sres

pect

that

som

e fo

rum

mem

bers

di

spla

y to

war

ds o

ur s

taff,

who

con

sist

ently

atte

mpt

to re

tain

a w

orki

ng re

latio

nshi

p to

impr

ove

the

patie

nt e

xper

ienc

e. W

e w

ould

re

ally

app

reci

ate

a re

latio

nshi

p w

ith th

e fo

rum

that

is a

ble

to p

rovi

de a

crit

ical

eye

with

out b

eing

offe

nsiv

e an

d in

sulti

ng.

This

ext

ract

is ta

ken

from

the

first

dra

ft of

a ‘g

uida

nce

for s

taff’

pap

er in

tend

ed to

rais

e aw

aren

ess

of T

rust

sta

ff to

the

need

to

cons

ult w

ith th

e fo

rum

and

or h

ealth

scr

utin

y co

mm

ittee

whe

n co

nsid

erin

g ch

ange

s in

ser

vice

s.

The

basi

s of

this

gui

danc

e ha

s be

en d

evel

oped

from

info

rmat

ion

gain

ed a

t the

con

sulta

tion

wor

ksho

p an

d th

ere

are

fund

amen

tal

erro

rs e

.g. w

here

‘Sco

pe’ i

s m

entio

ned

as th

e ad

min

istra

tive

supp

ort t

eam

sup

porti

ng th

e fo

rum

– th

e cu

rren

t sup

port

is n

ow

faci

litat

ed th

roug

h ‘in

hous

e fo

rum

sup

port’

– th

e fir

st d

raft

refe

rred

to th

e fo

rmer

. Th

e pa

tient

exp

erie

nce

com

mitt

ee, o

f whi

ch J

ean

Doh

erty

is a

mem

ber,

is a

sub

com

mitt

ee o

f the

Tru

st B

oard

at w

hich

dra

ft pa

pers

ar

e pr

esen

ted

for c

omm

ent.

Jean

was

not

pre

sent

at t

he la

st tw

o m

eetin

gs. W

hils

t we

ende

avou

r to

prov

ide

pape

rs in

a ti

mel

y m

anne

r for

mee

tings

, wor

k in

pro

gres

s up

to th

e da

te o

f the

mee

ting

may

be

tabl

ed, t

he m

embe

rs a

sked

to c

omm

ent p

rior t

o th

e ne

xt m

eetin

g.

This

did

app

ear a

t the

last

com

mitt

ee m

eetin

g an

d re

mai

ns ‘w

ork

in p

rogr

ess’

.

134

Issu

e nu

mbe

rs a

nd n

umer

ical

app

endi

ces r

efer

to th

ose

in th

e PP

IF d

ocum

ent

App

endi

ces u

sed

in th

e Tr

ust r

espo

nse

sect

ion

use

the

PPIF

issu

e nu

mbe

r fol

low

ed b

y a

lette

r e.g

. 1A

, 5B

24

Issu

es re

latin

g to

Poo

r Dat

a Q

ualit

y

• 10

. Tru

st c

once

rn in

Jun

e 20

05 th

at p

ropo

sed

war

d cl

osur

e st

ill n

ot q

uant

ified

C

omm

enta

ry fr

om P

PI fo

rum

In

Jun

e 20

05, a

pap

er p

rese

nted

at t

he T

rust

Boa

rd m

eetin

g on

the

"Fin

anci

al R

ecov

ery

Pla

n P

rogr

ess

Upd

ate"

repo

rted

as fo

llow

s th

at p

lans

to c

lose

30

beds

wer

e st

ill un

der d

iscu

ssio

n, th

at th

e pr

opos

ed s

avin

gs h

ad n

ot y

et b

een

fully

qua

ntifi

ed, a

nd th

at th

e ac

tion

plan

had

not

yet

bee

n de

velo

ped.

[App

. 13

& 1

4]

S

avin

gs p

lan

area

: Bed

Clo

sure

s –

30 A

cute

bed

s Ke

y Ac

hiev

emen

ts S

ince

Las

t Rep

ort:

Roa

d m

ap o

f act

ions

requ

ired

to d

eliv

er b

ed c

losu

res

has

been

dev

elop

ed a

nd is

now

und

er

disc

ussi

on.

Cur

rent

Con

cern

s: L

evel

and

tim

ing

of s

avin

gs th

at c

an b

e m

ade

as a

resu

lt of

the

revi

ew h

ave

not y

et b

een

fully

qua

ntifi

ed a

nd

revi

ewed

by

the

exec

s.

Rea

sons

for V

aria

nce

and

Actio

ns T

aken

: Act

ion

plan

to b

e de

velo

ped

Trus

t res

pons

e It

is u

ncle

ar fr

om th

e PP

I com

men

tary

how

this

rela

tes

to p

oor d

ata

qual

ity. I

t is

reco

rded

that

the

quan

tific

atio

n an

d su

bseq

uent

ac

tions

are

yet

to b

e de

velo

ped.

Pro

gres

s w

ith p

lans

for w

ard

clos

ures

was

out

lined

in th

e ro

adm

ap th

at id

entif

ied

our k

ey w

ork

area

s to

ach

ieve

bed

clo

sure

s. T

he ti

min

g of

the

clos

ure

was

nev

er u

nder

dis

pute

and

had

bee

n co

mm

unic

ated

to th

e fo

rum

from

Ja

nuar

y 20

05 o

nwar

ds. T

his

was

a v

ery

com

plex

pie

ce o

f wor

k an

d th

e tim

ing

of s

avin

gs w

as h

eavi

ly d

epen

dent

upo

n us

bei

ng

able

to a

chie

ve th

e re

duct

ion

in b

ed c

apac

ity. T

he ro

adm

ap a

nd o

ur G

AN

T ch

arts

dem

onst

rate

d th

ese

plan

s.

We

are

awar

e th

at o

ur s

tatis

tics

can

be d

iffic

ult t

o in

terp

ret a

nd in

ord

er to

hel

p fo

rum

mem

bers

to b

ette

r und

erst

and

the

info

rmat

ion

bein

g us

ed to

gen

erat

e id

eas

and

plan

futu

re b

ed c

onfig

urat

ion,

the

co c

hairs

atte

nded

a 2

hou

r mee

ting

with

Pet

er G

ill, D

irect

or o

f I,M

&T

on 1

6th F

ebru

ary

2006

.

135

Issu

e nu

mbe

rs a

nd n

umer

ical

app

endi

ces r

efer

to th

ose

in th

e PP

IF d

ocum

ent

App

endi

ces u

sed

in th

e Tr

ust r

espo

nse

sect

ion

use

the

PPIF

issu

e nu

mbe

r fol

low

ed b

y a

lette

r e.g

. 1A

, 5B

25

•

11. U

nrel

iabl

e da

ta o

n pr

opos

ed w

ard

clos

ure

sent

to F

orum

C

omm

enta

ry fr

om P

PI fo

rum

Th

e P

PIF

was

sen

t a c

opy

of d

etai

ls s

ent t

o O

verv

iew

& S

crut

iny,

with

two

tabl

es li

stin

g cu

rrent

and

pro

ject

ed b

ed c

apac

ities

: al

thou

gh th

e co

lum

n to

tals

quo

ted

in th

e se

cond

tabl

e ha

d pa

tent

ly n

ot b

een

chec

ked,

as

the

"Site

tota

l" (3

69) w

as le

ss th

an th

e "N

orm

al" t

otal

(373

). [A

pp. 1

5]

Trus

t res

pons

e A

polo

gies

– th

is w

as a

n er

ror i

n th

e ad

ditio

n of

a c

olum

n.

136

Issu

e nu

mbe

rs a

nd n

umer

ical

app

endi

ces r

efer

to th

ose

in th

e PP

IF d

ocum

ent

App

endi

ces u

sed

in th

e Tr

ust r

espo

nse

sect

ion

use

the

PPIF

issu

e nu

mbe

r fol

low

ed b

y a

lette

r e.g

. 1A

, 5B

26

• 15

. Del

ays

and

erro

rs in

sup

plyi

ng d

ata

on w

aitin

g lis

ts a

nd c

ance

llatio

ns.

C

omm

enta

ry fr

om P

PI fo

rum

O

n 16

th S

epte

mbe

r the

For

um re

ques

ted

deta

ils o

f wai

ting

lists

and

of c

ance

lled

oper

atio

ns, [

App

. 22,

pag

e 1]

, whi

ch w

e w

ante

d to

st

udy

and

dige

st in

goo

d tim

e be

fore

the

mee

ting

on b

ed c

losu

res.

Fiv

e fu

rther

rem

inde

rs w

ere

sent

ove

r the

follo

win

g m

onth

. A

repl

y w

as o

btai

ned

just

50

min

utes

bef

ore

the

bed

clos

ure

mee

ting

on 2

9th

Sep

tem

ber:

but a

t the

mee

ting

Gai

l Wan

nell

real

ised

th

at th

e fig

ures

wer

e w

rong

. A p

artia

l rep

ly w

as re

ceiv

ed o

n 10

th O

ctob

er, w

ith .X

LS a

nd S

NP

atta

chm

ents

. The

form

er

(rep

rodu

ced

in [A

pp. 2

2, p

age

2]) d

oes

not i

nclu

de th

e re

ques

ted

mon

thly

bre

akdo

wn

over

the

past

yea

r, an

d ra

ises

furth

er d

oubt

s ab

out t

he s

igni

fican

ce o

f the

"sus

pend

ed p

atie

nts"

not

incl

uded

in th

e fig

ures

. The

latte

r is

unin

tellig

ible

: and

the

cove

ring

emai

l (no

t re

prod

uced

her

e in

its

entir

ety,

as

it co

ntai

ns c

ontri

butio

ns fr

om th

ree

Trus

t sta

ff in

eig

ht d

iffer

ent f

onts

) con

tain

s th

e fo

llow

ing

war

ning

. –

Plea

se fi

nd a

ttach

ed th

e KH

07 a

nd A

dditi

ons

and

Rem

oval

s re

ports

for t

he

wee

k en

ding

25

Sept

embe

r 200

5.

Ther

e is

a k

now

n is

sue

with

a s

mal

l num

ber o

f pat

ient

s ap

pear

ing

in th

e lo

ng

wai

ting

time

band

s of

the

KH07

who

sho

uld

not b

e sh

own

ther

e. I

am lo

okin

g in

to th

is is

sue

and

hope

to h

ave

a re

solu

tion

shor

tly.

Trus

t res

pons

e It

is n

ot a

lway

s po

ssib

le to

com

ply

quic

kly

with

all

requ

ests

for i

nfor

mat

ion

for o

pera

tiona

l rea

sons

, but

we

mee

t mos

t req

uest

s in

a

timel

y fa

shio

n. T

he T

rust

is c

onst

antly

see

king

to im

prov

e th

e ro

bust

ness

and

acc

urac

y of

info

rmat

ion

in re

spon

se to

man

ager

s an

d ot

her s

take

hold

er’s

requ

ests

. Onc

e ge

nera

ted,

som

etim

es in

a fo

rmat

det

erm

ined

eith

er n

atio

nally

or r

egio

nally

, it m

ay n

ot b

e co

nduc

ive

to p

erso

nal c

ompu

ter s

oftw

are

avai

labl

e to

foru

m m

embe

rs. W

e ha

ve s

ugge

sted

that

the

foru

m c

hoos

e th

e da

ta th

ey

rout

inel

y w

ant t

o re

ceiv

e an

d th

at w

e en

sure

thei

r und

erst

andi

ng o

f tab

les,

gra

phs

and

term

inol

ogy

used

. As

men

tione

d ab

ove

the

co c

hairs

rece

ived

initi

al tr

aini

ng to

equ

ip th

em w

ith th

is k

now

ledg

e to

mak

e th

is c

hoic

e an

d in

terp

ret t

his

info

rmat

ion

on 1

6th

Febr

uary

200

6.

137

Issu

e nu

mbe

rs a

nd n

umer

ical

app

endi

ces r

efer

to th

ose

in th

e PP

IF d

ocum

ent

App

endi

ces u

sed

in th

e Tr

ust r

espo

nse

sect

ion

use

the

PPIF

issu

e nu

mbe

r fol

low

ed b

y a

lette

r e.g

. 1A

, 5B

27

• 18

. Dat

a ac

cess

ibili

ty a

nd p

rese

ntat

ion:

Com

men

tary

from

PPI

foru

m

Gra

phic

inte

rpre

tatio

ns o

f the

"bed

mod

el" c

hang

es (i

.e. w

ard

clos

ures

) wer

e re

ceiv

ed o

n 10

th O

ctob

er, [

App

. 26]

. The

se w

ere

rece

ived

as

Pow

erP

oint

pre

sent

atio

ns. M

ost m

embe

rs o

f our

For

um h

ave

no a

cces

s to

Pow

erP

oint

: and

as

Pow

erP

oint

dis

play

s on

ly o

ne o

f the

se a

t a ti

me,

it re

quire

s m

ore

IT s

kill

than

mos

t mem

bers

pos

sess

to v

iew

the

two

char

ts s

imul

tane

ousl

y fo

r co

mpa

rison

. Com

paris

on o

f the

two

diag

ram

s in

dica

tes

the

clos

ure

of tw

o w

ards

(Cra

ne 1

and

Cra

ne 2

), to

tallin

g 61

bed

s. A

t the

bo

ttom

of t

he s

econ

d di

agra

m is

a n

ew s

ectio

n, re

ferri

ng to

28

beds

; tho

ugh

with

no

geog

raph

ical

loca

tion.

The

frag

men

ted

man

ner

in w

hich

info

rmat

ion

is s

uppl

ied

mak

es it

ver

y di

fficu

lt to

det

erm

ine

wha

t is

happ

enin

g at

the

hosp

ital.

The

grea

t del

ays

in o

btai

ning

in

form

atio

n m

ean

that

, far

from

bei

ng c

onsu

lted

abou

t fut

ure

even

ts, t

he F

orum

is n

ot e

ven

bein

g ke

pt u

p to

dat

e w

ith c

hang

es th

at

have

alre

ady

occu

rred

. Th

e sa

me

day

we

wer

e em

aile

d th

e "S

ITR

EP

" rep

ort,

with

out c

omm

enta

ry, [

App.

27]

. As

mos

t of t

he e

ntrie

s ar

e ei

ther

zer

o or

bl

ank,

the

info

rmat

ion

conv

eyed

to F

orum

mem

bers

is lo

w. T

he d

ata

desc

riptio

ns a

re o

bscu

re: e

.g. S

ectio

n A

refe

rs to

Typ

es I,

II,

and

III, w

ithou

t any

exp

lana

tion

of w

hat t

hese

may

be.

Com

pute

d va

lues

app

ear t

o be

inco

rrect

: e.g

. ite

m D

1, c

olum

n 3

show

s 0.

00%

(alle

gedl

y co

rrec

t to

two

deci

mal

pla

ces)

– y

et, w

hile

it is

not

cle

ar w

heth

er th

is is

inte

nded

to re

pres

ent 4

/ 31

6 or

5 /

316,

th

ese

shou

ld d

ispl

ay (t

o tw

o de

cim

al p

lace

s) a

s 0.

01 a

nd 0

.02,

resp

ectiv

ely.

The

fina

l sec

tion,

for T

rust

com

men

tary

, is

tota

lly b

lank

: su

gges

ting

eith

er th

at th

e Tr

ust i

s su

bjec

t to

no p

ress

ures

(whi

ch w

e do

not

bel

ieve

), or

that

they

are

una

ble

to a

gree

a v

iew

to

repo

rt, (w

hich

we

thin

k m

ore

likel

y).

Trus

t res

pons

e Th

e Tr

ust m

akes

eve

ry e

ffort

to e

nsur

e th

at d

iagr

ams

are

com

plet

e an

d pr

esen

ted

in a

way

that

is u

nder

stan

dabl

e to

the

audi

ence

. W

e ar

e al

way

s ha

ppy

to e

xpla

in in

form

atio

n th

at w

e ha

ve p

rovi

ded

whe

n as

ked

to d

o so

. In

the

exam

ple

give

n th

e ne

w w

ard

title

(K

ew W

ard)

was

om

itted

in e

rror

. A

s st

ated

abo

ve, t

he d

ata

desc

riptio

ns u

sed

requ

ire k

now

ledg

e th

at w

e ha

ve s

tarte

d to

impa

rt to

the

foru

m c

o ch

airs

in o

rder

that

th

ey c

an in

terp

ret t

he in

form

atio

n w

e su

pply

. Thi

s w

ill al

so e

nabl

e th

em to

reac

h th

eir o

wn

conc

lusi

ons

base

d on

dat

a re

ceiv

ed. I

t is

not p

ract

ical

or c

ost e

ffect

ive

for t

he T

rust

to u

nder

take

det

aile

d na

rrat

ive

on e

ach

occa

sion

.

138

Issu

e nu

mbe

rs a

nd n

umer

ical

app

endi

ces r

efer

to th

ose

in th

e PP

IF d

ocum

ent

App

endi

ces u

sed

in th

e Tr

ust r

espo

nse

sect

ion

use

the

PPIF

issu

e nu

mbe

r fol

low

ed b

y a

lette

r e.g

. 1A

, 5B

28

We

sugg

est t

hat t

he fo

rum

nee

ds to

add

ress

the

issu

es o

f com

pute

r lite

racy

and

ava

ilabi

lity

of s

oftw

are

with

thei

r for

um s

uppo

rt te

am to

ena

ble

them

to m

ake

best

use

of t

he in

form

atio

n w

e pr

ovid

e th

em. T

hey

coul

d al

so g

et fu

rther

ass

ista

nce

to u

nder

stan

d th

e in

form

atio

n by

acc

essi

ng th

e D

ept o

f Hea

lth li

brar

y w

hich

will

prov

ide

them

with

a d

ictio

nary

of t

erm

inol

ogy

and

defin

ition

s of

in

form

atio

n th

at w

e ar

e re

quire

d to

pro

vide

nat

iona

lly. I

ndee

d th

e fo

rum

may

wis

h to

pur

sue

the

poss

ibilit

y of

hav

ing

dire

ct a

cces

s to

th

e S

TEIS

web

site

whe

re th

ey m

ay b

e ab

le to

vie

w th

e w

eekl

y in

form

atio

n su

bmitt

ed b

y th

e Tr

ust.

O

nce

agai

n th

e en

d co

mm

ent i

llust

rate

s th

e co

ntem

pt w

ith w

hich

som

e of

the

foru

m m

embe

rs a

ppea

r to

show

the

hosp

ital

man

agem

ent.

139

Issu

e nu

mbe

rs a

nd n

umer

ical

app

endi

ces r

efer

to th

ose

in th

e PP

IF d

ocum

ent

App

endi

ces u

sed

in th

e Tr

ust r

espo

nse

sect

ion

use

the

PPIF

issu

e nu

mbe

r fol

low

ed b

y a

lette

r e.g

. 1A

, 5B

29

•

25. S

tric

tly C

onfid

entia

l" a

ppen

dix:

Com

men

tary

from

PPI

foru

m

A B

oard

pap

er o

n pu

blis

hed

on th

e Tr

ust's

web

site

and

mai

led

to re

gula

r atte

ndee

s co

ntai

ns a

n ap

pend

ix m

arke

d "S

trict

ly

Con

fiden

tial",

[App

. 39]

. If t

his

is h

ow th

e ho

spita

l tre

ats

its o

wn

stric

tly c

onfid

entia

l dat

a, it

insp

ires

no tr

ust o

r con

fiden

ce th

at s

taff

will

mai

ntai

n th

e co

nfid

entia

lity

of p

atie

nts'

per

sona

l dat

a.

Trus

t res

pons

e Th

e pa

per r

efer

red

to w

as p

rese

nted

as

part

of th

e Tr

ust b

oard

pap

er a

bout

nur

sing

ski

ll m

ix. T

his

exte

rnal

ana

lysi

s w

as re

ceiv

ed

as a

‘stri

ctly

con

fiden

tial’

docu

men

t but

the

Dire

ctor

of N

ursi

ng w

as k

een

to s

hare

this

impo

rtant

det

ail w

ith th

e Tr

ust B

oard

. The

de

cisi

on to

pub

lish

with

the

boar

d pa

pers

was

del

iber

ate

and

shou

ld h

ave

had

the

‘stri

ctly

con

fiden

tial’

labe

l rem

oved

. W

e ar

e un

sure

how

the

foru

m c

ould

dra

w c

oncl

usio

ns in

resp

ect o

f ris

k to

pat

ient

con

fiden

tialit

y fro

m th

is o

pen

shar

ing

of

info

rmat

ion.

140

Issu

e nu

mbe

rs a

nd n

umer

ical

app

endi

ces r

efer

to th

ose

in th

e PP

IF d

ocum

ent

App

endi

ces u

sed

in th

e Tr

ust r

espo

nse

sect

ion

use

the

PPIF

issu

e nu

mbe

r fol

low

ed b

y a

lette

r e.g

. 1A

, 5B

30

Issu

es re

latin

g to

del

ays

in s

uppl

ying

info

rmat

ion

•

8. D

elay

of 6

½ m

onth

s in

ans

wer

ing

ques

tions

on

Stro

ke U

nit

C

omm

enta

ry fr

om P

PI fo

rum

In

May

200

5, D

r. P

latt,

a c

onsu

ltant

from

the

hosp

ital,

kind

ly s

poke

at a

pub

lic m

eetin

g of

the

PP

IF o

n th

e su

bjec

t of s

troke

s. A

s he

ha

d to

rush

aw

ay d

urin

g th

e in

terv

al, q

uest

ions

rela

ting

to h

is ta

lk w

ere

emai

led

to J

oe J

ohns

on (C

ompl

aint

s M

anag

er).

Des

pite

re

peat

ed re

min

ders

, no

resp

onse

was

obt

aine

d un

til la

te o

n th

e ev

enin

g of

28t

h N

ovem

ber:

over

six

mon

ths

late

r, an

d ju

st o

ne d

ay

befo

re th

e fo

rmal

refe

rral

to O

verv

iew

and

Scr

utin

y. [A

pp. 1

1]

Trus

t res

pons

e O

n th

is o

ccas

ion

the

requ

este

d in

form

atio

n to

ok s

ome

time

to re

triev

e fro

m th

e cl

inic

ian

invo

lved

how

ever

we

apol

ogis

e fo

r the

ex

tend

ed ti

me

it to

ok to

pro

vide

this

furth

er in

form

atio

n. T

his

apol

ogy

was

giv

en a

t the

tim

e.

141

Issu

e nu

mbe

rs a

nd n

umer

ical

app

endi

ces r

efer

to th

ose

in th

e PP

IF d

ocum

ent

App

endi

ces u

sed

in th

e Tr

ust r

espo

nse

sect

ion

use

the

PPIF

issu

e nu

mbe

r fol

low

ed b

y a

lette

r e.g

. 1A

, 5B

31

•

16. H

ealth

Impa

ct A

sses

smen

t – w

as o

ne p

erfo

rmed

? C

omm

enta

ry fr

om P

PI fo

rum

A

t the

mee

ting

on 2

9th

Sep

tem

ber w

here

we

wer

e in

form

ed o

f the

bed

clo

sure

s, w

e as

ked

whe

ther

a H

ealth

Impa

ct A

sses

smen

t ha

d be

en p

rodu

ced,

and

wer

e to

ld b

y P

atric

ia D

avie

s th

at o

ne h

ad. W

e re

ques

ted

a co

py o

f thi

s by

em

ail o

n 3r

d, 7

th, 2

7th,

31s

t O

ctob

er, [

App.

24]

. We

wer

e su

rpris

ed th

at, a

lthou

gh th

e Fo

rum

's d

ecis

ion

to re

fer t

he T

rust

to O

verv

iew

& S

crut

iny

was

mad

e pu

blic

and

not

ified

to th

e Tr

ust o

n 17

th O

ctob

er, t

his

did

not e

xped

ite a

repl

y.

On

3rd

Oct

ober

the

hosp

ital i

ssue

d a

pres

s re

leas

e, [A

pp. 2

5], a

void

ing

stat

ing

how

man

y be

ds h

ad b

een

clos

ed, b

ut ra

tiona

lisin

g th

is o

n gr

ound

s of

"im

prov

e[d]

pat

ient

car

e an

d ef

ficie

ncy"

, tog

ethe

r with

resu

ltant

sav

ings

, and

cla

imin

g th

at th

e ch

ange

s ha

d be

en

"pla

nned

for m

any

mon

ths

in c

onsu

ltatio

n w

ith d

octo

rs a

nd s

enio

r nur

ses"

, (th

ough

not

with

pat

ient

s or

the

Foru

m).

W

e w

ere

amaz

ed o

n 4t

h N

ovem

ber t

o re

ceiv

e an

em

ail f

rom

Alis

on M

cInt

osh

[App

. 41]

den

ying

that

any

exp

licit

Hea

lth Im

pact

A

sses

smen

t for

the

bed

clos

ures

ann

ounc

ed a

t the

AG

M h

ad b

een

perfo

rmed

, apa

rt fro

m th

eir d

aily

revi

ew o

f the

bed

situ

atio

n:

"The

bed

mod

el im

pact

ass

essm

ent t

hat w

e re

ferre

d to

is in

fact

wha

t we

do o

n a

daily

bas

is".

Giv

en th

at n

urse

s at

tend

ing

the

Trus

t's A

GM

sta

ted

that

they

had

lear

nt o

f the

clo

sure

that

wee

k, (o

nly

whe

n th

ey a

rriv

ed a

t wor

k on

the

Mon

day

mor

ning

and

foun

d th

eir c

usto

mar

y w

ard

clos

ed),

her s

tate

men

t "W

e ha

ve n

ot c

lose

d th

e w

ard

yet a

s yo

u al

read

y kn

ow" p

resu

mab

ly re

fers

to th

e (re

open

ed) e

scal

atio

n w

ard.

The

PP

IF h

as th

us b

een

unab

le to

obt

ain

relia

ble

and

cons

iste

nt in

form

atio

n on

wha

t pla

nnin

g (if

any

) th

e Tr

ust m

ay h

ave

cond

ucte

d, (w

heth

er H

ealth

Impa

ct A

sses

smen

t or b

usin

ess

case

) whi

lst p

lann

ing

the

bed

clos

ures

.

142

Issu

e nu

mbe

rs a

nd n

umer

ical

app

endi

ces r

efer

to th

ose

in th

e PP

IF d

ocum

ent

App

endi

ces u

sed

in th

e Tr

ust r

espo

nse

sect

ion

use

the

PPIF

issu

e nu

mbe

r fol

low

ed b

y a

lette

r e.g

. 1A

, 5B

32

Trus

t res

pons

e Th

e eq

uiva

lent

of a

hea

lth im

pact

ass

essm

ent i

n th

is ty

pe o

f hos

pita

l-bas

ed c

hang

e is

doc

umen

ted

in

wha

t we

desc

ribe

as a

road

map

. (16

A) I

t has

bee

n di

fficu

lt to

impr

ess

upon

the

foru

m, t

hat t

he ro

ad

map

to w

hich

they

wer

e ex

pose

d co

ntai

ns th

e in

form

atio

n th

ey s

ough

t. Th

is ro

ad m

ap d

etai

ls w

hat i

s re

quire

d to

hap

pen

to a

chie

ve th

e pl

anne

d be

d re

duct

ion

in a

num

ber

of a

reas

. Th

is w

as p

rovi

ded

to a

nd e

xpla

ined

at t

he m

eetin

g on

Jul

y 19

th (s

ee is

sue

14) T

he m

onito

ring

of a

ll co

mpo

nent

s w

ithin

this

pla

n w

as u

nder

take

n w

ith c

linic

al a

nd m

anag

eria

l lea

ds o

n a

mon

thly

bas

is a

nd

repo

rted

in th

e Tr

ust B

oard

repo

rts. T

he m

onito

ring

of th

e im

pact

of t

hese

cha

nges

is d

one

on a

dai

ly

and

wee

kly

basi

s. T

he k

ey c

ompo

nent

s of

this

mon

itorin

g ar

e; A

&E

wai

ting

time

perfo

rman

ce, d

aily

em

erge

ncy

adm

issi

ons

and

disc

harg

es, w

eekl

y re

view

of c

ance

llatio

ns, w

aitin

g lis

t mov

emen

t and

le

ngth

of p

atie

nt s

tay.

In a

dditi

on to

this

we

revi

ew o

n a

daily

bas

is s

taffi

ng le

vels

acr

oss

the

Trus

t.

Oth

er m

echa

nism

s fo

r mea

surin

g im

pact

are

com

plai

nts

and

PA

LS d

ata

and

nurs

ing

depe

nden

cy

info

rmat

ion.

In

clud

ed in

the

proc

ess

of c

hang

e w

as c

onsu

ltatio

n w

ith s

taff

and

staf

f sid

e re

pres

enta

tives

. It w

as

unfo

rtuna

te th

at s

ever

al m

embe

rs o

f sta

ff he

ard

abou

t the

pla

nned

clo

sure

bef

ore

thei

r man

ager

had

the

oppo

rtuni

ty to

spe

ak w

ith th

em. T

he fo

rum

was

info

rmed

in c

onfid

ence

how

this

had

com

e ab

out p

rior t

o th

e pu

blic

mee

ting.

Th

e pr

ess

stat

emen

t ref

erre

d to

abo

ve w

as fa

ctua

lly a

ccur

ate.

Atta

chm

ents

16

A -

Roa

d m

ap

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wto

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l\use

rs\

yfra

nks\

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2.06

143

Issu

e nu

mbe

rs a

nd n

umer

ical

app

endi

ces r

efer

to th

ose

in th

e PP

IF d

ocum

ent

App

endi

ces u

sed

in th

e Tr

ust r

espo

nse

sect

ion

use

the

PPIF

issu

e nu

mbe

r fol

low

ed b

y a

lette

r e.g

. 1A

, 5B

33

• 22

. Sta

ffing

on

esca

latio

n w

ards

and

hou

rs w

orke

d

Com

men

tary

from

PPI

foru

m

Dur

ing

the

visi

t on

13th

Oct

ober

, we

aske

d Ja

ckie

Har

dy, a

s a

mea

sure

of t

he c

ontin

uity

of s

taffi

ng o

n th

e es

cala

tion

war

ds, f

or s

tatis

tics

of s

taff

turn

over

in th

ese

war

ds: n

umbe

r of d

istin

ct in

divi

dual

s w

orki

ng

each

wee

k, n

umbe

r of p

eopl

e w

orki

ng ju

st o

ne s

hift,

wor

king

two

shift

s, e

tc. F

ollo

win

g a

rem

inde

r em

aile

d on

4th

Nov

embe

r, a

parti

al re

ply

was

obt

aine

d on

7th

Nov

embe

r, in

dica

ting

that

cur

rent

ly th

e Tr

ust i

s un

able

to re

gula

te o

r mon

itor t

he n

umbe

r of h

ours

wor

ked

by s

taff

in a

ny g

iven

per

iod.

It

conc

lude

s op

timis

tical

ly, "

for t

he fu

ture

, our

nur

se ro

ster

ing

syst

em w

ill a

lso

help

us

to m

onito

r thi

s m

ore

robu

stly

": th

ough

with

no

indi

catio

n as

to w

hen

this

is e

xpec

ted

to b

e in

trodu

ced.

O

n 11

th N

ovem

ber a

n A

genc

y nu

rse

who

had

bee

n w

orki

ng in

an

esca

latio

n w

ard

at th

e W

est

Mid

dles

ex re

porte

d th

at s

he li

ked

wor

king

ther

e, a

s "a

lot o

f the

sta

ff ar

e A

genc

y": s

o th

ere

is a

sen

se o

f co

mm

unity

, and

she

doe

sn't

feel

like

an

outs

ider

, as

is g

ener

ally

the

case

whe

n pe

rform

ing

agen

cy w

ork

in o

ther

war

ds o

r at o

ther

hos

pita

ls.

Atta

chem

ents

22

A e

mai

l fro

m Y

Fra

nks

re

staf

fing

num

bers

\\ne

wto

n\vo

l\use

rs\

yfra

nks\

OSC

\19.

2.06

Trus

t res

pons

e Th

is is

an

exam

ple

of a

requ

est f

or in

form

atio

n th

at is

not

rout

inel

y co

llect

ed b

y ou

r sta

ffing

sys

tem

s. H

owev

er in

resp

onse

to th

is

ques

tion,

Jac

kie

Har

dy u

nder

took

to c

olle

ct th

is in

form

atio

n ov

er a

3-w

eek

perio

d. T

he in

form

atio

n w

as th

en p

rovi

ded

four

day

s la

ter o

n 7th

Nov

embe

r. P

leas

e se

e at

tach

ed e

mai

l (22

A).

We

belie

ve th

is is

ano

ther

exa

mpl

e of

a ti

mel

y an

d fu

ll re

spon

se to

the

ques

tion

and

ther

efor

e do

not

bel

ieve

this

sho

uld

have

bee

n ci

ted

in th

e re

ferra

l. W

e no

te th

e in

divi

dual

opi

nion

of a

n ag

ency

nur

se w

ho e

njoy

ed w

orki

ng o

n th

is w

ard.

We

are

plea

sed

to h

ear t

his

feed

back

.

144

Issu

e nu

mbe

rs a

nd n

umer

ical

app

endi

ces r

efer

to th

ose

in th

e PP

IF d

ocum

ent

App

endi

ces u

sed

in th

e Tr

ust r

espo

nse

sect

ion

use

the

PPIF

issu

e nu

mbe

r fol

low

ed b

y a

lette

r e.g

. 1A

, 5B

34

• 23

. Flo

or P

lans

:

Com

men

tary

from

PPI

foru

m

Thes

e w

ere

requ

este

d as

par

t of t

he C

lean

lines

s In

spec

tion

Rep

ort s

ubm

itted

by

the

Foru

m in

Dec

embe

r 200

4: "P

leas

e ca

n yo

u pr

ovid

e flo

or p

lans

, ide

ntify

ing

for e

ach

war

d al

l the

room

s (m

ain

war

d, s

ide

room

s, to

ilets

, util

ity ro

oms,

cup

boar

ds, e

tc.)?

". At

the

PP

IF m

eetin

g on

11t

h O

ctob

er 2

005,

mem

bers

agr

eed

to s

ubm

it a

form

al re

ques

t, re

ferri

ng to

the

stat

utor

y re

quire

men

t for

a re

ply

with

in 2

0 w

orki

ng d

ays.

Dur

ing

an u

nrel

ated

vis

it on

4th

Nov

embe

r, m

embe

rs w

ere

allo

wed

to v

iew

a s

et o

f pla

ns o

n la

rge

form

at

pape

r. Tr

ust s

taff

refu

sed

to c

opy

them

on

grou

nds

of c

ost:

and

in fa

ct th

ey w

ere

too

larg

e fo

r For

um u

se. A

n el

ectro

nic

vers

ion

was

re

ques

ted:

but

furth

er d

elay

s en

sued

. Fin

ally

file

s w

ere

mad

e av

aila

ble

on 2

4th

Nov

embe

r: bu

t onl

y fo

r the

new

bui

ldin

g, a

nd o

nly

in

Aut

oCA

D fo

rmat

. Des

pite

the

avai

labi

lity

of a

free

ly d

ownl

oada

ble

utilit

y to

vie

w th

ese

files

, the

For

um h

as n

ot y

et b

een

able

to

conv

ert t

hese

to a

use

ful f

orm

at. W

e ac

know

ledg

e th

at th

e Tr

ust d

oes

not h

ave

appr

opria

te s

oftw

are:

but

we

are

surp

rised

that

the

arch

itect

s w

ere

not c

ontra

ctua

lly o

blig

ed to

sup

ply

a se

t of u

sefu

l pla

ns in

an

easi

ly a

cces

sibl

e el

ectro

nic

form

at. P

lans

of w

ards

in

the

old

Mar

jorie

War

ren

build

ing

have

not

yet

bee

n su

pplie

d.

Trus

t res

pons

e W

e ac

know

ledg

e th

at th

e ch

air o

f the

foru

m m

ade

the

requ

est i

n D

ecem

ber 2

004

and

we

appr

oach

ed th

e P

FI m

anag

er to

obt

ain

copi

es. A

t tha

t tim

e w

e w

ere

info

rmed

that

this

info

rmat

ion

was

onl

y he

ld in

har

d co

py, t

hat t

he c

opyi

ng o

f the

se v

ery

larg

e do

cum

ents

wou

ld h

ave

to b

e do

ne p

rofe

ssio

nally

at a

cos

t of a

ppro

xim

atel

y £4

00 w

hich

the

Trus

t did

not

feel

app

ropr

iate

to m

eet i

n ou

r fin

anci

al p

ositi

on. V

ia C

hern

a C

rom

e, th

is w

as e

xpla

ined

and

she

did

not

pur

sue

this

requ

est f

urth

er.

In O

ctob

er /

Nov

embe

r afte

r the

cha

nge

of P

PIF

cha

ir, th

e re

ques

t was

rene

wed

. We

appr

oach

ed E

cove

rt m

anag

emen

t who

co

nfirm

ed th

at h

ard

copy

larg

e ar

chite

ctur

al d

raw

ings

wer

e av

aila

ble

on s

ite a

nd th

at th

e fo

rum

was

wel

com

e to

vie

w th

ese

docu

men

ts. H

owev

er, c

once

rns

wer

e ra

ised

abo

ut th

e se

curit

y im

plic

atio

ns o

f rel

easi

ng d

etai

led

build

ing

plan

s in

to th

e pu

blic

do

mai

n. H

avin

g co

nsid

ered

the

impl

icat

ions

, we

deem

ed it

app

ropr

iate

to c

ontin

ue to

atte

mpt

to m

eet t

his

requ

est.

We

sugg

este

d th

at th

is v

iew

ing

coul

d be

acc

omm

odat

ed o

n an

alre

ady

plan

ned

visi

t to

the

hosp

ital d

urin

g th

e O

utpa

tient

Rev

iew

. U

nfor

tuna

tely

foru

m m

embe

rs w

ere

very

dis

appo

inte

d w

ith th

ese

draw

ings

, sta

ting

that

they

requ

ired

A4

or A

3 si

zes

in o

rder

to

145

Issu

e nu

mbe

rs a

nd n

umer

ical

app

endi

ces r

efer

to th

ose

in th

e PP

IF d

ocum

ent

App

endi

ces u

sed

in th

e Tr

ust r

espo

nse

sect

ion

use

the

PPIF

issu

e nu

mbe

r fol

low

ed b

y a

lette

r e.g

. 1A

, 5B

35

faci

litat

e us

e. E

cove

rt ad

vise

d us

that

dra

win

gs fo

r the

PFI

bui

ldin

g on

ly w

ere

avai

labl

e on

CD

Rom

dis

cs b

ut th

at n

eith

er th

e Tr

ust

nor E

cove

rt ha

d th

e pr

ofes

sion

al a

rchi

tect

ural

sof

twar

e to

vie

w th

e do

cum

ents

. Thi

s w

as e

xpla

ined

to th

e fo

rum

in a

n ex

chan

ge o

f em

ails

whi

ch c

ulm

inat

ed in

them

vis

iting

on

24th N

ovem

ber t

o do

wnl

oad

thes

e fil

es o

nto

a m

emor

y st

ick.

Th

e fo

rum

was

mad

e aw

are

that

the

files

do

not i

nclu

de th

e M

arjo

rie W

arre

n w

ards

and

thos

e fo

r the

PFI

bui

ldin

g do

es n

ot in

clud

e al

tera

tions

to th

e bu

ildin

g si

nce

its o

peni

ng.

We

cann

ot s

uppl

y in

form

atio

n th

at w

e do

not

pos

sess

. W

e ca

nnot

com

men

t on

the

oblig

atio

n of

arc

hite

cts

to p

rovi

de a

cces

sibl

e pl

ans

follo

win

g th

eir c

ompl

etio

n of

the

proj

ect.

The

follo

win

g is

sues

hav

e al

read

y be

en a

ddre

ssed

in th

e ‘re

fusa

l to

cons

ult’

sect

ion

and

are

ther

efor

e no

t dup

licat

ed h

ere.

•

9. re

duct

ion

in c

oron

ary

care

sta

ff •

12. B

usin

ess

case

for w

ard

clos

ure

in p

repa

ratio

n •

19. I

mpo

ssib

le d

eadl

ines

and

dat

a ac

cess

ibilit

y

146

Information submitted by J Hunt for consideration by the Panel -----Original Message----- From: John Hunt [mailto:[email protected]] Sent: 11 April 2006 13:43 To: [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; Sunita Sharma Cc: Bobbie Awan; [email protected]; [email protected]; [email protected]; Ilyas Khwaja; Linda Nakamura; Pam Fisher; Peta Vaught; Shivcharn Gill; Sohan Sangha; [email protected] Subject: Legal Test Case of S.11 -- PCT failure to consult

www.leighday.co.uk/doc.asp?cat=849&doc=789

North Eastern Derbyshire Primary Care Trust face judicial review 6th March 2006

Mr Justice Beatson has today awarded interim relief on a challenge being handled by Leigh Day & Co. Richard Stein is acting for Pam Smith, a local parish councillor. She is a resident and a patient at the Creswell Primary Care Centre (CPCC), Nottinghamshire. Pam is challenging the decision-making process of the North Eastern Derbyshire Primary Care Trust (PCT) in relation to a tender process for the contract to provide general practitioner services to the patients of Creswell and Langwith. She is particularly incensed about the award of 'preferred provider status' to United Health Europe Ltd which is part of US giant UnitedHealth Group . While the government is keen to push the idea of a 'patient-led' NHS, the reality is that true accountability is fast disappearing for the taxpayers who fund the service. The awarding of interim relief today means that a contract cannot be signed between UHE and the NEDPCT until the court has had a proper opportunity to consider the case.

Recent history

The PCT has responsibility for providing GP services to its area, including the villages of Creswell & Langwith where Pam lives, an ex-mining community with higher than average levels of deprivation and poor health. Until recently Creswell PCC, which serves about 7,500 patients, has operated from Creswell, and has also run a 'branch surgery' in Langwith. The doctor running this service retired approximately three years ago and the practice was then taken over by a nurse and her husband who provided care for patients using employed doctors.

Concerns about the service

Concerns arose in early 2005 that the level of care provided by the nurse-led practice was unacceptable. Concern centred around the lack of flexibility at the Langwith surgery. Patients were often unable to see a doctor because of the opening hours at the surgery, the only alternative being to use the poor public transport links between Langwith and Creswell, a three-hour round trip, or to use expensive taxis to cover the three miles. Pam

147

is a member of the Patients' Participation Group (PPG) and regularly attends their meetings.

Hope for change

A proposal from the local parish council that a nearby surgery, Shirebrook Surgery, should register all Langwith patients was dismissed by Shirebrook. However, one of the GPs at Shirebrook, Dr Elizabeth Barrett, put together a proposal to form a new multi-disciplinary team which would take over the Langwith surgery. Parish council members, including Pam Smith carried out a survey, which showed that local residents were strongly in favour of a new and separate GP practice for Langwith. The parish council made a piece of land available for the new surgery despite an ominous silence from the PCT who had been informed of the new plans.

Hopes dashed

The PCT had not been inactive however. In the autumn of 2005 it initiated steps to terminate the exiting contract. A PCT directly run service has been in operation since the end of last year. In November 2005 the PCT advertised an invitation to tender for general medical services for the Creswell PCC. The PCT received nearly 50 expressions of interest, including one from the team headed by Dr Elizabeth Barrett. However this bid was not short-listed. Pam did not hear about the invitation to tender until December 2005, and by the end of December the PCT announced that preferred provider status had been awarded to United Health Europe.

Challenge

Despite Pam's best efforts to find out more about UHE's bid she has been unsuccessful. However, it is understood that UHE do not employ any medical or other healthcare staff who could provide the healthcare services that are needed in Langwith and Creswell. Doctors would need to be recruited before any services could be offered. Pam's challenge to the PCT is based on a failure to involve and consult the very people who will be using the services, under s.11(1) of the Health and Social Care Act 2001.

Conclusion

Substantial cuts and other changes to the health services are being introduced by PCTS& Hospital Trusts all over the country with very little, if any, consultation with patients. With regard to GP services, a number of different types of contact have recently been introduced. These different models are bringing in changes to the way that healthcare services are provided and have been introduced with very little scrutiny. The whole relationship between PCTs and service providers is shifting, and the duty to consult which has, until now, been an integral part of the NHS seems under threat. Leigh Day & Co will continue to represent NHS users to want to challenge PCT who fail to consult about the most important of our public services.

148

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154

From: Stephen Piper Sent: 14 October 2005 09:00 To: Yvonne Franks Cc: Gail Wannell; Simon Marshall Subject: URGENT : Standards for Better Health - PPI Forum Problem Importance: High Yvonne, I've just received this email from John Hunt. This is the first I knew of any problem with accessing the documentation etc that we sent out on the 23rd September. Obviously this is going to present a problem since the deadline is pretty much fixed, we need to have the final document ready to present to the forthcoming Trust Board in advance of the actual submission by the 31st October. I have not responded to John directly on the basis that you, as lead for the PPI forum, will do so. Please give me a shout if you need me to send anything additional over to you, although everything required should be contained within the email which Saeeda sent out on the 23rd September. Regards, Steve.

Stephen Piper Associate Director of Finance and Performance Finance Dept, Level 2, East Wing West Middlesex University Hospital NHS Trust Tel: 020 8321 2551 Fax: 020 8321 2509 email : [email protected]

This e-mail and any files transmitted with it are intended solely for the use of the individual or entity to whom they are addressed and may not be divulged to any third party without the express permission of the originator. Any views expressed in this message are those of the individual sender, except where the sender specifically states them to be the views of West Middlesex University Hospital. If you have received this in error, please contact the sender and delete the material from any computer.

-----Original Message----- From: John Hunt [mailto:[email protected]] Sent: 13 October 2005 23:29 To: Stephen Piper Cc: [email protected] Subject: Re: FW: West Middlesex University Hospital NHS Trust - Standards for Better Health Draft Declaration[Scanned]

Dear Stephen, At 08:57 2005.10.13, Bob Hardy-King forwarded:

155

-----Original Message----- From: Stephen Piper [mailto:[email protected]] Sent: Tue 10/11/2005 11:54 AM To: ForumSupport.Inhouse2 Dear Colleagues, This email is a reminder that we are expecting final responses to the West Middlesex University Hospital NHS Trust draft declaration of compliance to the annual health check core standards by this Friday, 14th October. Members of the PPI Forum were told by Yvonne Franks on the 15th September that the "Standards for Better Health" were an immediate priority for her, and that we would receive them shortly. However, these were sent to members only on the 10th October -- and as an Excel file, which most members are unable to read. We were also told that the deadline for responses was the end of October: not the 14th. As the majority of our members are still awaiting receipt of a hard copy (with legible print), please can we have an extension of the deadline? Regards, John Hunt, (cochair).

____________________________________________________________________ John Hunt, 123, Twickenham Road, ISLEWORTH. TW7 6AW; 020-8568 7416 Patient and Public Involvement Forum for the West Middlesex University Hospital [Forum Support: Bob Hardy-King, 020-8832 1164, [email protected]]

156

2005/06 Standards for Better HealthDraft Core Standards AssessmentTrust self declaration

First Domain : Safety

Compliance

Compliance

Compliance

Insufficient assurance

Compliance

Compliance

Compliance

Compliance

Compliance

Second Domain : Clinical and cost effectiveness

Compliance

Compliance

Compliance

Compliance

Compliance

C1bHealthcare organisations protect patients through systems that ensure that patient safety notices, alerts and other communications concerning patient safety which require action are acted upon within required timescales

C2Healthcare organisations protect children by following national child protection guidelines within their own activities and in their dealings with other organisations.

C3Healthcare organisations protect patients by following National Institute for Clinical Excellence [NICE] interventional procedures guidance

C4aHealthcare organisations keep patients, staff and visitors safe by having systems to ensure that (a) the risk of healthcare acquired infection to patients is reduced, with particular emphasis on high standards of hygiene and cleanliness, achieving year on year reductions in Methicillin-Resistant Staphylococcus Aureus [MRSA].

Healthcare organisations ensure that clinicians participate in regular clinical audit and reviews of clinical services.

C6Healthcare organisations cooperate with each other and social care organisations to ensure that patients' individual needs are properly managed and met.

C5d

C5aHealthcare organisations ensure that they conform to National Institute for Clinical excellence [NICE] technology appraisals and, where it is available, take into account nationally agreed guidance when planning and delivering treatment and care.

C5c Healthcare organisations ensure that clinicians continuously update skills and techniques relevant to their clinical work.

C5b Healthcare organisations ensure that clinical care and treatment are carried out under supervision and leadership.

C4cHealthcare organisations keep patients, staff and visitors safe by having systems to ensure that all reusable medical devices are properly decontaminated prior to use and that the risks associated with decontamination facilities and processes are well managed.

C4dHealthcare organisations keep patients, staff and visitors safe by having systems to ensure that medicines are handled safely and securely.

C4eHealthcare organisations keep patients, staff and visitors safe by having systems to ensure that the prevention, segregation, handling, transport and disposal of waste is properly managed so as to minimise the risks to the health and safety of staff, patients, the public and the safety of the environment.

C1aHealthcare organisations protect patients through systems that identify and learn from all patient safety incidents and other reportable incidents, and make improvements in practice based on local and national experience and information derived from the analysis of incidents.

C4bHealthcare organisations keep patients, staff and visitors safe by having systems to ensure that all risks associated with the acquisition and use of medical devices are minimised.

157


Third Domain : Governance

Compliance

Compliance

Compliance

Compliance

Compliance

Compliance

Compliance

Compliance

Compliance

Compliance

Compliance

Compliance

Fourth Domain : Patient focus

Compliance

Compliance

Compliance

Compliance

Compliance

Compliance

Compliance



C16Healthcare organisations make information available to patients and the public on their services, provide patients with suitable and accessible information on the care and treatment they receive and, where appropriate, inform patients on what to expect during treatment, care and after care.

C15aWhere food is provided, healthcare organisations have systems in place to ensure that patients are provided with a choice and that it is prepared safely and provides a balanced diet.

C15bWhere food is provided, healthcare organisations have systems in place to ensure that patients' individual nutritional, personal and clinical dietary requirements are met, including any necessary help with feeding and access to food 24 hours a day.

C14bHealthcare organisations have systems in place to ensure that patients, their relatives and carers are not discriminated against when complaints are made.

C14cHealthcare organisations have systems in place to ensure that patients, their relatives and carers are assured that organisations act appropriately on any concerns and, where appropriate, make changes to ensure improvements in service delivery.

C13cHealthcare organisations have systems in place to ensure that staff treat patient information confidentially, except where authorised by legislation to the contrary.

C14aHealthcare organisations have systems in place to ensure that patients, their relatives and carers have suitable and accessible information about, and clear access to, procedures to register formal complaints and feedback on the quality of services.

C13aHealthcare organisations have systems in place to ensure that staff treat patients, their relatives and carers with dignity and respect.

C13bHealthcare organisations have systems in place to ensure that appropriate consent is obtained when required, for all contacts with patients and for the use of any confidential patient information.

C7e Healthcare organisations challenge discrimination, promote equality and respect human rights.

C7a & C7cHealthcare organisations apply the principles of sound clinical and corporate governance and C7c Healthcare organisations undertake systematic risk assessment and risk management.

C7bHealthcare organisations actively support all employees to promote openess, honesty, probity, accountability, and the economic, efficient and effective use of resources.

C8aHealthcare organisations support their staff through having access to processes which permit them to raise, in confidence and without prejudicing their position, concerns over any aspect of service delivery, treatment or management that they consider to have a detrimental effect on patient care or on the delivery of services.

C8bHealthcare organisations support their staff through organisational and personal development programmes which recognise the contribution and value of staff, and address, where appropriate, under-representation of minority groups.

C10aHealthcare organisations undertake all appropriate employment checks and ensure that all employed or contracted professionally qualified staff are registered with the appropriate bodies.

C9Healthcare organisations have a systematic and planned approach to the management of records to ensure that, from the moment a record is created until its ultimate disposal, the organisation maintains information so that it serves the purpose it was collected for and disposes of the information appropriately when no longer required.

C11bHealthcare organisations ensure that staff concerned with all aspects of the provision of healthcare participate in mandatory training programmes.

C10b Healthcare organisations require that all employed professionals abide by relevant published codes of professional practice.

C11aHealthcare organisations ensure that staff concerned with all aspects of the provision of healthcare are appropriately recruited, trained and qualified for the work they undertake.

C11cHealthcare organisations ensure that staff concerned with all aspects of the provision of healthcare participate in further professional and occupational development commensurate with their work throughout their working lives.

C12Healthcare organisations which either lead or participate in research have systems in place to ensure that the principles and requirements of the research governance framework are consistently applied

158


Fifth Domain : Accessible and responsive care

Compliance

Compliance

Sixth Domain : Care, environment and amenities

Compliance

Compliance

Compliance

Seventh Domain : Public Health

Compliance

Compliance


Compliance

C23Healthcare organisations have systematic and managed disease prevention and health promotion programmes which meet the requirements of the national service frameworks [NSFs] and national plans with particular regard to reducing obesity through action on nutrition and exercise, smoking, substance misuse and sexually transmitted infections.

C24Healthcare organisations protect the public by having a planned, prepared and, where possible, practised response to incidents and emergency situations, which could affect the provision of normal services.

C22a & C22c

Healthcare organisations promote, protect and demonstrably improve the health of the community served, and narrow health inequalities by cooperating with each other and with local authorities and other organsiations and C22c Healthcare organisations promote, protect and demonstrably improve the health of the community served, and narrow health inequalities by making an appropriate and effective contribution to local partnership arrangements including local strategic partnerships and crime and disorder reduction partnerships.

C22bHealthcare organisations promote, protect and demonstrably improve the health of the community served, and narrow health inequalities by ensuring that the local Director of Public Health's annual report informs their policies and practices.

C20bHealthcare services are provided in environments which promote effective care and optimise health outcomes by being supportive of patient privacy and confidentiality.

C21Healthcare services are provided in environments which promote effective care and optimise health outcomes by being well designed and well maintained with cleanliness levels in clinical and non-clinical areas that meet the national specification for clean NHS premises.

C18Healthcare organisations enable all members of the population to access sewrvices equally and offer choice in access to services and treatment equitably.

C20aHealthcare services are provided in environments which promote effective care and optiise health outcomes by being a safe and secure environment which protects patients, staff, visitors and their property, and the physical assets of the organisation.

C17The views of patients, their carers and others are sought and taken into account in designing, planning, delivering and improving healthcare services.

159

2005/06 Standards for Better Health - Draft DeclarationUPDATE : 23rd September 2005

SUMMARY

Page Ref CORE STANDARDS Assessment%

Complete

First Domain : SafetyExecutive Lead : Janet Baldwin, Medical Director

1sbh C1 Fully Met 4 100%1sbh C2 Fully Met 4 100%

1sbh C3 Almost Met 3 100%1sbh C4 Fully Met 4 100%

Second Domain : Clinical and Cost EffectivenessExecutive Lead : Yvonne Franks, Director of Nursing


Third Domain : GovernanceExecutive Lead : Gail Wannell, Chief Executive

3sbh C7 Fully Met 4 100%


3sbh C10 Fully Met 4 100%4sbh C11 Fully Met 4 100%4sbh C12 Fully Met 4 100%

Fourth Domain : Patient FocusExecutive Lead : Yvonne Franks, Director of Nursing

5sbh C13 Fully Met 4 100%5sbh C14 Fully Met 4 100%5sbh C15 Fully Met 4 100%6sbh C16 Almost Met 3 100%

Fifth Domain : Accessible and Responsive CareExecutive Lead : Alison McIntosh, Director of Acute Care

7sbh C17 Fully Met 4 100%

7sbh C18 Fully Met 4 100%7sbh C19

Sixth Domain : Care, Environment and AmenitiesExecutive Lead : Simon Marshall, Director of Finance and Performance


Seventh Domain : Public HealthExecutive Lead : Peter Gill, Director of IM&T, Janet Baldwin, Medical Director

9sbh C22 Fully Met 4 100%9sbh C23 Almost Met 3 100%9sbh C24 Fully Met 4 100%

Protection of PatientsProtection of ChildrenAdherence to NICE guidanceHealthcare Acquired Infection Controls

NICE Technology Appraisals & Clinical AuditPartnerships with other organisations to meet patients' individual needs

Clinical & Coroprate Governance, Risk Management, Financial Management & Meet Existing TargetsOrganisational & Personal DevelopmentManagement of RecordsEmployment ChecksMandatory Training & Continuous Professional DevelopmentResearch Governance

Dignity & Respect to patients, carers and relatives, consent and patient confidentialityAccess to Information & ComplaintsFood & FeedingProvision of Care & Treatment Information

Views of Patients, Carers & OthersEqual Access to Services & Treatment

Provision of environment which is safe & secure and provide privacy & confidentiality to patients

Access to Emergency Health Services

Cleanliness & Hygiene

Improve the health of the local communityDisease prevention and health promotion programmesMajor Incidients Plan

163

2005/06 Standards for Better Health - Draft Declaration

UPDATE : 23rd September 2005

First Domain : Safety

Fully Met 4

Fully Met 4

Fully Met 4

Fully Met 4

Fully Met 4

Fully Met 4

Fully Met 4

Fully Met 4

Fully Met 4

Almost Met 3

Almost Met 3

Fully Met 4

Fully Met 4

Fully Met 4

Fully Met 4

Almost Met 3

Fully Met 4

Fully Met 4

Fully Met 4C4-e1

C4-a2

C4-b1

C4-c1

C4-d1

C4-b2

C3

C3-a1

C4

C4-a1

Responsible Manager(s) : Dr May Kyi, Director of Infection Control; Maite Graham, Risk Manager; Andrew Caunce, Chief Pharmacist; Penny Rastall, Environmental Manager

C1

C1-a1

C1-a2

C1-a3

C1-b1

C2

C2-a1

C2-a2

C2-a3

Healthcare organisations protect patients through systems that (a) identify and learn from all patient safety incidents and other reportable incidents, and make improvements in practice based on Local and national experience and information derived from the analysis of incidents (b) ensure that patient safety notices, alerts and other communications concerning patient safety which require action are acted upon within required timescales

The healthcare organisation has a defined reporting process and incidents are reported, both within the local reporting process and to the National Patient Safety Agency [NPSA] via the National Reporting and Learning System, taking into account Building a safer NHS for patients: implementing an organisation with a memory [Department of Health 2001]

Reported incidents are analysed to seek to identify root causes and likelihood of repetition, taking into account Building a safer NHS for patients: inplementing an organisation with a memory.

Improvements in practice are made as a result of analysis of local incidents taking into account Building a safer NHS for patients: implementing an organisation with a memory , and also as a result of information arising from the NPSA's national analysis of incidents via the National Reporting and Learning System.

Responsible Manager(s) : Mike Toner, Associate Director Governance and Risk

Patient safety notices, alerts and other communications issued by the Safety Alert Broadcast System [SABS] and Medicines and Healthcare products Regulatory Agency [MHRA] are implemented within the required timescale, in accordance with Chief Executive's bulletin article [Gateway 2326] and the drug alerts system administered by the Defective Medicines Support Centre [part of the MHRA].

Healthcare organisations protect children by following national child protection guidelines within their own activities and in their dealings with other organisations.

The healthcare organsiation has defined and implemented effective processes for identifying, reporting and taking action on child protection issues, in accordance with the Protection of Children Act 1999, the Children Act 2004, Working together to safeguard children [Department of Health 1999] and Safeguarding children in whom illness is induced or fabricated by carers with parenting responsibilities [DoH July 2001]

The healthcare organsiation works with all relevant partners and communities to protect children in accordance with Working together to safeguard children [DoH 1999]

Responsible Manager(s) : Tonie Neville, Associate Director Maternity Services

Criminal records Bureau [CRB] checks are conducted for all staff and students with access to patients and relatives in the normal course of their duties in accordance with CRB disclosures in the NHS [NHS Employers 2004]

Healthcare organisations protect patients by following National Institute for Clinical Excellence [NICE] interventional procedures guidance

The healthcare organsiation follows NICE interventional procedures guidance in accordance with The interventional procedures programme [Health Service Circular 2003/011]

Healthcare organisations keep patients, staff and visitors safe by having systems to ensure that (a) the risk of healthcare acquired infection to patients is reduced, with particular emphasis on high standards of hygiene and cleanliness, achieving year on year reductions in Methicillin-Resistant Staphylococcus Aureus [MRSA], (b) all risks associated with the acquisition and use of medical devices are minimised, (c) all reusablemedical devices are properly decontaminated prior to use and that the risks associated with decontamination facilities and processes are well managed, (d) medicines are handled safely and securely, (e) the prevention, segregation, handling, transport and disposal of waste is properlymanaged so as to minimise the risks to the health and safety of staff, patients, the public and the safety of the environment.

Responsible Manager(s) : Paula Guerra, Head of Clinical Governance

The healthcare organisation has systems in place to ensure that medicine are handled safely and securely, taking into account Building a safer NHS: improving medication safety [DoH 2004], and in accordance with the statutory requirements of the Medicines Act 1968, the Misuse of Drugs Act 1971 and the Misuse of Drugs Act 1971 [Modification] Order [2001].

Waste is properly managed to minimise the risks to patients, staff, the public and the environment, in accordance with Health and Safety executive [HSE] guidance: Safe disposal of clinical waste [ISBN 0 7176 24927] [updated publication scheduled for May 2005].

The healthcare organisation has taken steps to minimise the risk of healthcare acquired infection to patients, taking account of Winning ways [DoH 2003], A matron's charter: an action plan for cleaner hospitals [DoH 2004], Revised guidance on contracting for cleaning [DoH 2004], and Audit Tools for Monitoring Infection Control Standards [Infection Control Nurses Association 2004]

The healthcare organisation has systems in place to ensure that it contributes to year on year reductions in MRSA in inpatient wards, in accordance with local delivery plans.

The healthcare organisation has systems in place to minimise the risks associated with the acquisition and use of medical devices in accordance with guidance issued by the MHRA.

Reusable medical devices are properly decontaminated in appropriate facilities, in accordance with guidance issued by the MHRA and Medical devices Directive [MDD] 93/42 EEC

There are systems in place to minimise the risks associated with the use of medical devices.

Page 8sbh of 16sbh164



Second Domain : Clinical and cost effectiveness

Fully Met 4

Almost Met 3

Fully Met 4

Fully Met 4

Fully Met 4

Fully Met 4

Fully Met 4

Fully Met 4

Fully Met 4

Fully Met 4

Nearly Met 3

Fully Met 4

C6

C6-a2

C5-b2

C5-c2

C5-d1

C5-d2

C5-c1

C6-a1

C5

C5-a1

C5-a2

C5-b1

Healthcare organisations ensure that: (a) they conform to National Institute for Clinical excellence [NICE] technology appraisals and, where it is available, take into account nationally agreed guidance when planning and delivering treatment and care, (b) clinical care and treatment are carried out under supervision and leadership, (c) clinicians continuously update skills and techniques relevant to their clinical work, (d) clinicians participate in regular clinical audit and reviews of clinical services.

The healthcare organisation conforms to the procedures for the adoption of NICE technology appraisals in accordance with Impementation of NICE guidance [DoH 2004]

The healthcare organisation takes into account, when planning and delivering care, nationally agreed best practice as defined in national service frameworks [NSFs], NICE clinical guidelines, national plans and nationally agreed guidance.

All staff involved in delivering clinical care and treatment receive appropriate supervision, taking into account national guidance from the relevant professional bodies.

Responsible Manager(s) : tbc

Healthcare organisations cooperate with each other and social care organisations to ensure that patients' individual needs are properly managed and met.

The healthcare organsiation works with relevant partner agencies to ensure that patients' individual needs are properly met and managed across organisational boundaries in accordance with Guidance on the Health Act Section 31 partnership arrangements [DoH 1999]

Clinical leadership is supported and developed within all disciplines.

Clinicians from all disciplines have access to and participate in activities to update the skills and techniques relevant to their clinical work.

Clinicians are involved in prioritising, conduucting, reporting and acting on clinical audits.

Clinicians particpate in reviewing the effectiveness of clinical services through evaluation, audit or research.


There are mechanisms in place to identify the skills required to deliver the clinical care provided by the healthcare organisation.

The healthcare organisation has systems in place to ensure health and social care organisations cooperate with each other.





Fully Met 4

Fully Met 4

Fully Met 4

Fully Met 4

Fully Met 4

Fully Met 4

Fully Met 4

Fully Met 4

Fully Met 4

Fully Met 4

Almost Met 3

Fully Met 4

Fully Met 4

Fully Met 4

Fully Met 4

Fully Met 4

Fully Met 4

C7-c1The healthcare organisation has effective arrangements in place for clinical governance which take account of Clinical governance in the new NHS [HSC 1999/065]

C7-c2The healthcare organisation has arrangements in place for corporate governance, that accord with Governing the NHS: A guide for NHS Boards [DoH & NHS Appointments Commission 2003], Corporate governance framework manual for NHS trusts [DoH 2003], Assurance: the board agenda [DoH 2002] and Building the assurance framework: a practical guide for NHS boards [DoH 2003]

C10-b1The healthcare organisation requires staff to abide by relevant codes of professional practice, including through employment contracts and job descriptions.

C10-b2 The healthcare organisation has systems in place to identify and manage staff who are not abiding by their published codes of professional practice.

C9-a1

Responsible Manager(s) : Nina Singh, Director of Human Resources, Yvonne Franks, Director of Nursing; Janet Baldwin, Medical Director

C10

C10-a1

The healthcare organsiation has systems in place to ensure that records are managed in accordance with the NHS Information Authority's [NHSIA] Information governance toolkit

Healthcare organisations: (a) undertake all appropriate employment checks and ensure that all employed or contracted professionally qualified staff are registered with the appropriate bodies, (b) require that all employed professionals abide by relevant published codes of professional practice.

The necessary employment checks are undertaken for all staff in accordance with Pre and Post employment checks for all persons working in the NHS in England [HSC 2002/008] and CRB disclosures in the NHS [NHS Emplyers 2004].

C8-a1

C8-b1

C8-b2

Responsible Manager(s) : Shan Jones, Executive Director Family & Ambulatory Care

C9

The healthcare organsiation has arrangements in place to ensure that staff know how to raise concerns, and are supported in so doing, in accordance with The Public Disclosure Act 1998: Whistle blowing in the NHS [HSC 1999/198]

The healthcare organsiation supports and involves staff in organisational and personal development programmes as defined by the relevant areas of the Improving Working Lives standard at Practice Plus level.

Staff from minority groups have opportunities for personal development in accordance with Leadership and Race equality in the NHS Action Plan [DoH 2004]

Healthcare organisations have a systematic and planned approach to the management of records to ensure that, from the moment a record is created until its ultimate disposal, the organisation maintains information so that it serves the purpose it was collected for and disposes of the information appropriately when no longer required.

C7-d1

C7-e1

C7-f1

Responsible Manager(s) : Jane Brennan, Head of Corporate Affairs; Nina Singh, Director of Human Resources

C8

The healthcare organisation challenges discrimination, promotes equality and respects human rights, in accordance with current legislation and guidance, with particular regard to the Human Rights Act 1998, the Race Relations Act 1976 [as amended], the Equal Pay Act 1970 [as amended], the Sex Discrimination Act 1975, the Disability Discrimination Act 1995, the Sex Discrimination [Gender Reassignment] Regulations 1999, the Employment Equality [Religion or Belief] Regulations 2003 and the Employment Equality [Sexual Orientation] Regulations 2003,a nd takes into account the supporting codes of practice produced by the Commission for Racial Equality, the Equal Opportunities Commission and the Disability Rights Commission.

Healthcare organisations support their staff through: (a) having access to processes which permit them to raise, in confidence and without prejudicing their position, concerns over any aspect of service delivery, treatment or management that they consider to have a detrimental effect on patient care or on the delivery of services, (b) organisational and personal development programmes which recognise the contribution and value of staff, and address, where appropriate, under-representation of minority groups.

Measured through the use of resources assessment

Measured through the existing targets assessment

C7

C7-a1

C7-a2

C7-b1

Healthcare organisations: (a) apply the principles of sound clinical and corporate governance and undertake systematic risk assessment and risk management, (b) actively support all employees to promote openess, honesty, probity, accountability, and the economic, efficient and effective use of resources, (d) ensure financial management achieves economy, effectiveness, efficiency, probity and accountability in the use of resources, (e) challenge discrimination, promote equality and respect human rights, (f) meet the existing performance requirements.

The healthcare organisation has effective arrangements in place for clinical governance which take account of Clinical governance in the new NHS [HSC 1999/065]

The healthcare organisation has arrangements in place for corporate governance, that accord with Governing the NHS: A guide for NHS Boards [DoH & NHS Appointments Commission 2003], Corporate governance framework manual for NHS trusts [DoH 2003], Assurance: the board agenda [DoH 2002] and Building the assurance framework: a practical guide for NHS boards [DoH 2003]

The healthcare organisation actively supports staff to promote openness, honesty, probity, accountability and the economic, effective use of resources in accordance with the Code of conduct for NHS Managers [DoH 2002] and Directions to NHS bodies on counter fraud measures [DoH 2004].

Responsible Manager(s) : Janet Baldwin, Medical Director; Mike Toner, Associate Director Risk & Governance; Simon Marshall, Director of Finance & Performance; John Wilkinson, Interim Deputy Director of Finance; Nina Singh, Director of Human Resources





Fully Met 4

Fully Met 4

Fully Met 4

Fully Met 4

Fully Met 4

Almost Met 3

Fully Met 4

Fully Met 4

Fully Met 4

C11-c1

Responsible Manager(s) : Janet Baldwin, Medical Director; Alison Banerjee, Project Lead - Nurse Competency Development

C12

C12-a1

C11-a2

C11-a3

C11-b1

C11-b2

Responsible Manager(s) : Nina Singh, Director of Human Resources

C11

C11-a1

Healthcare organisations ensure that staff concerned with all aspects of the provision of healthcare: (a) are appropriately recruited, trained and qualified for the work they undertake, (b) participate in mandatory training programmes, (c) participate in further professional and occupational development commensurate with their work throughout their working lives.

The healthcare organisation recruits staff in accordance with relevant legislation and with particular regard to the Employment Relations Act 1976, the Equal Pay Act 1970, the Sex Discrimination Act 1975, the Race Relations Act 1976 [as amended], the Disability Discrimination Act 1995, the Sex Discrimination [Gender Reassignment] Regulations 1999, the Employment Equality [Religion or Belief] Regulations 2003 and the Employment Equality [Sexual Orientation] Regulations 2003, and the C ode of practice for the international recruitment of healthcare professionals [DoH 2004].

The healthcare organisation undertakes workforce planning which aligns workforce requirements to its service needs.

The healthcare organisation ensures that staff participate in work-based training programmes necessary to the work they undertake as defined by the relevant areas of the Improving Working Lives standard at Practice Plus level.

The healthcare organisation complies with the requirements of the Research governance framework for health and social care [DoH 2001].

All staff participate in relevant mandatory training in accordance with the Management of Health and Safety at Work Regulations 1999

Staff and students participate in relevant induction programmes.

Staff have opportunities to participate in professional and occupational development in accordance with Working together - learning together: a framework for lifelong learning for the NHS [DoH 2001] and Continuing professional development: quality in the new NHS [HSC 199/154]

Healthcare organisations which either lead or participate in research have systems in place to ensure that the principles and requirements of the research governance framework are consistently applied





Fully Met 4

Fully Met 4

Fully Met 4

Fully Met 4

Fully Met 4

Almost Met 3

Fully Met 4

Fully Met 4

Fully Met 4

Fully Met 4

Fully Met 4

Fully Met 4

Fully Met 4

Fully Met 4

Fully Met 4

Fully Met 4

Fully Met 4

Almost Met 3

Almost Met 3

C15-a2

C15-b1

C15-b2

C15-b3

C14-c2


C15

C15-a1

The healthcare organisation uses concerns and complaints from patients, relatives and carers, to improve service delivery, where appropriate.

Where food is provided, healthcare organisations have systems in place to ensure that: (a) patients are provided with a choice and that it is prepared safely and provides a balanced diet, (b) patients' individual nutritional, personal and clinical dietary requirements are met, including any necessary help with feeding and access to food 24 hours a day.

The healthcare organsiation offers patients a choice of food in line with the requirements of a balanced diet and in accordance with the six key requirements of the Better hospital food programme [NHS Estates 2001], reflecting the needs and preferences and rights [including faith and cultural needs] of its service user population.

C14-a1

C14-a2

C14-b1

C14-c1

C13-b1

C13-b2

C13-c1

Responsible Manager(s) : Jane Brennan, Head of Corporate Affairs

C14

The healthcare organisation has processes in place to ensure that valid consent, including from those who have communication or language support needs, is obtained by suitably qualified staff for all treatments, procedures (including post-mortem) and investigations in accordance with the Good practice in consent: achieving the NHS plan commitment to patient centred consent practice [HSC 2001/023], Reference guide to consent for examination or treatment [DoH 2001], Families and post mortems: a code of practice [DoH 2003] and Seeking Consent: working with children [DoH 2001].

Patients, including those with language and/or communication support needs, are provided with information on the use and disclosure of confidential information held about them, in accordance with Confidentiality: NHS code of practice [DoH 2003].

Staff act in accordance with Confidentiality: NHS code of practice [DoH 2003], the Data protection Act 1998, Protecting and using patient information: a manual for Caldicott guardians [DoH 1999], the Human Rights Act 1998 and the Freedom of Information Act 2000 when using and disclosing patients' personal information.

Healthcare organisations have systems in place to ensure that patients, their relatives and carers: (a) have suitable and accessinle information about, and clear access to, procedures to register formal complaints and feedback on the quality of services, (b) are not discriminated against when complaints are made, (c) are assured that organisations act appropriately on any concerns and, where appropriate, make changes to ensure improvements in service delivery.

C13

C13-a1

C13-a2

C13-a3

Healthcare organisations have systems in place to ensure that: (a) staff treat patients, their relatives and carers with dignity and respect, (b) appropriate consent is obtained when required, for all contacts with patients and for the use of any confidential patient information, (c) staff treat patient information confidentially, except where authorised by legislation to the contrary.

The healthcare organisation has taken steps to ensure that all staff treat patients, carers and relatives with dignity and respect at every stage of their care and treatment.

The healthcare organisation acts in accordance with relevant equalities legislation, with particular regard to the Disability Discrimination Act 1995, the Race Relations Act 1976 [as amended] and the Human Rights Act 1998, to meet the needs and rights of different patient groups with regard to dignity and respect.

The healthcare organisation has systems in place to identify areas where dignity and respect may have been comprimised and takes action in response.

Responsible Manager(s) : Paula Guerra, Head of Clinical Governance

Patients, relatives and carers are provided with accessible information about, and have clear access to, formal complaints systems in accordance with the NHS [Complaints] Regulations 2004 and associated guidance.

The healthcare organsiation provides opportunities for patients, relatives and carers to give feedback on the quality of services.

The healthcare organisation has systems in place to ensure that patients, carers and relatives are not discriminated against as a result of having complained.

The healthcare organisation responds to complaints from patients, relatives and carers in accordance with NHS [Complaints] Regulations 2004 and associated guidance.

The preparation, distribution, handling and serving of food is carried out in accordance with food safety legislation and national guidance [including theFood Safety Act 1990, the Food Safety [General Food Hygiene] regulations 1995 and EC regulation 852/2004].

Patients have access to food and drink 24 hours a day in accordance with the requirements of the Better hospital food programme [NHS Estates 2001].

The nutritional, personal and clinical dietary requirements of individual patients are assessed and met, including the right to have religious dietary requirements met.

Patients requiring assistance with eating and drinking are provided with appropriate support.

Page 12 sbh of 16sbh168




Almost Met 3

Almost Met 3

Partly Met 2

C16

C16-a1

C16-a2

The healthcare organisation provides suitable and accessible information on the services it provides and in languages and formats relevant to its servicepoulation, and which accords with the Disability Discrimination Act 1995 and the Race Relations Act 1976 [as amended].

The healthcare organisation provides patients and where appropriate, carers (including those with communication or language support needs) with sufficient and accessible information on the patient's individual care, treatment and after care, taking into account the Toolkit for producing patient information [DoH 2003], Information for patients [NICE] and other nationally agreed guidance where available.

Healthcare organisations make information available to patients and the public on their services, provide patients with suitable and accessible information on the care and treatment they receive and, where appropriate, inform patients on what to expect during treatment, care and after care.

Responsible Manager(s) : Peter Gill, Director of IM&T

Page 13 sbh of 16sbh169



Fifth Domain : Accessible and responsive care

Fully Met 4

Fully Met 4

Fully Met 4

Fully Met 4

Fully Met 4

Fully Met 4

C19-a1

C18-a1

C18-a2

Responsible Manager(s) : Patricia Davies, Associate Director Emergency Care; Bennie Tilbury, Associate Director Planned Care

C19

The healthcare organisation has taken steps to ensure that all members of the population it serves are able to access its services on an equitable basis, including acting in accordance with the Sex Discrimination Act 1975, the Disability Discrimination Act 1995 and the Race Relations Act 1976 [as amended].

The healthcare organisation has taken steps to offer patients choice in access to services and treatment, where appropriate, and ensures that this is offered equitably, taking into account Building on the best: Choice, responsiveness and equity in the NHS [DoH 2003].

Healthcare organisations ensure that patients with emergency health needs are able to access care promptly and within nationally agreed timescales, and all patients are able to access services within national expectations on access to services.

This standard will be measured under the existing targets and new national targets assessments.

Responsible Manager(s) : Peter Gill, Director of IM&T

C17-a2

C18

The views of patients, their carers and others are sought and taken into account in designing, planning, delivering and improving healthcare services.

The healthcare organisation seeks the views of patients, carers and the local community, including those facing barriers to participation, in accordance with Strengthening accountability, patient and public involvement policy guidance - Section 11 of the Health and Social Care Act 2001 [DoH 2003] and, as appropriate, the associated practice guidance, and the Race Relations Act 1976 (as amended).

The healthcare organisation takes into account the views of patients, carers and the local community when designing, planning, delivering and improving healthcare, in accordnace with Strengthening accountability, policy guidance - Section 11 of the Health and Social Care Act 2001 [DoH 2003] and, as appropriate, the associated practice guidance.

Healthcare organisations enable all members of the population to access sewrvices equally and offer choice in access to services and treatment equitably.

Responsible Manager(s) : Amanda Fegan, Associate Director Service Improvement

C17

C17-a1




Sixth Domain : Care, environment and amenities

Fully Met 4

Fully Met 4

Fully Met 4

Fully Met 4

Fully Met 4

Fully Met 4

Fully Met 4

Fully Met 4C21-a2

C20-b1

Responsible Manager(s) : Ray Plummer, Associate Director Facilities

C21

C21-a1

The healthcare organisation has taken steps to provide services in environments that are supportive of patient privacy and confidentiality, including the provision of single sex facilities and accommodation.

Healthcare services are provided in environments which promote effective care and optimise health outcomes by being well designed and well maintained with cleanliness levels in clinical and non-clinical areas that meet the national specification for clean NHS premises.

The healthcare organisation has taken steps to provide care in well designed and well maintained environments taking into account Developing an estate's strategy [1999] and Estatecode: essential guidance on estates and facilities management [NHS Estates 2003], A risk based methodology [NHS Estates 2003], A risk based methodology for establishing and managing backlog [NHS Estates 2004], NHS Environmental assessment tool [NHS Estates 2002] and in accordance with the Disability Discrimination Act 1995 and associated code of practice.

The healthcare organisation provides care in an environment that needs the national specification for clean NHS premises in accordance with the Revised guidance on contracting for cleaning [DoH 2004] and A matron's charter: an action plan for cleaner hospitals [DoH 2004].

C20

C20-a1

C20-a2

C20-a3

Healthcare services are provided in environments which promote effective care and optiise health outcomes by being: (a) a safe and secure environment which protects patients, staff, visitors and their property, and the physical assets of the organisation, (b) supportive of patient privacy and confidentiality.

The healthcare organisation minimises the health, safety and environmental risks to patients, staff and visitors, in accordance with health and safety at work and fire legislation, the Disability Discrimination Act 1995, and The Management of Health, Safety and Welfare Issues for NHS staff [NHS Employers 2005].

The healthcare organisation protects patients, staff and visitors by providing a secure environment, in accordance with NHS Estates building notes and health technical memoranda and taking account of A professional approach to managing security in the NHS [Counter Fraud and Security Management Service 2003] and other relevant national guidance.

The healthcare organisation effectively protects its physical assets and those of patients, staff and visitors taking into account A professional approach to managing security in the NHS [Counter Fraud and Security Management Service 2003].





Seventh Domain : Public health

Fully Met 4

Fully Met 4

Fully Met 4

Fully Met 4

Almost Met 3

Almost Met 3

Almost Met 3

Almost Met 3

Fully Met 4

Almost Met 3

Fully Met 4

Almost Met 3

Fully Met 4

The healthcare organisation collects, analyses and makes available information on the current and future health and healthcare needs of the local population, to support the disease prevention and health promotion requirements of the NSFs and national plans.

The healthcare organisation commissions or provides disease prevention and health promotion services and programmes to improve health and narrow health inequalities based on population needs and using evidence of effectiveness.

The healthcare organisation monitors its disease prevention and health promotion services and programmes and uses the findings to inform the planning process.

C24-a1

C23-a1

C23-a2

C23-a3

C22-b1

C22-c1

C24-a2

C23-a4

C23-a5

C24


C23

Healthcare organisations promote, protect and demonstrably improve the health of the community served, and narrow health inequalities by: (a) cooperating with each other and with local authorities and other organsiations and making an appropriate and effective contribution to local partnership arrangements including local strategic partnerships and crime and disorder reduction partnerships, (b) ensuring that the local Director of Public Health's annual report informs their policies and practices.

The healthcare organisation actively works with partners to improve health and narrow health inequalities, including by contributing appropriately and effectively to nationally recognised and statutory partnerships, such as the local strategic partmership, or the crime and disorder reduction pertnership [CDRP], taking account of Choosing health: making healthier choices easier [DoH 2004] and associated implementation guidance, National standards, local action [DoH 2004], Tackling health inequalities: a programme for action [DoH 2003], Making partnerships work for patients, carers and service users [DoH 2004].

The healthcare organisation's policies and practice to improve health and reduce health inequalities are informed by the local Director of Public Health's annual public health report [APHR] taking account of Choosing health: making healthier choices easier [DoH 20004] and asociated implementation guidance.

Healthcare organisations have systematic and managed disease prevention and health promotion programmes which meet the requirements ofthe national service frameworks [NSFs] and national plans with particular regard to reducing obesity through action on nutrition and exercise,smoking, substance misuse and sexually transmitrted infections.


The healthcare organisation actively works with partners to improve health and narrow health inequalities, including by contributing appropriately and effectively to nationally recognised and statutory partnerships, such as the local strategic partmership, or the crime and disorder reduction pertnership [CDRP], taking account of Choosing health: making healthier choices easier [DoH 2004] and associated implementation guidance, National standards, local action [DoH 2004], Tackling health inequalities: a programme for action [DoH 2003], Making partnerships work for patients, carers and service users [DoH 2004].

C22

C22-a1

The healthcare organisation works with key partner organisations in the preparation of, training for and annual testing of major incident plans, in accordance with the Civil Contingencies Act 2004, Plan for major incidents: the NHS guidance [DoH 1998] [ID98c 173/235] and Beyond a major incident [DoH 2004].

The healthcare organisation implements policies and practice to support healthy lifestyles among the workforce in accordance with Choosing health: making healthier choices easier [DoH 2004] and associated implementation guidance.

The healthcare organisation has an identified lead for public health or access to public health expertise to meet its strategic and operational roles.

Healthcare organisations protect the public by having a planned, prepared and, where possible, practised response to incidents and emergency situations, which could affect the provision of normal services.

The healthcare organisation has up to date and tested plans to deal with incidents, emergency situations and major incidents, in accordance with relevant guidance, including the Civil Contingencies Act 2004, getting ahead of the curve [DoH 2002], P{lan for major incidents: teh NHS guidance [DoH 1998], and Beyond a major incident [DoH 2004].



19A

From: Saeeda Dudhia Sent: 23 September 2005 14:14 To: Trust Board; [email protected]; [email protected];

[email protected]; [email protected]; [email protected]; [email protected]

Cc: Stephen Piper Subject: FW: West Middlesex University Hospital NHS Trust - Standards for Better

Health Draft Declaration Importance: High PLEASE SEE THE MESSAGE BELOW FROM STEPHEN PIPER, OUR ASSOCIATE DIRECTOR OF FINANCE & PERFORMANCE. PLEASE NOTE THAT RESPONSES & ANY QUERIES SHOULD BE DIRECTED TO STEPHEN (HE IS COPIED IN ON THIS EMAIL). Thank you Saeeda PA to Gail Wannell, Chief Executive West Middlesex University Hospital Dear Colleague, Please find attached the draft declaration of compliance with core standards for the West Middlesex University Hospital NHS Trust. The attached spreadsheet contains the overall draft declaration in addition to the assessment for each element within the core standards for each of the seven domains. The Trust has used the Dr Foster Management Information Tool to complete the self-assessment and also to collate all the associated evidence and, where necessary, an action plan (although the action plans are, at this stage, still incomplete). The Dr Foster tool can be accessed as per the following : Login at: <https://da.drfoster.co.uk> UserName : WTrust Password : westmiddx (Please note the username and password are case-sensitive) Once you have accessed the system follow these steps: 1. Click the button in the top right hand corner labelled MIC2 2. Click the GO button on West Middlesex University Hospital NHS Trust This brings you to the high level summary screen. 3. Click on Compliance with core standards - this will expand this section into the 7 domains. 4. Click on any of the domain names to drill down to the individual standards.

173

19A

5. Click on the standards until you reach a box which has no background colour - this is the lowest level. 6. By clicking on the white box this opens up a screen which, in most cases, has prompts. which have been answered as either yes, no or not applicable in order to assess compliance. A score of 4 indicates full compliance. 7. By clicking on the VIEW button this opens up an additional window where the evidence supporting the assessment can be found. The evidence is provided as text, attachments and/or links. 8. To close the evidence window just click the X box in the top right hand corner. 9. To close the prompts window and return to the main screen click HIDE or the X box in the prompts window. In addition, the system also provides a summary report which also has the associated evidence linked. This can be accessed using the following steps: 1. Click on MENU in the top right hand corner. This opens up an additional window. 2. Click on Reports. 3. Click on Example Submission Report. This produces an example report based on the Dr Foster assessment tool. By clicking on the evidence you can access the supporting text and/or documentation. Once you have completed using the system please click on LOG OUT to exit the system. For clarity, the declaration in terms of insufficient assurance or not met is as per the spreadsheet version, not Dr Foster. We are still attempting to confirm the correct categorisation of any standards which are not fully compliant. Please can we be in receipt of your comments on the draft declaration no later

than Friday 14th October. If you have any questions on the above or require any assistance with the Dr Foster tool then please do not hesitate to contact me as per the details stated below. Regards, Stephen Piper Associate Director of Finance and Performance Finance Dept, Level 2, East Wing West Middlesex University Hospital NHS Trust Tel: 020 8321 2551 Fax: 020 8321 2509 email : [email protected] <mailto:[email protected]>

West Middx SfBH Draft Declarat...

174

14A Chronology of Consultation Process Relating to the Lampton Ward Closure

Chronology of Consultation 1. December 2004 - agreement by Trust Executive team that as part of the financial plan to

break even in 2005/6, there would be a need to close up to 30 beds. 2. February 2005 - formal disclosure of planned bed closures as part of the Staff Side &

Trust Board discussions. Senior nurses and consultants made aware of the requirement to close beds during staff forums, e.g. physician & surgeons division, MSC, senior nurse/modern matron meetings, Nursing & Midwifery professional meetings.

3. February 2005- a number of work streams were identified and work commenced that would in due course allow us to achieve this. The activities within this plan were detailed in the Roadmap which was used to monitor progress.

4. July 2005- Trust Board updated. Trust Board papers circulated to members of the PPI & Chair of Staffside prior to the meeting. Several members of the PPI forum were in attendance at the July Trust Board meeting.

5. Discussions with senior clinicians continued regarding the requirement to close beds, however, the exact location of the bed closures had not been confirmed at this point. Discussions between senior clinicians (i.e., Care of the Elderly) consultants, ward manager of Lampton, Director of Nursing & Medicine & Acute Care nursing leads/managers) and managers took place to identify likely closure configuration and Lampton ward was considered at this time. Consideration included; nurse staffing, quality, medical staffing structures, patient feedback and the development of alternative models of care i.e. the Rehab ward.

5. July 2005 – AD Nursing, J Hardy had discussions with Senior Nurses on Lampton (H, G

grades) stating that Lampton may be the choice of ward & that there would be more detailed discussion to follow. H & G grade in support of the closure and changes. The wider ward team was not informed at this point as the final decision regarding where which ward would close had not be made. However, staff across the Trust were aware that up to 30 beds would be taken out by Oct 05.

6. July 05- (19th) meeting between Executive team and PPI Forum where they were updated on Roadmap for bed closures and rehabilitation ward business case.

7. August 2005 – discussions with Care of the Elderly, Lead physician and Associate Medical Director regarding bed model structure, rota configuration and infrastructure to support the bed closure and moves.

8. Y Franks, Director of Nursing provided Rehabilitation ward update at PPI forum at August meeting.

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9. Business case for Rehabilitation ward finalised and agreed by the Trust Board in Mid August 05. This agreement underpinned the decision regarding the ward closure. It provided alternative models of care for patients across the hospital.

10. Davies Associate Director Acute Care, had informal discussion with Lynn McEvoy Staff Side Chair. PD stated that Lampton had been identified as the ward to close, however, emphasised that Exec sign off required on 27/8/05

11. JH/PD informed by senior nurses on Lampton that ward staff had become aware that Lampton ward might be the ward of choice to close. They had heard this from their senior colleagues and medical staff. Senior nurse concerned regarding level of anxiety. Ward staff asked for formal meeting with managers. JH & PD met with staff on 26/9 day before sign off of the proposed bed model by Execs. JH & PD stated that Lampton would be most probably be the ward of choice to close and gave the above rational, however, emphasised that sign off was required by Execs. Also emphasised that a full consultation process would ensue that would involve trade unions and staff.

12. 27/8/05 – Exec sign off. 13. Change papers sent out to Lynne McEvoy, Debbie Williams and Eddie Jaggers ( all Staff

side reps) on Monday 23rd August 2005. Meeting arranged for 3pm on Thursday 26th August 2005. Lynne McEvoy (Unison Rep and Chair of Staff side) and Debbie Williams (RCN rep) present. Jacqui Hardy & PD presented the staff change paper. JH & PD asked for staff meetings to commence ASAP. Lynne on annual leave for 2 weeks from Friday 27th August 2005 but stated that she would contact Eddie Jaggers and request that he be present at the staff meetings.

14. PD arranged provisional staff meeting for week commencing the 29th August 2005. Trade Unions not available. EJ not available to attend meeting in LM absence. Suggested sending memo to staff stating that meeting will be arranged when LM back from leave. PD concerned as to timescales and anxiety of staff who were requesting formal meeting. PD took HR advice from Lorraine Howard-Jones (AD for HR) who suggested that we arrange urgent meeting with staff and ask another Unison rep to attend in Lynne’ s absence. PD asked Dan Quershi to attend meeting on Tuesday 6th September 2005 which he was happy to attend. Debbie Williams (RCN rep and qualified nurse) also agreed to attend. PD re-sent paper to Debbie & Dan.

15. EJ contacted NS to say that he was unhappy for the staff meeting to go ahead without Lynne on the grounds that Lynne is a nurse & Dan works within IT. He also felt that Dan was too junior a TU rep to handle this level of consultation. However, Debbie Williams was invited in her capacity as RCN rep & nurse to provide guidance on the professional issues. PD decided to cancel and reconvene meeting on Tuesday 13th September 05 on Lynne’ s return. PD agreed to talk to Lynne on Monday 12/9/05 to state that an urgent staff meeting had been arranged at staff’ s request. PD sent staff memo out informing them of the meeting.

16. Lynne unable to attend meeting on 13/9/05. Meeting rescheduled for 16/9/05

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17. Meeting on 16/9/05 with staff. Lynne & Debbie present. Also in attendance were Jacqui Hardy, Yvonne Franks & Ranjit Kooner. Change proposal and vacancy information given to staff. Follow up meeting arranged for 23/9/05 as per action plan.

18. Individual meetings took place with all affected staff and their preferences for redeployment agreed.

19. September 15th 2005- Yvonne Franks invited PPI Forum to a meeting with Executive team. 5 options for dates and times given. 29th September chosen by the Forum at which the rationale for the choice of Lampton ward was explained.

20. Detailed action plan and daily meetings with ward sisters and support services on the two week run up to the ward changes and opening of the Rehab ward.

21. October 2005- ward changes completed.

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WEST MIDDLESEX UNIVERSITY HOSPITAL OVERVIEW AND SCRUTINY COMMITTEE

BED CAPACITY

1. INTRODUCTION The Overview and Scrutiny Committee have asked for some details surrounding West Middlesex University Hospital’s (WMUH) plans to reduce the acute bed base at the Trust. Specifically, the committee has asked for the following information:

1. Actual bed capacity broken down by specialities/departments;2. Projected bed capacity broken down by specialities/departments, short and long term;3. Identified current and potential spare capacity, and4. Interactions between booking in-patients admissions and hospital capacity requirements.

2. THE CURRENT ACTUAL BED CAPACITY The bed number and configuration of funded beds at West Mid in May 2005 is shown in the table below

Speciality



Site total




Cardiology 6 18 24



Maternity 10 38 48



Endocrinology 28 28



Rheumatology 13 13

Stroke 14 14

ITU & HDU 6 4 10

Total 12 26 361 399

Figure 1 - Current bed configuration

As can be seen from Figure 1, the vast majority of adult beds (359) are for emergency admissions (333), approximately 93%.

3. PROJECTED BED CAPACITY SHORT AND LONG TERM The projected bed capacity from 1 Oct 2005 is shown in Figure 2. There is a planned reduction of 30 beds. This has been shown against the line for general surgery/trauma and orthopaedic emergency surgery although the configuration of the bed reduction has not yet been confirmed.

No further decisions have been taken at this time about the longer-term bed capacity. However, as will be shown later in this paper, the Trust has a considerable number of patients that stay for a long time after the acute phase of their illness. The Trust is actively considering how some of its beds can be configured to support the faster rehabilitation of patients to facilitate a speedier recovery and a shorter length of stay.

Agenda Item 4

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Speciality



Site total




Cardiology 6 18 24



Maternity 10 38 48



Endocrinology 28 28



Rheumatology 13 13

Stroke 14 14

ITU & HDU 6 4 10

Total 12 26 373 369

Figure 2 - Projected bed capacity from 1 Oct 2005

4. CURRENT AND POTENTIAL SPARE BED CAPACITY Currently the Trust does not have any spare bed capacity. However, the potential spare bed capacity is considerable and is best described by considering the current bed occupancy and the current/potential length of stay for patients in WMUH beds.

4.1 Bed Occupancy The occupancy within the Trust’s beds typically runs at about 97% across any given month. Unfortunately it is not a static 97%, the pressure tends to build at the beginning of a week and then reduce towards the end of a week. This often means that the Trust has higher than 100% bed occupancy which necessitates the opening of unfunded beds (which causes the Trust to overspend against its budget).

In overall terms, in any given month, bed occupancy is directly related to the number of patients that need a bed, the number of beds in the Trust and the length of stay of admitted patients. As such there are 3 ways that monthly bed occupancy can be reduced:

• Reduce the number of patients that are admitted as an emergency – the Trust has recently performed an audit and discovered that 22% of patients that were admitted as an emergency could have been treated within the community if services, that other parts of the country have established, were available.

• Reduce the length of stay – through many studies the Trust has recognised that it has a significantly longer length of stay in certain specialties. This area represents a viable and relatively quick way for the Trust to reduce bed occupancy.

• Increase the number of staffed beds – the Trust’s financial allocation from its commissioners prevents this tactic from being used.

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4.2 An overview of Length Of Stay. To understand Length of Stay in a meaningful way patients with similar diagnoses and procedures are grouped into Healthcare Resource Groups (HRGs) of which there are about 500. Furthermore these HRGs are grouped into HRG Chapters (of which there are 18), which enables high level comparisons to be made.

A recent study (Figure 3) shows how WMUH’s patients Length of Stay within each HRG Chapter compared to the national averages:

Figure 3 - Length of Stay by HRG Chapter, 2003/4 and 2004/5

Explanation of Figure 3 using Chapter A (Nervous System) as an example: Patients treatment within the Nervous System chapter are typically patients who have suffered a stroke, cerebral infarction or have parkinsons disease or Multiple sclerosis etc. The brown boxes relate to 2003/4. The yellow boxes relate to 2004/5. Ntl LOS – The national average Length of Stay of all patients in all the hospitals in England who were coded with an HRG which is part of the Nervous System chapter. Spells – the number of WMUH inpatients that were treated within the Nervous System chapter. Tot Beddays - the number of WMUH Beds days that were consumed by all the inpatients in that year that were treated within the Nervous System chapter. WMUH LOS – The average Length of Stay of all WMUH inpatients within the Nervous System Chapter. This is simply the bed days divided by the number of spells. Excess Bed days – The number of bed days consumed by WMUH inpatients because they stayed longer than the national average. I.e. if the WMUH Length of Stay for Nervous System patients was exactly at the national average of 9.43 days rather than 15.8 days then 4870 bed days would have not been needed, in 2003/4. 4870 bed days equates to about 13 beds being open all year.

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4.3 Length of stay in detail

Average Length of Stay hides a lot of interesting detail. Continuing with Nervous System patients as an example one can describe the 2004/5 length of stay by a simple average (14.7 days) and suggest that an improvement was made from the previous years average (15.8 days).

If we delve into more detail we find that the range of LOS for all the patients within the HRG Chapter A is between 0 and 296 days. Furthermore one can look at the “shape” of the data - Figure 4 shows the frequency of observed LOS for all patients treated within Chapter A within the last 2 years.

Figure 4 - Frequency chart for HRG Chapter A LOS (2003/4 and 2004/5)

Figure 4 explained

80% line – 80% of all patients stayed less than 23 days. Trim point – the trim point is based on a national calculation to separate the outliers from the rest of the data set. I.e. if a patient stays more than 42 days (for this chapter) they can be statistically considered an outlier. 50 days above trim point – 31 patients, in the last 2 years have stayed more than 92 days (50 days above trim point).

So for the HRG Chapter A alone, 15 beds are being used all the time in the hospital by patients who are considered outliers and 5 beds are being used all the time by patients who have stayed 50 days and more beyond the point where they would be considered outliers.

4.4. Length of Stay reductions in summary In summary, reducing length of stay as a tactic to reduce bed utilisation takes two distinct types of action.

1. Reducing the overall average length of stay – by reducing the number of days that 80% of the patients stay. This is typically by removing the inefficiencies and blockages to the patients pathway: e.g.:

a. Increasing the frequency of ward rounds that have the authority to discharge patients when they are medically fit.

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b. Reduce waiting times for complex diagnostic tests (e.g. MRI scans, echo-cardiology).

c. Reduce waiting times for therapy assessments and therapeutic intervention. d. Reduce the complexity of administration surrounding patient’s discharge.

2. Reducing the number of people who stay in the acute setting well beyond the end of the acute phase of their illness/condition. This is typically achieved by:

a. Developing different care services in collaboration with the independent sector, voluntary sector, community services and social services for people who need to be supported in a different care setting.

b. Changing the policies associated with the transfer of patient care – i.e. currently some patients are waiting in an acute hospital bed for a place to be available in their choice of nursing/residential home.

5. INTERACTIONS BETWEEN BOOKING IN-PATIENTS ADMISSIONS AND

HOSPITAL CAPACITY REQUIREMENTS. A booked in-patient admission relates to a planned episode of care. As can be seen from Figure 1, the Trust has 26 beds which are dedicated to planned episodes of care the Trust also carries out approximately 55% of all elective operations as daycases. The Trust has efficient processes of booking and unlike emergency care typically has a lower than average LOS for planned patients.These two factors enables the Trust to manage its waiting list down to the required level, by and large, within this available bed base.

Currently 73% of the patients on the Trusts elective waiting list (for both Inpatient and Day care) have been waiting less than 3 months. There is no one waiting over 9 months and the Trust expects to bring the maximum waiting time for all elective surgery to 6 months by end of Dec 2005.

6. CONCLUSION The Trust hopes that the above information provides a coherent answer to the questions raised by the Overview and Scrutiny Committee.

It is worth taking the opportunity to make clear that none of the above discussion suggests that the Trust seeks to discharge a patient before they are medically ready. The Trust views reducing patients Length of Stay as a positive move that improves patient’s care:

• Less time away from family and friends and normal routines, in a foreign environment

• Less chance of being dependent on institutional care.

• Less exposure to hospital acquired infection.

• Less frustrations with waiting times and delays in the care process.

Peter Gill Director of IM&T and Service Improvement West Middlesex University Hospital June 2005

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At a meeting of the Adult, Health and Social Care Scrutiny Panel held on Monday, 11 July 2005 at 7:00 pm at Civic Centre, Lampton Road, Hounslow TW3 4DN.

Present: Councillors Fisher, Gill,SCS, Hibbs, Khwaja, Nakamura and Sangha. Councillors Virk (Chair of Overview and Scrutiny)

Co-opted Member: Cherna Crome

Apologies for Absence: Councillors Vaught., Mel Collins and Anthony Hurley

Also in Attendance:

London Borough of HounslowIsabelle Granet – Scrutiny Officer Maggie Wilson – Head of Strategy and Performance Social Services & Health Partnerships.

West Middlesex University Hospital Trust: Gail Wannell - Chief ExecutiveYvonne Franks - Director of NursingJoe Johnson - PPI Manager

Hounslow Primary Care Trust :Niall Fitzgerald – Head of Corporate Affairs Michael Carman – Non Executive Director

The meeting finished at 9:00 pm.Apologies for Absence, declarations of Interest and other Communication

The Chair welcomed Cllrs G Hibbs (winner of the IDEA Councillors Competition) and S.C Gill to the meeting as newly elected Members of the newly named Adult, Health and Social Care Scrutiny Panel.

• (Tri Borough Workshop 22nd June 2005). A tri borough workshop of Councillors, Health colleagues and Ealing, Hammersmith and Hounslow met on 22nd June to discuss the issues around substantial variation. The workshop went well and raised a number of issues as well as enhancing better communication between the different partners. It was agreed that notes arising out of the workshop will be circulated to the Panel.

• Councillor Premila Bhanderi The meeting observed a minute’s silence in memory of Councillor Premila Bhanderi Osterley and Spring Grove ward councillor who sadly died on (15 June 2005) after a long illness. Councillor Barwood described Councillor Bhanderi as a person who took special interest in her local community. Councillor Bhanderi also took a special interest in health and social services issues, having worked locally for many years as a pharmacist. Members acknowledged that Councillor Bhanderi would be sadly missed.

The meeting finished at 9:00 pm.Minutes of the meeting of 8th June 2005

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The minutes of the meeting of 8th June 2005 were agreed as a correct record subject to the following amendments

- Page 1, Item 87, to note that Mr C Thompson is Chair of Ashford &St Peter’s Hospital. - Page 3, Item 90, para 4, the first line should read ‘The Chair … number of care

workers available’.

The meeting finished at 9:00 pm.Hospital Capacity - Relevant Information

Gail Wannell, Chief Executive, WMUH, talked generally about why the trust had chosen the direction in which they were proceeding in terms of bed capacity and length of stay. Gail explained about the deficit financial position, which the trust were currently facing and referred to quality issues. Gail reported that the trust had feedback on models of care and patient’s experience overall in the last year and had started to look at issues of length of stay. The ATOS KPMG audit had focused on the length of stay, the hospital deficit and the quality concerns. As a result of the survey the trust had started remodelling on the emergency pathways where they found most of the discrepancy and the longest length of stay. As part of that remodelling the medical assessment unit was established and had made significant inroads into length of stay last year. the trust had managed to reduce bed capacity while at the same time dealing with the same amount of patients using fewer beds.

Gail advised that the report provided a break down on the amount of beds in relation to specialties and picked up on where the diagnostic case reviews on where the long lengths of stay are. The document outlined where improvements had been made over the past year and set out the case for continued improvement over the coming year, which would be achieved by continuing to introduce new models of care. The overall aim of the trust was to ensure that the money which they attracted was spent wisely, and they were also reviewing not just the number of beds available but ascertaining if they were for the right length of stay. The challenge was if the length of stay was too long the trust needed to know why this was the case, was it the model of care, or internal inefficiency and this was why the trust had matched the pathway of care and in particular in terms of emergency provision. The trust was continuing to work with colleagues and partners in the PCT and Social Services to identify whether patients staying in hospital for long periods of time could better be accommodated and receive alternate and better ways of providing care in another environment.

Moving WMUH forward – the trust were looking at models of care they could initiate themselves, and pushing for diagnostic tests being done on time. Ensuring that ward rounds are conducted at an appropriate time, by the whole team so that decisions can be agreed at an earlier time, thus enabling people to go home and ensuring that people are not being kept in inappropriately was another area the trust was working on. Nurses are also being empowered with the right criteria and if the doctor has signed a patient off they will be permitted to send patients home. Gail advised on the number of patients received into the hospital and the challenges facing the hospital in ensuring that discharges were dealt with in an efficient, caring and appropriate manner. She agreed that there was an element of seeking to achieve savings by bed cutting, however, the trust were not reducing beds and expecting activities to diminish, the hospital was seeing more patients

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than ever, but they were providing services with the right models of care, and by optimising the right length of stay. Analysis of the data captured in the surveys had shown that some patients coming to the trust did not all have acute problems, and the trust was working with colleagues in Social Services and the PCT to ascertain if services could be provided in a different way with the required support the hospital wouldn’t necessarily see the same number of patient. Turning to the issue of readmission Gail advised that the data captured had been analysed and to date there had been no increase in readmission, this tended to support the trust’s view that they were providing the right type of care and supporting people appropriately.

The Chair welcomed questions

Councillor Sangha stated that cutting beds to save money was not helpful to patients and indeed was detrimental to the health of the general public. Gail Wannell accepted Councillor Sangha’s point and acknowledged that it could be perceived that they were cutting bed capacity just to save money however, that was not the only reason for cutting length of stay / bed capacity. She explained how increasing the length of stay could lead to an increase in the rate of infection and was not good for health outcomes, however, by providing the right models of care it was possible to reduce the length of stay safely. Decisions on length of stay were taken in consultation and authenticated by the Director of Nursing and the relevant Clinician.

Yvonne Franks offered the clinical perspective regarding the length of stay. She advised the there was a national drive to move more patients from inpatients to day surgery and day surgery to out patients. She reminded the panel that it was clinical practice for some operations to routinely admit, while lots of other hospitals successfully carry out the same procedures as day surgery. She outlined the benefits to patients in conducting some routine operations as day patients, including sleeping in ones own bed and eating ones own food, all of which contributed to better health outcomes for patients. Next year the trust would be more challenged in terms of the way they were paid to provide services and they would be benchmarked to other acute services..

Councillor Fisher asked what impact cutting bed capacity would have on patient’s waiting lists. Yvonne Franks advised that the overall waiting list for patients is currently a maximum of 9 months and the national directive is that by the end of December no patient should be waiting longer than 6 months. the trust are confident of achieving the projection that no patient will wait longer than 6 months on the waiting list. Gail Wannell advised that they were reviewing what procedures could be performed as day surgery and they were confident that as a greater number of procedures could be done as day surgery they could achieve their 6 months waiting time. Times ahead were challenging and ensure that the right equipment was available to carry out day surgery was essential. The trajectory for the future by 2008 the waiting time should reduce further to 18 weeks and the trust were looking forward to meeting that challenge.

Councillor Virk asked why the trust performance was so poor and Gail Wannel advised about the poor infrastructure, the buildings blotted all over the stie which were not interrelated, she described the journey an emergency patient would have taken round the old hospital and moved on to explain how with the new purpose built hospital they now had a hospital that helped the patient process not hindered

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it. They had ensured that emergency departments were co-located and over the last 12 – 18 months a vast improvement in the length of stay for patients had been experienced. the trust had not applied any benchmarking exercise in the past they had been aware that they were managing the numbers on the waiting list however, their current benchmarking exercise they are becoming more aware of areas for improvement and becoming more commercially aware.

Councillor S.G Gill what the patient’s response was towards all the modifications and in terms of the all the new changes in clinical practice how were the changes disseminated down to the patients. The Panel were advised that the trust had introduced to new major initiative on medical care in relation to getting messages out to the community. They were successful in getting profiles in the local press on the changes taking place. In the future they how to have an interview in the local press with their Modern Matron. Gail acknowledged that as an organisation they were not always quick to trumpet their success. In relation to the patients, Gail explained how she used to receive a great number of complaints from patients now she stated the norm now was to receive more compliments and fewer complaints.

Councillor Gill suggested that the trust should provide this information to GPs so that patients attending their surgeries could be provided with leaflets. Gail Wannell explained that they had been linking up with colleagues in the PCT and this was one issue that they would take up, i.e. passing the information onto GP’s about the work they were doing. Gail thanked Cllr Gill for his suggestion.

Councillor Nakamura questioned whether staff would be subjected to additional pressures and find themselves working in a more stressful situation working to meet the targets. Gail Wannell gave an example of how they moved to the new building they had a model of care that theoretically was the right one to use. It lead to ‘safari ward round’ and the working lives for doctors and nurses were very difficult. Everything they have done on length of stay has involved clinicians, and they believe that the model of bed care which they now had was better for Doctors, and staff had advised that it was better for them. Last year clinicians advised that the trust weren’t doing clinical procedure, which other hospitals were, this had now changed and now with models of care the clinicians were comfortable with they were managing to boost recruitment of staff.

Councillor Khwaja referred to the report, page 7, bed capacity, which advised that the majority of beds are allocated to emergency care, and he asked for a) details of the overall impact on the overall performance of the hospital b) how this affected the waiting list. Gail Wannell stated that there were 26 non- emergency beds, 26 beds for elective surgery work and this was successful. One of the aims in the models of care was to separate emergency and planned care. Gail outlined how the care path now operated and explained the efficiencies of using this system with wards now closer to main theatre and the staff that cover the planned care are more familiar with the emergency work. In a supplementary question Councillor Khwaja asked how the trust had coped following the recent London bombings. Gail Wannell advised that when the emergency was called, Pan London, the trust implemented their emergency procedures, they continued with emergency surgery, discharged patients, where it was safe to do so, this in consultation with colleagues in Social Services and Health Partnerships and managed to free up 50 beds in 1 hour. She praised all her staff for the excellent and professional way they had

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implemented the emergency plan.

Cherna Crome questioned the statement made that in particular day surgery was very challenging from the professional perspective. She suggested it was even more stressful and very challenging from the patient’s perspective, and questioned whether the infrastructure was in place to support patients coming out of hospital following day surgery, otherwise the burden of care would fall on families. The panel were advised that as far as the procedures carried out as day surgery these are comparable with those trust currently offering the facility. Where day surgery is provided issues such as pain relief is comprehensively covered, the hospital trust were not looking to be pioneers in the delivery of day surgery but were adopting best practice and proven models of care developer by other hospitals. Day Surgery was being conducted as a way forward for providing the right type of care in appropriate setting and for those patients assessed as being medically suitable for this type surgery. Yvonne Franks advised that consideration would be given to social and clinical reasons for day surgery, and a robust pre assessment criteria was enacted prior to surgery.

John Hunt referred to the report and suggested that it provided some interesting background information. With regard to the future he questioned whether plans on the proposed reduction of work had been developed and asked if they could be disclosed and whether Gail could describe how the plan would work. The panel was advised that the paper was a starting point for discussion, a number of ‘draft’ plan had been written / rewritten. It was hoped to have a final definite plan ready for Tuesday 19th July 2005 ready for disclosure to the Patients Forum. It was stressed that all the models of care pathways had not yet been finalised.

Councillor Fisher advised that she had a number of questions, which she was happy to email to Gail Wannell.

The Chair welcomed the report and advised that a further update on bed capacity would be brought back to the panel later in the year. It was noted that a report was being produced on Hospital Acquired Infection and would be brought before the panel in November - January 06.

The meeting finished at 9:00 pm.Staff Attitude to Patients - Relevant Information

The Chair agreed to take Agenda Items 5 and 6 together.

Staff Attitude to Patients.

Yvonne Franks advised the panel that contained in the report were the results of a range of national and local surveys, which WMUH had participated in over the last 12 months. At a National level of the 4 surveys participated in, the outcomes of two of those, A&E and Outpatients, were detailed in the report for member’s information. Yvonne advised that a staff survey was also conducted and the results didn’t make good reading.

With the survey results the hospital recognised that there were themes in all of the surveys and they could pick out advances in some areas for example when the

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survey results were compared to the one carried out two years earlier by the hospital it could be view that the trust did better in the area of A&E however, in Outpatients the results showed that the trust remained static. It was for this reason that the trust and Patient’s Forum had identified this as areas of development / action point over the next year. Organisationally, each department had produced an action plan based on the answers, which were distributed widely. Also many of the board had taken part in presentation to staff. A joint presentation had been produced that talked about the staff and patient surveys. Some of the elements the patients talked about, i.e. lack of communications/ way they were spoken to/ lack of communication were mimicked in the staff survey. Yvonne suggested that if this was the way staff spoke to each other it was highly possible this deficit/ lack of communication skills would present itself when dealing with patients. For this reason each department had developed an ongoing action plan.

The report highlighted some of the areas of improvements for example cleanliness and car parking, not so good all the time on food. There were some trends identified in the four surveys which outlined areas of work for the trust, for example talking in front of a patient as if they weren’t there, while standing at the end of the patients bed, not involving patients in discussions and decisions about their care. To address these areas a large amount of work had been carried out on training and staff development.

Yvonne highlighted that the number of assaults to staff had increased and suggested that this could fuel a negative circle in relation to staff attitude to patients.

Complaints and PALS Annual Report.

Joe Johnson referred to the report on pages 12 – 15, which detailed the major changes in PALS at WMUH and advised that the complaints and PALS function changed from the Corporate Affairs management to come under the Nursing Directorate. This was a conscious decision in terms of where WMUH were going in relation to training and development and forging closer links with the Nursing Director and had been successful over the last six months. He reported on the staffing levels and advised the panel on the reduction of the number of complaints received as a result of the move towards local resolution. Independent Reviews - Second Stage reviews had now moved from the Trust to the Healthcare Commission and they had taken on the role to manage independent reviews. Joe advised that the Healthcare Commission had recently contacted them with a view to conducting their first review around the case of a couple whose child had died while in the care of WMUH. In reviewing the number of complaints received - 332 formal complaints and just under 1000 PALS enquires about patients dissatisfied with the services received were reported Joe suggested that these should be taken in the context of the 70,000 A&E patients and 130,000 outpatients treated yearly at the WMUH and the number of positive praise received from satisfied patients.

In response to the question raised by Councillor Virk around the complaints panel and their frequency of meetings. Joe agreed that while the complaints panel met quarterly, all complaints received were reviewed on a month by month basis and reviewed by the various managers/ departmental heads and indeed they managed to respond to 81% of those complaints received within 20 working days. He

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acknowledged that in relation to clinical complaints work continued to improve responses.

Yvonne Franks advised that there had been improvements and gave the example of 12 moths ago WMUH had 40% staff vacancy and the pressure on staff had been enormous, now with proper leadership in place the trust had seen real advances in staff morale. She acknowledged that there were still pockets of problems and they were working to resolve this.

Councillor Khwaja asked about the feedback, which the trust had received, from the public in relation to staff attitude to patients. Yvonne Franks advised that the agenda papers contained a great deal of information. She explained that the trust was in the bottom 20% of acute trusts. She reminded the panel of the variety and number of surveys carried out and explained that the trust was constantly seeking patient feedback to advance their service provision; the trust engaged with a number of forums and panels the Cancer Forum and the Patients Panels to name two. Another tool employed was the discovery interview, where patients tell their story about the stay in hospital and this was played back to the clinician team. This scheme had been introduced in Cardiology and if found to be successful would be rolled out across the hospital.

Councillor Fisher welcomed the staff training to enable them to deal more courteously with patients, and asked whether the consultants would engage in the same training. The Panel were advised that this was an area for further training for consultants. In a supplementary question Councillor Fisher referred to the administration staff in the hospital and suggested that some of them required further training. Gail Wannell advised that the trust were working to modernise its workforce and part of the modernisation would include better training for administration staff. The trust was reviewing its current mode of working and seeking to introduce less traditional methods of working and this could include, voice recognition software i.e. looking to be less people dependant. As part of the modernisation the trust were also looking at the skills and knowledge base of its staff and all jobs descriptions been upgraded.

The Chair made reference to the results of the outpatients survey and stated that the overall results were disappointing; she questioned whether this was because long-term patients, seeing the problems on a long term / regular basis and they were familiar with the problems. Gail Wannell stated that the trust was getting a lot of feedback from repeat patients; they had designed the new hospital on the basis of it being paperless and without medical records . The trust had aimed at being able to scan in all the records and have everything electronically available however; while they were able to get the imaging introduced and this had assisted accessing records they hadn’t improved on the medical records. The waiting areas are quite small, and in their original design for the hospital it had been anticipated that patients would feel comfortable waiting in the large atrium / restaurant and then coming across to the waiting area in good time for their appointment sadly this had not proven to be the case. A lot of patients don’t have a lot of confidence yet in the management of the out patients department and as a result they often attend the hospital very early for their appointments, and Gail acknowledged that until the systems and process of managing the outpatients changed patients the trust would not be able to encourage patients to move away from this small area. Councillor Fisher suggested an advertising campaign that advised patients that if

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the came for an appointment too early they wouldn’t be seen.

Councillor Sangha asked to what extent the rules of fairness were protected as staff investigating the complaints were directly employed by the trust and the complaints were directed by members of the public against their employers. Joe Johnson acknowledged that the people involved in the handling of complaints were directly employed by the trust, and to maintain the independence and integrity of the trust independent impartial conciliators were used. Where difficult / complex clinical cases were complained about an independent external expert Doctor / Nurse was employed. The patient was also offered the opportunity to take their complaint to the Healthcare Commission if they were unhappy with the responses received.

Niall Fitzgerald, Head of Corporate Affairs, Hounslow PCT advised that one of the areas that had changed in the handling of complaints in Hounslow PCT and WMUH was the introduction of the PALS service. He advised that because of the work done around local resolution of complaints the numbers of formal complaints have reduced for both organisations.

In response to Councillor Virks question about disciplinary action being taken against staff for their bad attitude, the panel were advised that the trust was equipped to challenge staff attitude, disciplinary action had been taken around individual attitude problems, and this could have arisen out of a patient complaint or as a result of other staff highlight the problem. Staff complained about were always spoken to, and if appropriate it could lead to disciplinary action being taken and depending on the severity of the breach of discipline could lead to dismissal. Joe Johnson advised that if the complaint related to a GP’s attitude these would be taken up by the Medical Director and the approach to managing the disciplinary process would be the same.

Councillor Virk stated that WMUH had a bad reputation and suggested that the reports circulated highlighted that there were a lot of issues to be resolved. Gail said that WMUH were on a journey to resolve the issues. The new building was the start of the process of improvement supported by the new models of care, which had led to improved patients care. What hadn’t changed were patient’s perceptions of changes and improvements provided. The trust had seen significant transformations in service provision what was not being seen was the changes in perception of changes. Gail advised that the changes were ongoing and the trust with its high standards would continue to strive to always do better. She was unable to offer a definitive deadline when the changes would be complete. Gail welcomed suggestions from Members of the panel on ways to improve patient’s perceptions of the improved services and how to raise patient confidence in the hospital services. There remained a long way to go, the teams were ambitious and they wished to change for the better.

The Chair advised as the Health Scrutiny Panel was a public forum this was one of the ways in which local residents could be advised of the changes taking place at WMUH, she reminded the panel that this area of work would be revisited as part of the scheduled work programme for the year ahead.

The Chair thanked Gail Wannell, Yvonne Franks and Joe Johnson for their contribution to the discussion.

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The meeting finished at 9:00 pm.Referrals from the Patient Forums

The scrutiny panel noted that no referrals from the Patient’s Forum had been received.

The meeting finished at 9:00 pm.Date of Next Meeting

The Chair explained that the meeting may be on 6th September 2005, and not the 7th as previously stated, this will be confirmed to Members shortly.

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12B

Minutes of an extra ordinary meeting between the Trust and the WMUH PPI Forum held on Tuesday 19th July 2005


Gail Wannell W L Ford Simon Marshall Tim Spring Alison McIntosh Cherna Crome Janet Baldwin Jean Doherty Shân Jones Tony Foster Jane Brennan Basil Mann In attendance: Mr E Prosser (work shadowing Alison McIntosh)

1. Introduction

Mrs Wannell opened the meeting by welcoming everyone and explaining the purpose of the meeting was to address the Forum’s concerns they had raised at the Trust Board meeting held on 20th June. Their concerns were about the Trust’s savings programme which includes a proposal to reduce the number of beds. The proposals have been reported in the Board papers since December 2004. A number of the executive team attended a Forum meeting on 18th February to present the savings plan and it’s implications. The driving force behind the saving plans is the Trust’s legal responsibility to deliver and operational break even position at the year end. In financial year 2004/05 the Trust reduced it’s deficit from around £10m to an end of year deficit of £4m. In addition to recovering the £4m deficit, the Trust is required to repay a loan of £3.5m. The North West London Strategic Health Authority’s financial position was £54m deficit at the end of the last financial year and this year’s position is set to be equally if not more challenging. Over the past few years the Trust has been on a service improvement journey which is aimed at reducing costs and improving the quality of care it provides. The Trust knows that compared to similar Trust’s it’s costs are higher, and this is in the main linked to length of stay. Within this context, the Trust has a responsibility and duty of care to ensure it delivers the right model of care for all it’s patients and one that is cost effective.

2. Issues raised on the Savings and Service Improvement Plans

Mrs Crome stated that the Forum aren’t disputing the principles of the plan but rather how it’s delivered in the context of the community infrastructure or lack of it.

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Miss Baldwin emphasised that as part of the improvement journey to date, the Trust has reduced it’s bed stock by 54. This was only done once the quality improvements had been made to patient care. This approach is paramount – quality improvement first – bed reductions second and the same approach will be taken with the next phase. There are a number of work streams underway which are reviewing patient pathways to identify bottlenecks in the patients journey through the hospital. Many recurring themes have been identified, some of which are for the Trust to resolve, others such as frequent attendees & delayed discharges are whole health economy issues. The Trust is therefore working with it’s partner organisations, PCT’s Social Services etc to address these issues. The Forum received a presentation from the IARDS team at it’s last meeting. Mrs Wannell added that the team are developing a business case which will address the Trust’s concerns about the cohort of patient’s whose discharge is delayed due to a lack of community rehabilitation services. These patients currently sit in an acute bed awaiting discharge to a suitable community facility. The amount of patients this applies to is equivalent to a 28 bedded ward. The proposal is that the 28 beds, which are currently spread across the Trusts bed stock, should be re-provided in Kew Ward, ground floor of Marjory Warren. This is an ideal location opposite the day rehabilitation facilities. Whilst this group of patients are currently cared for throughout the hospital and are ‘safe’, they often do not receive timely attention in relation to their discharge. This new facility will provide a more appropriate environment for this group of patients, appropriately trained nursing and therapy staff and an intensive focus on the patient’s discharge. The IARDS proposal is different to the Hotel Ward at Kingston Hospital. The IARDS ward will be a dedicated area for rehabilitation, patients care will be managed with the objective of ensuring timely discharge to appropriate community facility. Hotel wards are generally used for overnight stays where day surgery patients don’t have appropriate support at home to ensure a safe discharge. The IARDS initiative is separate to the bed reduction proposals set out in the Saving Plan, although the objectives of both initiatives are to improve the quality of patient care and to reduce costs. The IARDS area will be staffed by a combination of staff who are displaced by the reconfiguration of general beds and the recruitment of permanent staff. The IARDS area will require a different skilled workforce to an acute ward but it is unlikely there will be enough existing staff available to transfer. When the further bed reductions occur current staff will be relocated to the new bed/ward configuration. The Trust has a number of vacancies which should ensure all staff will be relocated. The Trust has agreed a Change Management policy with the Trade Unions which will be used to initiate formal consultation at the earliest opportunity.

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The Trust is aiming to preclude the need to use escalation areas. This will be achieved in the fullness of time once the patient pathway has been modified to eliminate the current level of inherent inefficiencies. It is important to remember that the Trust is not allowed to close it’s doors once it’s full. There will always be a need for a safety valve. Admissions are unpredictable and there will on occasion be a need to be able to flex up the number of beds, which may require the use of escalation beds. The service improvement proposals have involved clinical teams throughout the Trust with the majority of ideas originating from them. Therefore the executive team are confident they have their full support. The Trust is on the 12th bed configuration since moving into the new hospital and each new configuration brings improvements to the way care is provided. The identified savings will be realised from a number of sources including a reduction in the reliance of bank and agency staff. This in turn will have a positive impact on the quality of care. The proposals aim to deliver a service which is in line with national best practice, which the Trust knows is out of kilter at the moment. National benchmarks indicate a number of areas for improvement, i.e. length of stay; the number of patients having day surgery. There are no significant demographic issues relating to the local population that impact significantly on the Trust’s ability to implement the service improvement goals. Whilst there are obvious challenges, such as a lack of community rehabilitation and continuing care for the Trust, these can not be used as an excuse for inertia. It is recognised that on occasion there have been problems associated with packages of care upon patient’s discharge. Mrs McIntosh is working with key partner organisations to identify shortfalls in community provision with a view of improving care across the acute, primary and social care sectors. Mrs Wannell reiterated that a ‘do nothing’ approach was not an option. If the Trust does not address it’s financial challenges, it may result in the Trust having service changes or reductions imposed upon them. It must be remembered however, that this exercise isn’t just about delivering value for money but equally it’s about improving patient care and improving the patient experience. As the plans stand at the moment the Trust is not loosing any specialities but gaining a rehabilitation facility which is much needed across the health economy. In addition to the improvements already discussed staff are continually coming up with ideas on how to improve the patient pathway. Initiatives include the critical care improvements (previously presented to the PPI

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Forum and Trust Board) and an increase in maternity capacity. Ideas in the pipeline include direct GP referrals to the Medical Assessment Unit. Mrs McIntosh agreed to update the ‘road map’ which details the planned service improvement initiatives and circulate it to the Forum with the minutes along with the IARDS business case. ACTION: Mrs McIntosh

Mr Marshall stated that many of the savings won’t impact fully until the next financial year although he believes that the budgets that have been set for this year are achievable. The impact of changes at Ashford & St Peter’s planned for later this year have already been factored into the Trust’s plans. At this stage it is felt that adequate provision has been made. Any unexpected increase in demand will need to be reviewed once the changes have been made. Mrs McIntosh added that part of the Trust’s plans is to analyse the demand for emergency services and to put in place effective strategies with the PCT to address these issues. A number of initiatives have been considered and one such scheme has already been implemented with the Emergency Practitioner Scheme. It was agreed that further work to understand whether the 53% of patients who are being diverted from the A&E department receive adequate care. ACTION: Mrs McIntosh

3. Outpatient Service Improvement Plan

Following discussion, it was agreed that the Forum need to carry out an independent inspection of the outpatient service. After which time both the Forum and the Trust will discuss areas for joint working. The Trust is already undertaking a comprehensive service improvement programme and believes that joint working will be beneficial to both parties. The Trust wants to be open at all times and to this end, Ms Jones agreed to provide the outpatient information the Forum has previously requested. Ms Jones undertook to circulate the Outpatient Improvement Plan so the Forum can ascertain where joint working would beneficial. ACTION: Ms Jones

4. Sunday Times Good Hospital Guide - Dr Foster

Miss Baldwin advised the Forum that the annual Dr Foster data published in the Sunday Times is due for publication in October. The data that will be used will be from 2003/04. This will present a negative picture for the Trust with regards to mortality rates as the Trust will be ranked within the 10 poorest performing Trust’s in the country. Whilst the Trust has to accept the reporting of factual data, Miss Baldwin advised the Forum that the Trust’s performance in this area has improved significantly since that period. In respect to the Dr Foster analysis of mortality data for 2003/04, the Trusts performance is 123 against a standardised rate of 100. Using another method of measuring mortality rates, CHKS, the Trust performs slightly better at 108 against a standardised rate of 100. Performance for

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2004/05 demonstrates an improvement against both the aforementioned measures. The Trust now has a clearer idea of the issues that need addressing to improving the Trust’s mortality performance and indeed have implemented a number of corrective initiatives. One such being, the improvements to the critical care pathway which have been presented to the Forum and the Trust Board. Whilst it is too early to statistically demonstrate real improvements, the staff are confident that the initiatives are making a real difference to the patient experience and clinical outcomes Notwithstanding the Trust’s improved performance, the publication of data from 2003/04 will present PR challenges for the Trust which we will try to address through the promotion of our improved performance.

5. Trust Board Sub Committees

It was agreed that Mrs Doherty would become a member of the newly formed Patient Experience Committee and Mr Tony Foster will become a member of the Clinical Excellence Committee.

6. Consultation Protocol

The Trust expressed it’s disappointment that a protocol had not yet been agreed. Both parties agreed to have further discussions outside the meeting with a view of gaining consensus at the earliest opportunity.

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BUSINESS CASE FOR THE ESTABLISHMENT OF THE IARDS WARD REHABILITATION FACILITY

AUTHORS: PATRICIA DAVIES, ASSOCIATE DIRECTOR OF ACUTE CARE RANJIT KOONER, HEAD OF IARDS

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P. Davies & Ranjit Kooner, ‘Business Case for IARDS ward’ Version 7

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BUSINESS CASE FOR IARDS BEDS INTRODUCTION This case outlines a proposal to dedicate 28 IARDS (Integrated Assessment, Rehabilitation & Discharge Service) beds within Kew Ward on the ground floor of the Marjory Warren building at West Middlesex Hospital. Kew Ward was originally planned as a rehabilitation facility for the Hounslow Health Community. A number of key audits completed by the Trust and the PCT therapy department has identified a shortfall in the number of community rehabilitation, step down, intermediate care and continuing care beds (by approximately 28) available for West Mid patients. The introduction of the IARDS beds will: 1. Improve access to intermediate care and slow stream rehabilitation for patients

requiring these services. 2. Provide a temporary step down facility for patients who have been allocated

funding for continuing or local authority care, but are awaiting placement. 3. Make better use of the Trust’s facilities and improve patient satisfaction levels. 4. Provide additional income streams to the Trust. Currently the Trust is carrying the full cost of holding: • Up to 6 patients (at any one time) awaiting an available Nursing/EMI bed

following funding approval via the Hounslow Health panel. • Up to 16 patients (at any one time) awaiting intermediate care resources, step

down or short term rehabilitation within the community. The financial cost to the Trust inclusive of overhead charges for these 22 beds equates to a full year cost of £1.5m. Holding on to these patients effectively diverts acute capacity and impacts on total length of stay. The resulting effect is an overspill into unfunded acute escalation, increased cost associated with extended LOS, risk to key access targets (in terms of elective surgery and A&E), and potential clinical risk associated with a reduction in quality, all of which is currently being carried by the Trust. CURRENT SITUATION The West Middlesex University Hospital NHS Trust has 311 adult acute beds reduced from 365 beds over the last 18 months in line with LOS reductions within Medicine and the introduction of both the MAU and HDU services. The restructure of the Discharge service, A&E and Community RADIATE teams under IARDS, has also impacted on the LOS reduction and has improved access to community rehab & step down facilities. However, despite an increase in the number of community step down & rehab beds, we are still experiencing reportable delays at the rate of 6 new patients per week. In addition to these reportable delays, we have approximately

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16 patients in the acute system awaiting intermediate care. Approximately 6 patients per week would benefit from slow stream rehabilitation, which the sector currently does not provide. Patients that would benefit from this type of rehabilitation include fractured neck of femur & stroke who’s current length of stay exceeds the national benchmark by an average of 8 days per patient. In summary delays relate specifically to: • Lack of vacant/available permanent nursing/residential/EMI home facilities. At

any one time there are 6 patients awaiting placement following funding agreement. Average delay for these patients equates to 14 days due to a lack of available beds within the residential & nursing home sector.

• Lack of step down/intermediate care facilities. At any one time there are 16 patients awaiting these services. Average delay for these patients equates to 8 days.

• In addition to the above-lost bed days attributed to health delays, there are 6 patients (at any one time) who have a protracted LOS due to a lack of slow stream rehab that is not currently provided within the Hounslow Health community. This equates to an additional full year cost of £416k based on the total number of lost bed days.

The full year cost to the Trust equates to £1.9m based on the total number of bed days consumed by these patients over one financial year. The table below shows where the step down, intermediate care and continuing care beds currently are for Hounslow community patients TABLE 1 Service Criteria/Information How to Refer Contact

Details Coniston Lodge

10 step down beds and 5 continuing care beds.

Via the Discharge team/Social services

IARDS

Clayponds 6 Rehabilitation beds Referral form available on all wards, team will then come and assess, no time limit

Tel 0208 560 4011 Fax 8568 7341

Heston House cru

6 rehab beds open July 2004 SPA Kulvinder Jhita Tel 0208 560 2211 Fax 0208 568 8785

Elridge House

5 beds for Physical Disabilities and sensory impairment, age under 65 Open September 2004

SPA Kulvinder Jhita Tel 0208 560 2211 Fax 0208 568 8785

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Sandbanks rehab unit

7 beds Short term rehab(6wks) Over 65 Aim for discharge home Transfer with1 Opened 2000

SPA Kulvinder Jhita Tel 0208 560 2211 Fax 0208 568 8785

BENEFITS The key benefits of opening an IARDS ward facility within West Mid include: 1. Cost reduction associated with a decrease in LOS for adult surgical and medical

patients’. As the ward will be classified an IARDS ward rehab facility, the LOS data will not be reported as part of the acute Trust LOS. Therefore, at a stroke putting total LOS for adult inpatients in line with comparable Acute Trusts (e.g. Kingston, Hometon, St. Mary’s) who have access to community hospital resources. The Trust’s service improvement roadmap assumes that the Trust can reduce bed capacity by 30 beds. The IARDS ward forms part of this bed reduction by supporting LOS reduction within #NOF and stroke pathways by ensuring that there is appropriate step-down and slow stream rehab available for patients who require this service. Currently, #NOF and stroke patients who require slow stream rehab following adequate ‘work up’ by the acute team, do not have a resource in which to receive this facility. This results in extended LOS and the reduction in the patients’ ability to benefit from rehab or inappropriate admission to long-term care.

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TABLE 2: PREDICTED LOS REDUCTIONS RELATED TO SELECTED HRG’s

HRG Description Total Average National Expected Variance No. of bedsCode LOS LOS Average LOS saved

A23

Non-Transient Stroke or Cerebrovascular Accident <70 w/o cc (A23) 1070 26.10 15.8 647.8 422.2 1.2

H99

Complex Elderly with a Musculoskeletal System Primary Diagnosis (H99) 2659 35.45 30.54 2290.5 368.5 1.0

E31Syncope or Collapse >69 or w cc (E31) 1085 10.96 7.52 744.48 340.52 0.9

E29Arrhythmia or Conduction Disorders >69 or w cc (E29) 1294 9.18 6.77 954.57 339.43 0.9

Q15 Amputations (Q15) 975 60.94 44.34 709.44 265.56 0.7

H82Extracapsular Neck of Femur Fracture with Fixation w cc (H82) 458 50.89 22.44 201.96 256.04 0.7

H84Intracapsular Neck of Femur Fracture with Fixation w cc (H84) 485 40.42 21.42 257.04 227.96 0.6

H88Other Neck of Femur Fracture w cc (H88) 539 53.90 31.65 316.5 222.5 0.6

H36Closed Pelvis or Lower Limb Fractures >69 or w cc (H36) 1138 24.74 20.41 938.86 199.14 0.5

H87Neck of Femur Fracture with Hip Replacement w/o cc (H87) 852 25.82 20.02 660.66 191.34 0.5

H85Intracapsular Neck of Femur Fracture with Fixation w/o cc (H85) 578 23.12 16.09 402.25 175.75 0.5

H86Neck of Femur Fracture with Hip Replacement w cc (H86) 409 31.46 25.66 333.58 75.42 0.2

H39Closed Upper Limb Fractures or Dislocations >69 or w cc (H39) 558 12.68 11.05 486.2 71.8 0.2

H83Extracapsular Neck of Femur Fracture with Fixation w/o cc (H83) 252 22.91 16.65 183.15 68.85 0.2

H89Other Neck of Femur Fracture w/o cc (H89) 594 22.85 20.42 530.92 63.08 0.2

A12Disorder of Balance aetiology unknown w cc (A12) 394 17.13 14.72 338.56 55.44 0.2

R99Complex Elderly with a Spinal Primary Diagnosis (R99) 116 58.00 30.45 60.9 55.1 0.2

H31Musculoskeletal Signs and Symptoms >69 or w cc (H31) 169 13.00 9.19 119.47 49.53 0.1

9.4 The HRG chart above indicates that the IARDS ward would contribute up to 9 beds to the Trust’s target of 30 following implementation and establishment of this service alongside the development in the IARDS infrastructure and whole system working in relation to patients with long-term conditions.

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2. Remove the need for unfunded escalation This proposal should allow us to address the need for unfunded “escalation” beds . The number of “ escalation” beds varies throughout the year from 0 to 22. 3. Reducing clinical risk & Improving clinical Outcomes The IARDS ward will reduce clinical risk and improve the outcome for patients who require intermediate, step-down and rehabilitation. West Mid currently does not provide a defined rehab services and there is no provision for slow stream rehab across the health community. Data indicates that there is currently a shortfall in intermediate care provision. By having these services on site patients within the Hounslow health community can receive rehabilitation at the optimum time to meet their needs. A delay in accessing rehab at the optimum time can result in deterioration that can then adversely affect their ability to benefit from rehabilitation when this is available. Patients will have access to regular medical input and specialist advice from clinicians with expertise in both acute care and rehabilitation. Placing the 28 patients within a rehab environment will ensure that the patients receive the appropriate level of care within a skilled environment that meets their needs for re-enablement. This will improve the clinical outcome for the patient, reduce levels of dependency, reduce inappropriate admission into long term care term care and reduce LOS. 4. Improvement in staff morale, reduction in sickness and temporary staff usage Anecdotal feedback via senior nurse and medical forums indicates the level of frustration experienced by staff who feel that a number of patients do not require acute hospital admission, but need ‘social’ intervention by way of rehabilitation or intermediate care. 5. Reduction in readmission rates & inappropriate admissions into long-term care National research indicates that access to appropriate rehabilitation at the right time can reduce acute re-admissions and inappropriate admission into long-term care. The implementation of the IARDS will contribute to the Health Community target of reducing readmission rates by 1%.

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PROPOSAL FOR THE INTRODUCTION OF A 28-BEDDED IARDS WARD ON THE GROUND FLOOR OF MARJORY WARREN Kew ward is currently empty and has the capacity to house a maximum of 28 rehabilitation beds. This is a purpose built unit designed to support the re-enablement of patients requiring physical rehabilitation. The proposal will be to open 28 beds within Kew as an extension to the IARDS service. These beds will provide the following services over a 24-hour period seven days per week: • 6 beds for patients with who have agreed funding for long-term continuing or

local authority care (4 beds for Hounslow & 2 beds for Richmond based on IARDS data). Agreed funding should follow these patients. This must be agreed with IARDS partners.

• 16 beds for intermediate care. • 6 beds for slow stream rehabilitation (unfunded currently covered by the Trust). Medical Support and Accountability Medical responsibility will remain with the admitting medical/surgical team. It is not envisaged that this will greatly impact on either the medical or surgical workload (max 1-2 patients’ per firm). Patients admitted to this unit will meet the same criteria as for community beds, i.e.: • They will not be in the acute phase of illness • Patients will be classified as ‘medically stable’ • Patients cannot have their rehab needs met within an independent living

environment with care package, outreach and day hospital support and cannot, therefore, be safely discharged home.

The predominant needs of this patient group are nursing and therapy rather than medical therefore, patients may not require daily medical intervention. In similar units (e.g. Cas Ward at the Homerton Hospital) average medical input per patient is every 2-3 days for review of medication. This unit is nurse-led and has been in operation for 8 years. There is no envisaged increase in medical staffing costs for the proposed beds. Nursing Staff There will be a lower requirement for nursing resources within IARDS as compared to an acute ward to cover a 24-hour, 28-bedded service. The exact establishment and breakdown of costs are provided within the attached Excel spreadsheet. The IARDS service currently has 1 H grades & 1 G grade that can provide clinical leadership and support to the nursing staff on the ward. The H grade will oversee the ward managerially & the G grade clinical nurse specialist for older people will

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act as the expert link in terms of assessment, advice and patient co-ordination, thus ensuring that patients’ do not get ‘stuck’ in the system. Given the existing senior nurse skill mix available, there will not be a requirement for senior nurse (H & G grade) funding within the establishment. Funding will be required for a ratio of 1.3 nurses per patient, which will allow for the following skill mix: • 3 qualified nursing staff & 4 HCA rehab assistants per early shift • 2 qualified nursing staff & 2 HCA rehab assistants per late shift • 2 qualified nursing staff & 2 HCA rehab assistants per night shift Total costs for the proposed nursing staff are: 28 Beds

GradeProposed

WTENo. in post

WTEVariance

WTEProposed Budget (£)

Already Funded (£)

Variance (£)

H 1.00 1.00 0.00 47,475 47,475 0G 1.00 1.00 0.00 37,633 37,633 0F 2.00 0.00 2.00 72,578 0 72,578E 6.00 0.00 6.00 174,278 0 174,278D 6.00 0.00 6.00 164,827 0 164,827B 14.50 0.00 14.50 295,464 0 295,464

A&C 4 0.50 0.50 0.00 11,503 11,503 0Total 31.00 2.50 28.50 803,758 96,611 707,147

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Non-pay costs Agreement is required that the ward and the activity remains part of the West Middlesex structure, and that all services, re: catering, cleaning, porting pharmacy and supplies are continued as per acute ward facility. Additional costs associated with use of support services is estimated on the current usage of running Lampton 2 ward which is £130,000. Further discussions will be required with Ecovert to ensure we can open Kew and close another ward without incurring any additional running costs. Equipment Costs A one-off capital cost of £40K is expected to cover purchase of beds, hoists, lockers and other essential equipment. Capital funding for this will need to be discussed with the PCT. BREAKDOWN OF FINANCIAL COSTS Resources Cost implications Nursing £804k Non-pay costs (inc. Ecovert FM charges and drugs)

£130k

Social Work Costs 0 Medical Costs 0 (absorbed by WMUH) Therapies 0* Capital Costs 40K TOTAL (FULL YEAR COSTS) £940k *Via SLA Potential Cost Savings: The main cost savings to the Trust is as a result of the re-organisation of staff amounting to £200k per annum. The Trust would also been able to identify up to 9 beds, which would be saved through LOS efficiencies, which would contribute £360k of the Trusts existing recovery plan. Potential Sources of Funding for discussion This business case is predicated by the assumption that the Trust is already incurring significant costs in relation to these patients in excess of that that would be required to pay for the next phase of their treatment. These currently unfunded costs are a significant factor behind the Trust’s financial difficulties and excess LOS. The Trust does not believe it would be appropriate to discharge these patients without appropriate care and therefore proposes to divert the existing funding into more appropriate services with the expectation that one off funding for example from the sectors service reengineering fund can be obtained to support this in 05/06 and that the appropriate income for the future would be secured by the transitional arrangements for payment by results. The Trust also views these services as an income generation opportunity for the Trust, which will help to make full use of the Trust’s estate and therefore contribute towards the existing PFI overhead.

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Further income streams could also be generated via a combination of the following: • Funding attached to patients who have agreed funding for long-term care via

Hounslow or Richmond funding panels (equivalent to 6 beds). • 6 beds have been identified for intermediate care (4 beds for Hounslow & 2 for

Richmond). There is currently a lack of available beds for intermediate care in both areas. Based on discussion with Hounslow PCT commissioners, funding could be released from the proposed investment within Ashford Rehabilitation ward due to open in November 2005.

• Call off of the reimbursement charge and use of this money up front to fund the IARDS ward in order to prevent delayed discharges from occurring.

• Funding to be released from Teddington Memorial Hospital (TMH). TMH currently has 2 beds for West Mid patients. These are rarely accessible. WMUH would like to transfer the funding to IARDS for R&T patients admitted to WMUH who then require rehab.

CONCLUSION The economic and clinical argument for the redirection of existing resources into the proposed 28-bedded IARDS ward rehabilitation facility is strong. The patient will receive expert multidisciplinary assessment and rehabilitation at the point of need and without delay. This will improve the clinical outcome for the patient. Evidence from similar models across the UK suggest that investment within such a facility can reduce admissions and re-admissions to the acute sector, reduce inappropriate admission to long term care, and reduce the level of supportive care package on discharge into the community. The benefits to the acute sector relate to the reduction in LOS and the release of acute capacity resulting in better management of care for all patients and reduction in inappropriate expenditure. Timescales for action Week Commencing Exec presentation & agreement in principle 7th July 2005 IARDS board presentation & agreement 7th July 2005 Full agreement by 11th July 2005 Commence recruitment of staff via e-recruitment 11th July 2005 Closing date for application 29th July 2005 Interviews to be held by 12th August 2005 Staff in post by 12th September 2005

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Two-Week Staff Induction 12th September 2005 Ward Open 26th September 2005 P. Davies Associate Director of Acute Care Ranjit Kooner Head of IARDS 30/6/05

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210

of 5

Minutes of an extra ordinary meeting between the Trust and the WMUH PPI Forum held on Tuesday 19th July 2005


Gail Wannell W L Ford Simon Marshall Tim Spring Alison McIntosh Cherna Crome Janet Baldwin Jean Doherty Shân Jones Tony Foster Jane Brennan Basil Mann In attendance: Mr E Prosser (work shadowing Alison McIntosh)

1. Introduction

Mrs Wannell opened the meeting by welcoming everyone and explaining the purpose of the meeting was to address the Forum’s concerns they had raised at the Trust Board meeting held on 20th June. Their concerns were about the Trust’s savings programme which includes a proposal to reduce the number of beds. The proposals have been reported in the Board papers since December 2004. A number of the executive team attended a Forum meeting on 18th February to present the savings plan and it’s implications. The driving force behind the saving plans is the Trust’s legal responsibility to deliver and operational break even position at the year end. In financial year 2004/05 the Trust reduced it’s deficit from around £10m to an end of year deficit of £4m. In addition to recovering the £4m deficit, the Trust is required to repay a loan of £3.5m. The North West London Strategic Health Authority’s financial position was £54m deficit at the end of the last financial year and this year’s position is set to be equally if not more challenging. Over the past few years the Trust has been on a service improvement journey which is aimed at reducing costs and improving the quality of care it provides. The Trust knows that compared to similar Trust’s it’s costs are higher, and this is in the main linked to length of stay. Within this context, the Trust has a responsibility and duty of care to ensure it delivers the right model of care for all it’s patients and one that is cost effective.

2. Issues raised on the Savings and Service Improvement Plans

Mrs Crome stated that the Forum aren’t disputing the principles of the plan but rather how it’s delivered in the context of the community infrastructure or lack of it.

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Miss Baldwin emphasised that as part of the improvement journey to date, the Trust has reduced it’s bed stock by 54. This was only done once the quality improvements had been made to patient care. This approach is paramount – quality improvement first – bed reductions second and the same approach will be taken with the next phase. There are a number of work streams underway which are reviewing patient pathways to identify bottlenecks in the patients journey through the hospital. Many recurring themes have been identified, some of which are for the Trust to resolve, others such as frequent attendees & delayed discharges are whole health economy issues. The Trust is therefore working with it’s partner organisations, PCT’s Social Services etc to address these issues. The Forum received a presentation from the IARDS team at it’s last meeting. Mrs Wannell added that the team are developing a business case which will address the Trust’s concerns about the cohort of patient’s whose discharge is delayed due to a lack of community rehabilitation services. These patients currently sit in an acute bed awaiting discharge to a suitable community facility. The amount of patients this applies to is equivalent to a 28 bedded ward. The proposal is that the 28 beds, which are currently spread across the Trusts bed stock, should be re-provided in Kew Ward, ground floor of Marjory Warren. This is an ideal location opposite the day rehabilitation facilities. Whilst this group of patients are currently cared for throughout the hospital and are ‘safe’, they often do not receive timely attention in relation to their discharge. This new facility will provide a more appropriate environment for this group of patients, appropriately trained nursing and therapy staff and an intensive focus on the patient’s discharge. The IARDS proposal is different to the Hotel Ward at Kingston Hospital. The IARDS ward will be a dedicated area for rehabilitation, patients care will be managed with the objective of ensuring timely discharge to appropriate community facility. Hotel wards are generally used for overnight stays where day surgery patients don’t have appropriate support at home to ensure a safe discharge. The IARDS initiative is separate to the bed reduction proposals set out in the Saving Plan, although the objectives of both initiatives are to improve the quality of patient care and to reduce costs. The IARDS area will be staffed by a combination of staff who are displaced by the reconfiguration of general beds and the recruitment of permanent staff. The IARDS area will require a different skilled workforce to an acute ward but it is unlikely there will be enough existing staff available to transfer. When the further bed reductions occur current staff will be relocated to the new bed/ward configuration. The Trust has a number of vacancies which should ensure all staff will be relocated. The Trust has agreed a Change Management policy with the Trade Unions which will be used to initiate formal consultation at the earliest opportunity.

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The Trust is aiming to preclude the need to use escalation areas. This will be achieved in the fullness of time once the patient pathway has been modified to eliminate the current level of inherent inefficiencies. It is important to remember that the Trust is not allowed to close it’s doors once it’s full. There will always be a need for a safety valve. Admissions are unpredictable and there will on occasion be a need to be able to flex up the number of beds, which may require the use of escalation beds. The service improvement proposals have involved clinical teams throughout the Trust with the majority of ideas originating from them. Therefore the executive team are confident they have their full support. The Trust is on the 12th bed configuration since moving into the new hospital and each new configuration brings improvements to the way care is provided. The identified savings will be realised from a number of sources including a reduction in the reliance of bank and agency staff. This in turn will have a positive impact on the quality of care. The proposals aim to deliver a service which is in line with national best practice, which the Trust knows is out of kilter at the moment. National benchmarks indicate a number of areas for improvement, i.e. length of stay; the number of patients having day surgery. There are no significant demographic issues relating to the local population that impact significantly on the Trust’s ability to implement the service improvement goals. Whilst there are obvious challenges, such as a lack of community rehabilitation and continuing care for the Trust, these can not be used as an excuse for inertia. It is recognised that on occasion there have been problems associated with packages of care upon patient’s discharge. Mrs McIntosh is working with key partner organisations to identify shortfalls in community provision with a view of improving care across the acute, primary and social care sectors. Mrs Wannell reiterated that a ‘do nothing’ approach was not an option. If the Trust does not address it’s financial challenges, it may result in the Trust having service changes or reductions imposed upon them. It must be remembered however, that this exercise isn’t just about delivering value for money but equally it’s about improving patient care and improving the patient experience. As the plans stand at the moment the Trust is not loosing any specialities but gaining a rehabilitation facility which is much needed across the health economy. In addition to the improvements already discussed staff are continually coming up with ideas on how to improve the patient pathway. Initiatives include the critical care improvements (previously presented to the PPI

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Forum and Trust Board) and an increase in maternity capacity. Ideas in the pipeline include direct GP referrals to the Medical Assessment Unit. Mrs McIntosh agreed to update the ‘road map’ which details the planned service improvement initiatives and circulate it to the Forum with the minutes along with the IARDS business case. ACTION: Mrs McIntosh

Mr Marshall stated that many of the savings won’t impact fully until the next financial year although he believes that the budgets that have been set for this year are achievable. The impact of changes at Ashford & St Peter’s planned for later this year have already been factored into the Trust’s plans. At this stage it is felt that adequate provision has been made. Any unexpected increase in demand will need to be reviewed once the changes have been made. Mrs McIntosh added that part of the Trust’s plans is to analyse the demand for emergency services and to put in place effective strategies with the PCT to address these issues. A number of initiatives have been considered and one such scheme has already been implemented with the Emergency Practitioner Scheme. It was agreed that further work to understand whether the 53% of patients who are being diverted from the A&E department receive adequate care. ACTION: Mrs McIntosh

3. Outpatient Service Improvement Plan

Following discussion, it was agreed that the Forum need to carry out an independent inspection of the outpatient service. After which time both the Forum and the Trust will discuss areas for joint working. The Trust is already undertaking a comprehensive service improvement programme and believes that joint working will be beneficial to both parties. The Trust wants to be open at all times and to this end, Ms Jones agreed to provide the outpatient information the Forum has previously requested. Ms Jones undertook to circulate the Outpatient Improvement Plan so the Forum can ascertain where joint working would beneficial. ACTION: Ms Jones

4. Sunday Times Good Hospital Guide - Dr Foster

Miss Baldwin advised the Forum that the annual Dr Foster data published in the Sunday Times is due for publication in October. The data that will be used will be from 2003/04. This will present a negative picture for the Trust with regards to mortality rates as the Trust will be ranked within the 10 poorest performing Trust’s in the country. Whilst the Trust has to accept the reporting of factual data, Miss Baldwin advised the Forum that the Trust’s performance in this area has improved significantly since that period. In respect to the Dr Foster analysis of mortality data for 2003/04, the Trusts performance is 123 against a standardised rate of 100. Using another method of measuring mortality rates, CHKS, the Trust performs slightly better at 108 against a standardised rate of 100. Performance for

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2004/05 demonstrates an improvement against both the aforementioned measures. The Trust now has a clearer idea of the issues that need addressing to improving the Trust’s mortality performance and indeed have implemented a number of corrective initiatives. One such being, the improvements to the critical care pathway which have been presented to the Forum and the Trust Board. Whilst it is too early to statistically demonstrate real improvements, the staff are confident that the initiatives are making a real difference to the patient experience and clinical outcomes Notwithstanding the Trust’s improved performance, the publication of data from 2003/04 will present PR challenges for the Trust which we will try to address through the promotion of our improved performance.

5. Trust Board Sub Committees

It was agreed that Mrs Doherty would become a member of the newly formed Patient Experience Committee and Mr Tony Foster will become a member of the Clinical Excellence Committee.

6. Consultation Protocol

The Trust expressed it’s disappointment that a protocol had not yet been agreed. Both parties agreed to have further discussions outside the meeting with a view of gaining consensus at the earliest opportunity.

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12A

From: Alison McIntosh Sent: 22 February 2006 07:51 To: Yvonne Franks Subject: FW: Minutes of an extra ordinary meeting between WMUH and the WMUH

PPI Forum Attachments: PPI forum meeting 19th July 2005.doc; roadmap - final for ops leads11.xls;

version78.doc Alison McIntosh Director of Acute Care Direct Line: 0208 321 6802 Mobile: 07990521283 [email protected] ______________________________________________ From: Tracey Wallace Sent: 17 August 2005 14:03 To: 'Cherna Crome'; 'Daniel Mann'; 'Francis Brown'; 'Jean Doherty'; 'John Hunt'; 'Mr A Vanags'; 'Mr T

Spring'; 'Ms T Ndwru'; 'Noshaba Sainsbury'; 'Tony Foster' Cc: Gail Wannell; Pie Julie; Johnson Joe; McIntosh Alison; Marshall Simon; Janet Baldwin; Jones Shan;

Jane Brennan; Saeeda Dudhia; O'Doherty Monica; Nina Singh; Peter Gill; Yvonne Franks; Laila Rhout Subject: Minutes of an extra ordinary meeting between WMUH and the WMUH PPI Forum Dear all, Please find attached the minutes from the above meeting which was held on the 19th July. Also attached is the Road Map. Apologies for the delay in sending these out. Kind Regards, Tracey Wallace

PPI forum meeting 19th July 20...

roadmap - final for ops leads1...

version78.doc (423 KB)

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9D CARDIAC REHABILITATION

SERVICE DEVELOPMENT PROPOSAL

INTRODUCTION Standard Seven of the National Service framework (NSF) for Coronary Heart Disease (CHD) relates to the provision of cardiac rehabilitation. According to this document, cardiac rehab should begin as soon as possible after someone is admitted to hospital with CHD (Phase 1). Where appropriate & based on assessment this should be extended through the early discharge period (Phase 2). Some patients on discussion with their medical and nursing practitioners find that Phase 1 & 2 is sufficient to meet their requirements for support and advice and are ready at this point to be handed back to their GP’s for ongoing monitoring. Others, however, benefit from a more formal and structured rehabilitation programme, which includes advice on diet, lifestyle changes and an exercise component lead by trained therapists. This should be offered, according to the NSF, 4 to 6 weeks after an acute cardiac event. Long-term maintenance of changed behaviour (Phase 4) denotes the ongoing support required within primary care. The NSF suggests that the following categories of CHD patients be offered a flexible service to meet their needs for rehab & support: • Post MI patients* • Pre (where possible) & Post revascularisation patients (both CABG, angioplasty

& Primary angioplasty)* • Stable angina • Heart Failure • Other specialist interventions, e.g. cardiac transplant *The initial priority for Trusts is to ensure that people who have survived an MI or who have undergone revascularisation have access to rehab. Only when these services are embedded & working effectively should PCT’s & Acute Trusts extend rehab to the later three categories. In other words, the Acute Trust and PCT have a statutory obligation to provide cardiac rehab to the first two categories of patients. CURRENT SIUTATION The following phases of rehabilitation are provided by WMUH: • Phase 1 – This has historically been provided effectively by the ward staff on the

Coronary Care Unit and the cardiology ward. We already provide an enhanced service by ensuring the cardiac rehab physiotherapist and dietician are named professionals, along side the nursing team, to provide phase 1 rehab. The aim of this three-pronged approach is to provide health education advice on all aspects of rehabilitation as early as possible by the appropriately trained professionals who have specific competencies in both cardiology and cardiac rehabilitation.

• Phase 2 – This is provided by the cardiology nurse specialist (CNS) in an

outpatient clinic. There is a wait for this service (up to 6 weeks) as it is run by a single CNS with no cover arrangements in place.

• Phase 3 – Currently the only option for phase three is to come in to WMUH to

have exercise. The cardiac physiotherapist who returned from leave in May 2005 and a nurse from the cardiology ward area currently provide Phase 3. There has been an intermittent problem of physio cover over the past year due to maternity

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and subsequently sick leave of the post holder. This post is managed and funded by the PCT who were unable to cover this post for some of this time. During this period the exercise component of this phase was not covered and has resulted in a waiting list for this service.

In addition the nursing post holder resigned in September 2004 and despite advertising at a number of grades WMUH were unable to recruit. During this time the nursing element of phase 3 has been covered by nursing staff from the cardiology ward – either by permanent or bank cardiology staff who have appropriate skills required to run this service safely.

• Phase 4 – patients are referred to phase 4 by the CNS for cardiology which is provided by the PCT in the community.

Following process mapping of all the rehab phases by doctors and nurses from the cardiology team, a high level of duplication was found resulting in patients being brought back two or three times in order to receive the same information. In addition understanding of each element and the differing needs of patients was more completely understood. Other models, both locally and nationally provide patient choice in relation to Phases 2 & 3, which we not offer. Patients are brought in on a Tuesday where they receive exercise and health education and again on a Wednesday afternoon for a 4 to 6 week period depending on the needs of the patient. By removing the repetition, there is no requirement to bring the patient back twice per week for six weeks Process mapping identified that by stream lining the service, we could reduce repetition and remove the waiting list for both phase 2 and phase 3 rehab. FUTURE PROPOSALS

Phase 2 • A ‘one stop clinic’ for patients in phase 2 could provide an enhanced service

allowing patients the opportunity to access health education advice from physio and dietician as well as the CNS at one visit.

• Run co-terminously to the medical consultant in the OPD dept, the patient could be medically assessed if required following review by the CNS

• Patients could also access diagnostics (e.g. ECG, ETT, etc) if these are required at this visit.

• By developing the ‘one-stop-shop’ approach all MI & post angioplasty patients would be seen within 1 - 4 weeks of discharge dependant on clinical priority.

• A suite of rooms in the OPD has been earmarked to accommodate the multidisciplinary team to work closely together.

• Referral to other services e.g. smoking cessation provided by WMUH and the PCT are available

Phase 3 • A designated nurse from existing cardiac nurse specialist pool will provide the nursing component of Phase 3. This senior nurse would provide a higher level of assessment and care than the previous model of service delivery.

• Patients would be offered a choice of how to access phase 3 namely; - In-house structured exercise programme - Self-referral to other community exercise programmes via provision of a

directory of options

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- The heart manual - that provides step by step video/written programme supported by telephone counselling from a clinician who is also trained facilitator. Money for this element will be part funded from vacancy monies within the existing budget and will cover the training required of the team to become facilitators.

BENEFITS • This model provides a clear, structured, multi-discplinary approach from phase 1

through to phase 3. • Leadership of the patients whole journey will be provided by the CNS for

cardiology who will act as the case manager and co-ordinator for all patients going through cardiac rehab. This person will ensure that systems are in place for referring patients on to phase 4 rehab provided by the PCT in the community.

• The phase 3 exercise programme will be run by a senior (grade G equivalent) nurse with the designated cardiac physiotherapist. This nurse has specialist skills (at Msc level) in cardiology.

• By reconfiguring existing skills we propose to provide a much higher level of skill and knowledge to this group of patients, which we have been unable to do prior to this time.

• Absorbing this role into this senior nurses remit also provides greater continuity of care.

• The cardiac rehab team and nurse specialist team for cardiology will provide clear cover arrangements for leave.

• Patients can choose how they want their rehab to be delivered depending on personal circumstances, e.g. patients seeking to return to work tell us that they prefer to receive their cardiac rehab via the manual with one-to-one telephone support and the option to come into clinic to see the team if needed.

Summary Through the review and development of cardiac rehab (phases 1-3) we can ensure that patients are seen by appropriately skilled senior professionals (medical, nursing, therapy and dietetics) at each and every stage of the process. We currently have one trained facilitator and plan to train four other cardiac clinicians. The CNS is already a trained facilitator and we propose to train up senior nurses and therapists on the ward and within the cardiac rehab service. This proposal has been developed in association with cardiologists, senior cardiac nurses and therapists. Opinion is sought from the Director of Public Health on behalf of the PCT and from patient groups within the next two weeks. Please comment to Kevin Hargreaves CC to Shan Jones at [email protected] or [email protected] by Friday 4th November 2005.

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9C Cardiac Rehabilitation Services

State of service April 2005

Introduction Cardiac Rehabilitation forms Standard Seven of the National Service framework (NSF) for Coronary Heart Disease (CHD) released in March 2000. This document outlines the key milestones for PCT’s and Acute Trusts in the delivery of what it terms ‘comprehensive and tailored’ rehab via ‘help with lifestyle modification involving education and psychological input as well as exercise training’ (DoH, 2000). According to the NSF, cardiac rehab should begin as soon as possible after someone is admitted to hospital with CHD (Phase 1). Where appropriate & based on assessment this should be extended through the early discharge period (Phase 2). Some patients on discussion with their medical and nursing practitioners find that Phase 1 & 2 is sufficient to meet their requirements for support and advice and are ready at this point to be handed back to their GP’s for ongoing monitoring. Others, however, benefit from a more formal and structure rehabilitation programme, which includes advice on diet, lifestyle changes and an exercise component, lead by trained therapists. This should be offered, according to the NSF, 4 to 6 weeks after an acute cardiac event. Long-term maintenance of changed behaviour (Phase 4) denotes the ongoing support required within primary care. Based on health evidence the NSF suggests that the following categories of CHD patients be offered a flexible service to meet their needs for rehab & support: • Post MI patients* • Pre (where possible) & Post revascularisation patients (both CABG, angioplasty

& Primary angioplasty)* • Stable angina • Heart Failure • Other specialist interventions, e.g. cardiac transplant *The initial priority for Trusts is to ensure that people who have survived an MI or who have undergone revascularisation have access to rehab. Only when these services are embedded & working effectively should PCT’s & Acute Trusts extend rehab to the later three categories. Current Situation within WMUH & Hounslow PCT 1. Current Funding

The WMUH is provided with funding from Hounslow PCT to cover what has historically been: • 1 WTE G grade nurse employed on a WMUH contract. Funding is provided

to the WMUH by the PCT. This post has been vacant since November 2004. Recruitment has been unsuccessful to date.

• 0.5 WTE dieticians and 0.5 WTE physiotherapists. This is provided directly

by the PCT to the PCT therapy department. The post holders are on PCT

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contracts and there is a service level agreement regarding delivery of service.

2. Service Provision

• The ward staff within CCU and the cardiac ward have historically provided phase 1 & 2 rehab. All MI/post MI patients are admitted or transferred to the CCU/coronary care ward where they receive the initial rehab as outlined within the NSF. Primary angioplasty patients and patients who have received or who are awaiting CABG, angioplasty or angiography are all transferred to this area and access Phase 1 & 2 rehab in the same way as MI patients. Patients on outlining wards with these conditions receive rehab via the Clinical Nurse Specialist. This provision continues to date.

• Phase 3 rehab is currently and has historically only been provided to post MI

patients. This provision was structured as a 6-week rehab course, which ran twice weekly in O Block. Patients would attend one of the two afternoon sessions and have contact with the rehab nurse for health promotion advice/titration of treatment. They would see the dietician re: diet and join in the group exercise session & have 1:1 contact with the physiotherapist. In November 2004 the G grade rehab nurse who co-ordinated these sessions left the Trust. Following her departure there was a query by the PCT regarding continued funding. This has now been resolved. However, recruitment to this post to date has been unsuccessful. The advice and follow up component of phase 3 is still being provided to post MI patients. Cas Shotter and the dietician see all post MI’s 6 weeks after discharge. However, due to the physio being on maternity leave we have not been able to provide the ongoing 6-week exercise course.

• HHT has written to us to say that they will no longer be providing rehab to

post revasc patients/surgery patients from the Hounslow area. They were originally going to stop this service from 1/4/05 but have extended this to late May. They are awaiting our reply regarding what services will be put in place to pick these patients up.

In summary, the West Mid:

• Continue to provide Phase 1 & 2 rehab to the two major categories of CHD patients outlined within the NSF. There has been no change to this service. • We continue to provide nursing and dietetic follow up by inviting all post MI

patients to a follow up clinic. This did form part of a structured 6-week course which now does not happen due to lack of physio input. Therefore, there has been a significant change in this service.

• Although there is not yet a structured rehab programme for revasc patients, Cas Shotter has recently introduced a telephone follow up service for all MI and revasc patients on discharge

3. Future Provision

It is clear that the Acute Trust and PCT are failing to provide Phase 3 rehab in terms of a structured course as highlighted within the NSF. However, WMUH has been able to cover the nursing component of all three phases. The element that patients seem to want is the structured exercise component, which the nursing

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staff cannot provide as this is outside of their scope of practice. Given the difficulties associated with nurse recruitment in this area it seems timely to review requirements for rehab across the health economy.

In response to this an urgent meeting has been scheduled with key players from the PCT and Acute Trust. This will take place on 5/5/05 in the Critical Care Seminar room from 8.30-10.30. The purpose of the meeting will be to: • Identify the immediate, short term provision that meets the requirements for

Phase 3 rehab • Review the requirements for rehab in light of the need for increased therapy

input

• Explore alternative ways of delivering this service to patients which offers them choice & flexibility

• Look at how we can extend the rehab provision to revasc & surgery patients

in light of HHT letter Update on service June 2005 The aforementioned meeting took place and the following actions agreed; Phase 1& 2

1. Job description for rehab nurse agreed. This is about to go out to advert. Cas Shotter CNS, continues to provide nursing input until the rehab nursing post is filled.

2. With financial slippage from not appointing to this post as yet- use any

available resources to assist Physiotherapy in covering the gap from Mat leave. Post meeting note- this was not required due to physiotherapist returning from leave.

Phase 3 Patients post MI are receiving nursing input but have no exercise plan. This is an issue for the PCT who continue to search for ways of resolving

this.

Phase 4 3. Post CABG rehabilitation is still unresolved with HHT. PCT taking the

lead in resolving this. Patients are receiving their exercise plans through their GPs.

4. Progress is being monitored through the CHD steering group, which is chaired by Sharon Daye Acting Director of Public Health Hounslow PCT.

Alison McIntosh

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9B

Patient & Public Involvement Forum Bulletin

June 2005

News items Updates on previous issues

• Solid tumour chemotherapy patient survey results favourable

• Rapid access chest pain patient survey positive

• Parents forum and suggestion cards in paediatrics resulted in catering group

• Cancer Users forum patient survey in outpatients is completed. Report due July 2005

• Trust objectives – handout for information

• Trust board sub-group structure – Patient experience panel - ? Patient panel

• PPI & PALS awareness Atrium event Tuesday 26th April 2005

• Nursing & Midwifery awards 27th May – good publicity

• Patient dependency work to begin 18.6.05

• Smoking policy - update • Cardiac rehab – written update to

Forum • HDU and ITU outreach • Overview & scrutiny committee

report response completed. Draft action plan in progress

• ‘Help us to help you’ leaflet – 1st meeting with Jean

• Big baby media interest • A&E activity

Comments welcomed Forthcoming events

• Deposits for crutches & charging for prescriptions plans will be developed by end of June – both documents will be sent to the Forum for comment.

• Dress code policy for launch July 2005

– (including conduct code)

Advance notice Requests for information/ participation • Race equality scheme – may we

place on next agenda? • Patient property policy review

commenced • Overview & scrutiny future work –

capacity and staff attitude

• Forum work plan for 2005 –

discussion around OPD project / offer of presentation on service improvement work

• Consultation proposal response • Essence of care – steering group rep

& any interest in project groups

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9A


April 2005


• Neonatal hearing screening to start on site in June 2005 (part of a national initiative) • Cancer Users forum will undertake a patient survey in outpatients w/b 25.4.05 • Work is underway with PCT and social care to prepare a plan for a possible flu pandemic

• Smoking policy comes into effect on ??? • PPI Strategy Group is to be renamed the Patient Partnership Group to reduce confusion with the PPI Forum

Comments welcomed Forthcoming events • Standards for Better Health – forum participation • PPI Strategy draft 3 will be sent for consultation in the next two weeks

• PPI & PALS awareness Atrium event Tuesday 26th April 2005 • International nurses day celebration of nursing atrium event Thursday 12th May 2005 • Nursing awards ceremony 3pm Friday 27th May 2005

Advance notice Requests for information • Coronary Heart Disease

strategy group meeting on Monday 18th April will discuss cardiac rehab services

• Forum work plan for 2005 • Consultation proposal

response

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6A


February 2005


• Queen Mary’s Maternity Unit

retained its Charter Mark • Outpatient and A&E patient

survey results • PEAT assessment 7.2.05 • Nursing awards launched • Nurse rostering system • Joint WMUH & PCT infection

control team

• Paediatric phlebotomy • Ravenscourt Park media story • Post PPI report inspection • Availability of Trust Board

papers on the Internet • Escalation ward usage • New gel dispensers in all

patient areas

Comments welcomed Forthcoming events • No smoking policy • Name boards in patient areas • Travel plan • The format of this brief

• 25.2.05 Consultation workshop • 28.2.05 Think clean day • 28.2.05 Forum members ‘meet

the patient’ session in Atrium • 4.3.05 PPI strategy group

meeting • 10.3.05 Patient survey

presentation by Picker at Public Trust Board (11am)

• 12.3.05 National No Smoking Day & launch of policy awareness

Advance notice Requests for information

• Business planning priorities

from the forum • Maternity capacity issues

• Forum work plan for 2005 • Forum CRB checks update

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1

5C Notes on meeting between West Middlesex PPI Forum and West Middlesex

University Hospital on 22nd December 2004 starting at 1 pm in the Education Centre at West Middlesex University Hospital.

Present. Janet Baldwin West Middlesex Hospital Medical Director Francis Brown PPI Forum Member Cherna Crome PPI Forum Chairman Patricia Davies West Middlesex Hospital Associate Director for Acute Care Jean Docherty PPI Forum Member Yvonne Franks West Middlesex Hospital Director of Nursing and Midwifery John Hunt PPI Forum Member Joe Johnson West Middlesex Hospital PPI Lead Gail Wannell West Middlesex Hospital Chief Executive In Attendance. Bob Hardy-King Forum Support Organisation Community Liaison Officer Yvonne Franks thanked everyone for attending, especially at such short notice, and explained that the meeting had been called because the Hospital had concerns that the relationship with the Forum was in danger of degenerating. This could have the effect of both sides disengaging; the losers would be the patients. It was agreed that this must not be allowed to happen; patients were the people the Forum represents and the hospital’s customers. It was agreed that a working relationship must be re-established, and that the meeting would be an honest discussion, with both sides listening to the others perspective. The Hospital’s position was that they provided staff to speak at Forum meetings, and their expectation was that those staff should not be harassed or insulted by Forum members. The Forums position was that staff who attended meetings should be briefed, and sufficiently informed, to speak, and answer questions Mrs Franks explained that, at a recent meeting Patricia Davies had attended for a 15 to 20 minutes slot, on a particular subject, with a brief from the Director of the department. The slot had extended to an hour, and went beyond the agreed brief. The member of staff felt that she had been verbally attacked, and had become defensive, and this had led to further disagreement. The Hospital felt that this behaviour was inappropriate.

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2

Members explained that the issue, where the disagreement had arisen, was in fact, part of the subject on the Agenda, and also part of a report presented to the Board of Trustees. At the meeting, a member of the Forum felt that issues of consultation were being ignored, and the Forum was being sidelined again. The point was made forcefully. Forum members did not all feel that the questioning had been inappropriate, although some voices had been raised. Forum members had families that used the Hospital, and when it was perceived that patients were not being served well, some members did get upset. Staff made the point that it was not what had been said, but the way, it had been said. They felt that the questions had been phrased in such as way as to be a personal attack. Consultation was not always possible, as sometimes operational decisions had to be made quickly and instructions from the Department of Health had to be acted upon. Failure to do so would be bad management. It was not possible to consult on every issue that affected patients, because every decision affected patients. That was who the hospital was there for. With regard to the issue raised at the meeting, the Forum had been consulted before the Hospital Trust Board, and that was an indication of how important the Hospital considered their relationship with the Forum; this was also part of the reason for their concerns over a breakdown of trust between the Hospital and the Forum. The Chairman of the Forum apologized to Miss Davies and explained that the critic cal comments were in no way intended to be personal. At this point Miss Davies left the meeting for another appointment. When the staff member had appeared to back track and become defensive it had been felt that the Hospital were covering up, and presenting the Forum with a fait accompli. Members felt that they tried to keep their questions ‘patient centered’. A letter had been promised by the Hospital and this had not arrived till the day of the meeting, if this had arrived when promised Members would have had time to study the issues and not have to make snap decisions. Staff agreed that the letter was late and apologized for that. However, the issue of body language and what needed consultation had yet to be addressed. It was important that the Forum was involved/informed of changes, even small ones, as it was possible that a number of small seemingly unconnected changes could result in a major problem which might not be evident to staff making decisions. It was agreed that the way forward was to set out in writing a ‘Compact or Rules of Engagement’; the Forum would make a draft with assistance from their Support Organisation and the Hospital PPI. The compact/rules of engagement should encompass, Representation, Consultation, Behaviour, Visiting, Information sharing, Information provision and other issues from both sides, and following discussion be adopted by both parties at their meetings in public.

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3

It was further agreed that the compact/rules of engagement must not detract from statutory functions of both the Forum and the Hospital, rather that they establish guidelines for the performance of the functions; so that the Forum can be the ‘ independent critical friend’ working closely with the hospital, but representing the public’s and patient’s views. It was further agreed that the two points of contact would be Yvonne Franks for the Hospital and Cherna Crome for the Forum. Yvonne Franks thanked everyone for attending.

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From: John Hunt [[email protected]] Sent: 17 December 2004 17:47 To: Franks Yvonne Cc: [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; Johnson Joe; Wannell Gail; Rhout Laila Subject: Re: invitation to meeting at WMUH Dear Yvonne, At 16:42 17.12.2004, you wrote: please see the attached invitation to a meeting on Wednesday 22nd December in the Tutorial Room, Education Centre. Please let us know if you can come by leaving a message on Laila's answer phone - number below. Yes, I can attend: and will leave a message on Laila's 'phone to that effect. I sincerely hope that this will be a productive meeting. I relate specifically to the behaviour of some of your members towards a member of Trust staff who attended your Forum meeting on Tuesday 14th December about which she is making a complaint. I cannot imagine what Patricia Davies --the only member of Trust staff who attended, replacing Alison McIntosh-- could possibly have complained about. She was offered refreshments upon arrival, and was treated with courtesy and respect by all members at all times: both while she was present, and after her departure. We did express (quite mildly, in the circumstances) concern about an item which was discussed at a public meeting of the Trust Board that afternoon. But at no point was concern about happenings at the Trust directed in any way at Ms. Davies. ============================================= I heard this morning that you have since spent some considerable time making and discussing unfounded accusations about one of our members, in connexion with an article which appeared in this week's Richmond and Twickenham Times. I am doubly dismayed to hear this, following the recent discussion I had with you and Joe Johnson about allegations made about me in my absence. =============================================

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As you are the official channel for PPI Forum requests, I had already been planning to write to you about the Trust's web site. I corresponded with Richard Elliott and Jane Brennan about this in September and again (with copy to you) on 22nd November, during your recent holiday. The page at www.west-middlesex-hospital.org.uk/publications.html offers a choice of Minutes for public Trust Board meetings -- but only for July. The selection of Agendas is a little greater -- .July, Sep., Oct.. When I accessed this in September, I encountered the following problem, (which I suspect has still not been addressed). -- I succeeded in downloading the incredibly large Agenda, which appears to have an embedded Powerpoint presentation, and also a couple of the linked documents. I've had a number of problems with the links. In particular: 1) Once the file has been saved to disc, the links are no longer valid, as they are only relative. This means that it is necessary to wait and download the agenda again, before attempting to access other linked documents. 2) Attempting to view http://www.west-middlesex-hospital.org.uk/docs/TrustBoard_September2004/CEO's%20Report.doc generates a "HTTP 404 - File not found" message. Regards, John.

www.richmondandtwickenhamtimes.co.uk/news/localnews/display.var.555052.0.inquest_told_of_hospital_blunders.php

Inquest told of hospital blunders

By Andrew Raine

AN ISLEWORTH woman died at West Middlesex Hospital after staff ignored the correct diagnosis that her medically trained son had supplied them with. Doctor Luke Howard told medical staff at the hospital that he believed his mother Valerie Clare Howard, an antique porcelain dealer from the Old Farmhouse on Osterley Lane, had suffered an aortic dissection when she collapsed on January 6, 2003. But they did not listen to his diagnosis - believing that the 63-year-old grandmother had merely fractured her hip when she collapsed giving a local gardener a Christmas

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present - West London Coroner's Court heard on Monday. The inquest heard a string of admissions from the hospital, paraphrased by the recorder as 'putting their hands up' over the care Mrs Howard received. Lead consultant in A&E medicine, Dr Mike Beckett, admitted that the triage staff had given Mrs Howard an inappropriate category of three on her arrival to hospital, while her pain warranted a category of one - the highest possible. He also admitted that she didn't receive adequate pain-killing drugs for three and a half hours, despite intense pain, that the doctor she saw should have referred her to a more senior doctor, and that her son's correct diagnosis should not have been ignored. She was described as "writhing around in agony, wailing in pain" in evidence handed to the court, but was not seen by a doctor for over an hour and a half. It was three and a half hours before she received morphine - the relevant drug needed to relieve her pain. It was four and a half hours before Mrs Howard received the diagnosis that her son had given all along - a difference in time, said her family, that could have seen her transferred to Hammersmith Hospital, which specialises in the field Dr Beckett said the problems had been compounded by a lack of senior doctors at the Isleworth hospital at the time - which he says has since been addressed by government initiatives. Holding back tears, Dr Howard asked Dr Beckett: "But the doctor was told I thought she had an aortic dissection - why didn't she take any notice? It was four and a half hours before anyone took notice of my diagnosis." Dr Beckett replied: "She should have and that should have prompted her to find a more senior doctor." The hospital has since written to the Howards saying that they recognise this as a significant failure and have offered "unreserved apologies". The post mortem by Dr Patel showed cause of death as a cardiac tamponade caused by a ruptured dissecting aortic aneurysm - as suggested by Mrs Howards son around six hours before she finally died. Research given to the coroner showed that between 90 and 60 per cent of patients reaching the operating table with this condition survive in a specialist hospital such as Hammersmith. Mr Howard argued that had his mother's diagnosis been made more quickly she could have been moved there in time. Giving the cause of death as natural causes, the recorder said: "An inappropriate triage assessment led to delays in the patient being seen by a doctor of sufficient seniority and in being treated. Earlier medical intervention and possible surgery would've improved her chances of survival and may have prevented her death."

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The hospital is undertaking a review of its triage policy, has raised the case with the A&E clinicians over the treatment of severe undiagnosed pain, and the case is being used as a case study in Dr Beckett's teaching programme with junior doctors.

4:05pm Thursday 16th December 2004

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5A

December 17, 2004 Dear Forum members I am writing to you today to raise serious concerns about the effectiveness of the Trust’s working relationship with the Forum. I relate specifically to the behaviour of some of your members towards a member of Trust staff who attended your Forum meeting on Tuesday 14th December about which she is making a complaint. From the Trust perspective, this type of behaviour is unacceptable and is having an affect on the reputation of the Forum amongst our staff. In order to address this issue and in the hope of initiating some joint work on ‘conditions of engagement’ to specify our communication channels, attitude and behaviours, we would like to invite you to a meeting at the hospital on Wednesday 22nd December at 1pm in the Tutorial Room in the Education Centre. The meeting will last no longer than one hour due to diary commitments. I am very aware that this is short notice and that many of you are likely to have other commitments, however I understand that Cherna is able to attend and any others will be most welcome. Gail Wannell, Chief Executive, Joe Johnson, PPI Manager and myself will be present. I hope that you are able to attend, however understand if this is not possible. As ever, we look forward to working together to highlight and address key issues that can improve the services we provide at West Middlesex University Hospital. Yours sincerely Yvonne Franks Director of Nursing & Midwifery CC Joe Johnson

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Gail Wannell

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1J

From: Daisi Ogunro [mailto:[email protected]] Sent: 18 July 2005 11:00 To: [email protected] Cc: Cherna Crome; [email protected]; [email protected]; francishbrown; [email protected]; John Hunt; [email protected]; [email protected]; [email protected]; [email protected] Subject: Consultation protocol

Dear Yvonne,

Please find below the terms on which the PPI Forum have agreed to work with the Trust.

Consultation between the West Middlesex University Hospital and the PPI Forum

The criteria for when the PPI Forum should be consulted and involved are very

clearly set out in section 11 of the Health and Social Care Act 2001.

The Trust must consult the Forum on-

a) The planning and provision of services.

b) The development and consideration of proposals for change in the way the services are provided. and

c) Decisions to be made by the Trust affecting the operation of these services.

The Forum recognises that on a rare occasion the Trust may have to respond to a

crisis, making it impossible to warn the Forum. However, other than in exceptional circumstances, the Trust will inform the Forum at the planning stage when, in the spirit of meaningful consultation, there is still time for the Forum to influence the

outcome of the consultation.

It is in the interest of both the Trust and the Forum that we have an open and honest relationship. To that end the Trust will, at the planning stage, e-mail the chair and Forum members when the need arises. In a crisis situation the Trust will ring the

Forum chair, or in the event that the chair is unavailable the Trust will ring................ This phone call will be followed by the customary e-mails.

Section 11 of the 2001 Health and Social Care Act www.opsi.gov.uk/acts/acts2001/10015--b.htm#11

11 Public involvement and consultation

(1) It is the duty of every body to which this section applies to make arrangements with a view to securing, as respects health services for which it is responsible, that

persons to whom those services are being or may be provided are, directly or through representatives, involved in and consulted on-

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(a) the planning of the provision of those services, (b) the development and consideration of proposals for changes in the way those services are provided, and (c) decisions to be made by that body affecting the operation of those services.

(2) This section applies to-

(a) Health Authorities, (b) Primary Care Trusts, and (c) NHS trusts.

(3) For the purposes of this section a body is responsible for health services-

(a) if the body provides or is to provide those services to individuals, or (b) if another person provides, or is to provide, those services to individuals-

(i) at that body's direction, (ii) on its behalf, or (iii) in accordance with an agreement or arrangements made by that body with that other person;

and references in this section to the provision of services include references to the provision of services jointly with another person

Thank you Regards Daisi Daisi Ogunro Forum Administrator Tel : 020 8780 1188 Ext 208 DD : 020 8780 6237 Fax: 020 8780 1373 Mobile : 0783 400 6220

PPI Forum Support Organisation c/o Scope Ground Floor (East Suite) 113-123 Upper Richmond Road Putney London SW15 2TL

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1I

Patient & Public Involvement Forum Bulletin June 2005


• Solid tumour chemotherapy patient

survey results favourable • Rapid access chest pain patient survey

positive • Parents forum and suggestion cards in

paediatrics resulted in catering group • Cancer Users forum patient survey in

outpatients is completed. Report due July 2005

• Trust objectives – handout for information

• Trust board sub-group structure – Patient experience panel - ? Patient panel

• PPI & PALS awareness Atrium event Tuesday 26th April 2005

• Nursing & Midwifery awards 27th May – good publicity

• Patient dependency work to begin 18.6.05

• Smoking policy - update • Cardiac rehab – written update to

Forum • HDU and ITU outreach • Overview & scrutiny committee

report response completed. Draft action plan in progress

• ‘Help us to help you’ leaflet – 1st meeting with Jean

• Big baby media interest • A&E activity

Comments welcomed Forthcoming events

• Deposits for crutches & charging for prescriptions plans will be developed by end of June – both documents will be sent to the Forum for comment.

• Dress code policy for launch July 2005

– (including conduct code)

Advance notice Requests for information/ participation • Race equality scheme – may we

place on next agenda? • Patient property policy review

commenced • Overview & scrutiny future work –

capacity and staff attitude

• Forum work plan for 2005 –

discussion around OPD project / offer of presentation on service improvement work

• Consultation proposal response • Essence of care – steering group rep

& any interest in project groups

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1H


April 2005 News items Updates on previous issues

• Neonatal hearing screening to start on site in June 2005 (part of a national initiative) • Cancer Users forum will undertake a patient survey in outpatients w/b 25.4.05 • Work is underway with PCT and social care to prepare a plan for a possible flu pandemic

• Smoking policy comes into effect on ??? • PPI Strategy Group is to be renamed the Patient Partnership Group to reduce confusion with the PPI Forum

Comments welcomed Forthcoming events • Standards for Better Health – forum participation • PPI Strategy draft 3 will be sent for consultation in the next two weeks

• PPI & PALS awareness Atrium event Tuesday 26th April 2005 • International nurses day celebration of nursing atrium event Thursday 12th May 2005 • Nursing awards ceremony 3pm Friday 27th May 2005

Advance notice Requests for information • Coronary Heart Disease

strategy group meeting on Monday 18th April will discuss cardiac rehab services

• Forum work plan for 2005 • Consultation proposal

response

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From: [email protected] Sent: 25 February 2005 21:40 To: [email protected] Cc: [email protected] Subject: Consultation Dear Joe, Please convey my thanks to all those involved in making today's session such a success. It now remains to be seen if it can be translated into a written document that does it justice. According to my diary the next Hounslow Forum meeting scheduled is on 8 March, which I suspect is not too different to what I said today. It obviously would be a great help if we could see at least a draft of the proposals before that. I suggest you e-mail them to me with a copy to Tanya Marius at SCOPE. I will then forward them to the other members of Hounslow PCT Forum. About the only member I cannot reach by e-mail is the chair, Mel Collins. You probably know that Mel is blind but he can read very large type or Braille. I can certainly print any e-mail in large type unless it is very long and I can then mail it to him. Alternatively, if you could produce a version in at least 16 point type and Arial font, you could mail it to him yourself. It is a pity that Mel does not have the computer resources to receive e-mails. It is actually possible to send e-mails to blind people and let special software read them aloud to the recipients. I have thought of asking RNIB to instruct Mel in using this. A major problem is that Mel's wife is also blind so if the computer system gave any sort of problem they would have trouble sorting it out. If you do not know Mel's address it is: Mel Collins 2 Cressage House Ealing Road Brentford Middlesex TW8 0LA Thanks again for your efforts, John C. Murphy (vice chair Hounslow PCT PPI Forum)

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From: John Hunt [[email protected]] Sent: 25 February 2005 08:42 To: Johnson Joe; [email protected]; Daisi Ogunro; Franks Yvonne; 'Robert Hardy-King'; 'Cherna Crome' Cc: [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; Kathy Sheldon; John Murphy; John Dimond; Clive Casey Subject: RE: Consultation Worhsop - 25th February 2005 J hunt Dear Joe, Thank you for your reply. At 11:13 24/02/2005, you wrote: I am sorry too, that you were not sent the sample protocol which is currently being used in Westminster. ... I don't know how many people / organisations have been involved in planning this event. However, at the meeting on 22nd Dec., we were promised that several existing protocols would be laid before us, as samples to consider. There was reference to one from somewhere in or near Devon. I would like to stress that Friday's workshop is meant to be a starting point in creating the basis for consultation with Forums, rather than the Trust proposing a predefined approach for discussion. In this way, people will come without prejudging the outcomes. The outputs of the meeting will then be up for discussion among people who cannot attend. Thank you for providing this reassurance. I would hope that this workshop will improve understanding of how we work together and so help to end the adversarial and aggressive tone of communication between those involved. I am sure that I all my PPIF colleagues will join me in saying that we wish to see an end to this situation.

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We will ensure that copies of any slides, handouts and copies of any outcomes are copied to Scope who can disseminate this information to the respective Forums. Many thanks. I await with interest a report of today's proceedings. With best wishes, John.

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1E From: Daisi Ogunro [[email protected]] Sent: 14 January 2005 15:28 To: Dudhia Saeeda; Franks Yvonne; Wannell Gail; Johnson Joe; McIntosh Alison; Gard Baz; Tanya Marius Cc: [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected] Subject: FW: letter re Consultation Protocols Workshop Follow Up Flag: Follow up Due By: 18 January 2005 17:00 Flag Status: Flagged -----Original Message----- From: Cherna Crome [mailto:[email protected]] Sent: 14 January 2005 13:24 To: [email protected] Subject: letter re Consultation Protocols Workshop Dear Daisi, I'd be grateful if you'd send the following to everyone who was there last night: Dear Gail and Yvonne Thank you for your offer to host a workshop following on from last night's meeting. I have talked with all the various PPI forum members who were present and Friday would seem to be the best day of the week for us, so long as it were to finish not too late in the afternoon. Therefore could I suggest either Friday 25 February or Friday 4 March, perhaps 10am - 3pm? We would also like to suggest that you might like to frame some proposals for a protocol which could form the basis for discussion on the day. Regards, Cherna Copies to: WMUH: , Alison McIntosh, Joe Johnson, Baz Gard Hounslow PCT: Christine Hay, John James, Cath Attlee, Julie Fuller, plus Niall Fitzgerald. All WMUH Forum members, Hounslow PCT Forum members and Richmond & Twickenham forum members. Many thanks, Cherna. I will e-mail the full attendance list over the weekend.

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1D From: Johnson Joe Sent: 24 February 2005 11:14 To: 'John Hunt'; [email protected]; Daisi Ogunro; Franks Yvonne; 'Robert Hardy-King'; 'Cherna Crome' Cc: [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; Kathy Sheldon; John Murphy; John Dimond; Clive Casey Subject: RE: Consultation Workshop - 25th February 2005

Dear John

Thank you for your email.

Can I start by apologising to you and your Forum colleagues for the delay in sending the agenda for Friday's workshop to you.

I am sorry too, that you were not sent the sample protocol which is currently being used in Westminster. We only received a copy of that protocol recently from your Forum colleague Francis Brown. We did not have the document in electronic format and arranged for it to be typed up locally. An electronic copy is attached to this email. Whilst the Westminster Protocol is a useful starting point for our local discussions I am not sure that we can simply adopt this as a standard protocol.

I would like to stress that Friday's workshop is meant to be a starting point in creating the basis for consultation with Forums, rather than the Trust proposing a predefined approach for discussion. In this way, people will come without prejudging the outcomes. The outputs of the meeting will then be up for discussion among people who cannot attend.

The brief presentations at the beginning of the workshop are only meant to give some context for the discussions, from a Trust, Forum and Statutory perspective. We are conscious that some of the people attending might not be aware of the previous discussion between the WMUH and the Forum and we believe that it is important that we set the context for these people. The time for discussion is not just one hour –there is also 40 minutes for feedback and discussion as per the agenda plus the coffee break and lunch if needed.

I would hope that this workshop will improve understanding of how we work together and so help to end the adversarial and aggressive tone of communication between those involved.

We will ensure that copies of any slides, handouts and copies of any outcomes are copied to Scope who can disseminate this information to the respective Forums.

Joe Johnson

Patient & Involvement Manager

West Middlesex University Hospital

246

-----Original Message----- From: John Hunt [mailto:[email protected]] Sent: 23 February 2005 19:50 To: Johnson Joe; Witt Marjorie; Robert Hardy-King; Cherna Crome; [email protected]; Daisi Ogunro Cc: [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; Kathy Sheldon; John Murphy; John Dimond; Clive Casey Subject: RE: Meeting scheduled for 25th Feb.

Dear Joe, At 18:05 23/02/2005, Johnson Joe wrote: Thank you for your email. I can confirm that the 'Consultation' workshop is going ahead as planned this Friday 25th February 2005. The venue is the large conference room in the hospital's Education Centre. I'm sorry: but I find this completely unacceptable. Forum members were promised that sample protocols already in use by other PPI fora would be circulated to all PPIF members at least one week before the meeting. This has NOT happened. As I indicated to Forum members when the date of the 25th was proposed, I am unable to attend. I was therefore relying upon Bob's promise, so as to be able to comment on the samples. If the meeting goes ahead this Friday, I and other members who are unable to attend will be deprived of any opportunity to participate. This is clearly NOT an auspicious manner in which to begin discussing "Terms of Engagement". I have also discussed the Provisional Agenda with Forum colleagues Francis Brown and Jean Doherty. (Cherna Crome is not available this evening, and I shall be unobtainable all day Thursday.) We are all incensed that the "experience" has inexplicably been reduced (without consultation with PPIF members) to a set of poncy presentations followed by lunch, instead of the discussion format agreed at the meeting on 22nd Dec..

247

This is NOT what we expected. We do NOT believe that it will add any value. The provisional agenda reduces the discussion time from four hours to just one hour: 25 minutes of "Open Discussion", and 35 minutes in workshop groups. We therefore insist that the promise of circulating documents well in advance be honored, and that the discussion (without frills) accordingly be rescheduled. If any participants wish to include statements, reports, or Powerpoint presentations to be circulated with the sample protocols, this will, of course, save valuable discussion time. With best wishes, John H. A copy of the provisional agenda is set out below. Provisional agenda for the day 10.00 Arrive and Coffee 10.05 Welcome and introductions Andrew Butcher 10.10 Health community perspective Andrew Butcher 10.20 Statutory context for consultation Joe Johnson 10.30 The PPI Forum perspective Cherna Crome 10.40 The value to patients/ NHS Yvonne Franks 10.50 Open discussion re definitions/criteria/approach to consultation 11.15 Coffee 11.30 Introduction to workshop group sessions Andrew Butcher 11.40 Group working 12.15 Feedback from groups and discussion of protocols Andrew Butcher/All 12.55 Discussion of next steps and close Andrew Butcher 1.00 Lunch If you want to discuss the plans for the day please contact me on 020 8321 5630 I have already included your name is the list of expected attendees and I hope that you will be able to attend. Kind regards Joe Johnson -----Original Message----- From: John Hunt [mailto:[email protected] ] Sent: 23 February 2005 17:53 To: [email protected]; [email protected] Cc: Robert Hardy-King; Cherna Crome; [email protected]; Daisi Ogunro

248

Subject: Meeting scheduled for 25th Feb.

To: Marjorie Witt & Joe Johnson Copy: Bob Hardy-King, Cherna Crome, Daisi Ogunro, Sunita Sharma

Dear Marjorie, The meeting on "Terms of Engagement" with representatives of the WMUH Trust and local PPI Fora, subsequently widened to include local PCTs and the Hounslow Overview & Scrutiny Committee was scheduled for Friday, 25th Feb..

An undated letter from Scope confirming arrangements stated that a "programme/agenda" would be circulated electronically last week. There was a previous verbal assurance at the Civic Centre by Bob hardy-King that draft proposals for discussion would be distributed to all members of the PPI Forum for the WMUH, to enable those of us who cannot attend to email comments.

As I have still not received any draft documents for discussion, I trust that the meeting is being rescheduled.

Please can you confirm that this is so, and also indicate in what time scale you expect the draft documents to be made available?

Regards,

John Hunt.

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1

PATIENT AND PUBLIC INVOLVEMENT FORUM FOR

WEST MIDDLESEX UNIVERSITY HOSPITAL TRUST

Meeting notes of Special Meeting

Thursday, 13th January 2005, 7.00pm

Council Chamber,

Hounslow Civic Centre,

Lampton Road

Hounslow

Present:Cherna Crome (CC) – Chair WMUH PPI ForumFrancis Brown (FB) – WMUH PPI Forum

Jean Doherty (JD) – WMUH PPI ForumJohn Hunt (JH) - WMUH PPI ForumBasil Mann (BM) – WMUH PPI ForumTimothy Spring (TS) – WMUH PPI ForumAndris Vanags (AV) – WMUH PPI ForumJohn Murphy (JM) – Hounslow PCT PPI ForumJohn Dimond (JDM) – Ashford & St Peter’s PPI ForumMorris Shaer (MS) – Richmond & Twickenham PPI ForumPaul Conrathe (PC) – Speaker (Solicitor)Gail Wannell (GW) – Chief Exec WMUHYvonne Franks (YF) – Director of Nursing WMUHJacqueline Hardy (JacH) – WMUHJoe Johnson (JJ) – Complaints Manager WMUHBaz Gard (BZ) – WMUHChristine Hay (CH) – Hounslow PCT, ChairmanJohn James (JMS) – Hounslow PCT, Chief ExecutiveCath Attlee (CA) – Hounslow PCTJulie Fuller (JF) – Hounslow PCT, PALS ManagerIsabel Granet – Overview & Scrutiny CommitteeDaisi Ogunro – Forum Support Organisation (FSO) Admin.Tanya Marius – FSO AdministratorBob Hardy- King – FSO Community Liaison Officer

ApologiesNoshaba Sainsbury – WMUH PPI ForumTrizah Ndwaru – WMUH PPI ForumMel Collins – Chair, Hounslow PCT PPI ForumClive Casey – Hounslow PCT PPI Forum

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2

Update from West Middlesex University Hospital

YF updated the Forum stating that the hospital was under pressure from

Admissions; they were in the middle 90’s on A&E and would be updating PPI strategy by the following week, which would be circulated to members. The PPI strategy would be launched in April.

There would be a cleaning hands campaign starting on Monday, in which they would be working in partnership with Ecovert. The Trust board minutes and Agenda would be available on the web as well as performance data. The report of the Forum’s visit to the hospital and comments had been received and the Trust’s response would be received the following week.

CC asked about the cessation of blood tests for children over six.

YF noted they had approached the PCT if children between the ages of 5-12 could have their blood tests in the community. The PCT wanted training issues to be addressed. They were trying to re-recruit the nurses that had resigned.

CC asked if this was a temporary or permanent change.

GW stated this would be temporary.

CA also added that they had just heard at the end of the previous week and

she would be writing to West Middx and work with them on this.

JD asked if the service was being provided at present.

GW confirmed service was still being provided.

There was a further discussion about the issue of consultation brought up by

JD referring to letters received from Alison McIntosh and stating the Forum

had not been consulted, even though a telephone call had been made to CC.

The response of the staff was that sometimes, emergency situations occur and they need to react promptly, positive communication was needed.JD said so far every situation had been presented as an emergency situation.

At this stage, CC called the discussion to a halt; however, she noted that

even though a telephone call was made to her, a telephone call in itself was not consultation. She stated the reason they were all there was to receive some clarification regarding the issue of consultation and the options open to the Forum if this was not complied with.

The speaker, Mr Paul Conrath was introduced by CC.

Talk by Mr Paul Conrathe – Options available to PPI Forums in the event

of non-compliance with “Section 11”duty to consult

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3

PC explained the role of PPI and their powers. PPI was about patient power, patient involvement and patient consultation.The functions are to obtain information, evaluate information and make recommendations. These powers are given to them by statute. The Patient Forums also have the power to enter and inspect NHS premises, obtain information and make reference to the Overview & Scrutiny Committee (OSC) and any other body the forum thought appropriate.He then went on to read out Section 11 and explained this section is very far reaching and the courts had made decisions based on the circumstances of each case and had looked on a number of issues for instance lack of resources, waiting lists. He further stated that consultation should occur at the stage of planning and there was a clear breach if there was no consultation. The section was put in place to prevent the authority doing what they want to do. In addition, consultation opens the door to legal challenge. He then mentioned dispute resolution was to be considered because according to the regulations, referral to the OSC is after all discussions with the authority had failed.Finally, going to court was a last resort and a protective remedy, which was also an available option.

CC thanked PC and asked if anyone had questions.

Questions & Discussion

JDM asked if the Trust would accept consultation and that they had not

practiced it.

It was stated by GW that the issue they needed clarification on was the right

level of debate when they need to make emergency decisions because of lack of staff or resources which they had not got right yet. How to manage an emergency situation; reasonableness, when it looked like they had not consulted.

In response to this, PC stated that statute had not laid down a time scale and

the case was situation dependent, the definition of emergency depended on reasonableness. Consultation should occur in the planning stage, when their mind is not made up and there could be a range of possible outcomes. PC said the definition of ‘consultation’ was that it was carried out at a time when there was a possibility of influencing the outcome

It was stated by CA, that another area that could be looked at was different

responsibility. The individual versus collective balance of one statutory duty against another statutory duty.

It was advised by PC, that in the issue of consultation, they could not run

resource arguments as the duty to consult was not qualified.

JM asked if there were other choices which can be put into consultation.

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4

PC stated there was a challenge when the court was faced with the patient

standing before the court.

The letter received from the Trust, informing the Forum that changes would take place and the second letter received two days later, stating changes had

been implemented was referred to again by JD and she asked PC’s opinion

on this issue.PC said on the face of it, it seemed to be a breach of Section 11. He further

explained there could be a technical breach or a substantive breach but he would have to look into the case further and he would be judge or jury at that point.

TS asked about the funding options available.

It was stated by PC that legal aid was available based on certain

considerations like merit, moderation and financially eligibility.

JH asked if the Forum brought a case to court what would be the provision for funding in that situation.

It was advised by PC that a PPI Forum would not get legal aid funding.

YF asked for advice on how to define reasonable and who determines what

is reasonable.

It was stated by PC that it depended on different sets of circumstances and the concept of an open mind.

At this stage JDM stated that his question had not been answered.

CA said it was agreed they had a duty to consult and they were trying to

involve the Forum and the users in the changes. The issue was the proportionality of that, they are changing services all the time, the complexity of change and if they consulted all the time a great deal of time would be spent. She suggested that set down protocols be put in place.

It was advised by PC that technically the Trust was in a weak position if they do not consult, they needed to immunise themselves to legal challenge and establish what is reasonable. The Trust should not assume a technical breach had nothing behind it, as it portrays them in a bad light and there was no room for complacency. The PPI however, have many opportunities to litigate and patients have more power than the courts would give.

CH asked if a service was being provided but at a different time or place and

PC stated it was possibly a breach.

There was a discussion about orthopaedic services which had moved to Ravenscourt Park Hospital.

It was mentioned by JH that more information was needed about the Freedom of Information Act that had come into force on January 1st 2005.

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5

CC said it would be discussed in a future meeting.

There was a discussion about working out a protocol and it was agreed this would be done.

CC announced the Workshop on Health Development Plan by the Hounslow

PCT on the 19th of January 2005.

She then thanked PC again, called for a comfort break and excused the Trust

and PCT staff.The formal part of the meeting ended at 8.30pm.

Revised version – 10th February 2005

254

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odFo

rum

rol

e is

not

wid

ely

unde

rsto

od••

Foru

m r

eput

atio

n is

poo

r w

ithi

n th

e Fo

rum

rep

utat

ion

is p

oor

wit

hin

the

hosp

ital

hosp

ital

••Is

sues

rai

sed

so f

ar h

ave

been

Is

sues

rai

sed

so f

ar h

ave

been

pr

edom

inan

tly

nega

tive

des

pite

rea

l pr

edom

inan

tly

nega

tive

des

pite

rea

l pr

ogre

sspr

ogre

ss

259

We

shou

ld e

xpec

t W

e sh

ould

exp

ect

……

••T

o ha

ve a

pro

fess

iona

l rel

atio

nshi

p T

o ha

ve a

pro

fess

iona

l rel

atio

nshi

p w

ith

our

Foru

mw

ith

our

Foru

m••

To

be c

halle

nged

, ins

pect

ed a

nd

To

be c

halle

nged

, ins

pect

ed a

nd

scru

tini

sed

scru

tini

sed

••T

o fe

el u

ncom

fort

able

at

tim

esT

o fe

el u

ncom

fort

able

at

tim

es••

To

prov

ide

info

rmat

ion

whe

n T

o pr

ovid

e in

form

atio

n w

hen

requ

este

d an

d in

a t

imel

y m

anne

rre

ques

ted

and

in a

tim

ely

man

ner

••T

o in

tera

ct in

a m

anne

r al

l of

us

To

inte

ract

in a

man

ner

all o

f us

w

ould

con

side

r ap

prop

riat

e w

ould

con

side

r ap

prop

riat

e ––

verb

ally

ve

rbal

ly

and

in w

riti

ngan

d in

wri

ting

260

Foru

m m

embe

rs n

eed

to

Foru

m m

embe

rs n

eed

to

appr

ecia

te

appr

ecia

te ……

••C

ompl

ete

chan

ge o

f cu

ltur

e fo

r C

ompl

ete

chan

ge o

f cu

ltur

e fo

r cl

inic

ians

and

man

ager

scl

inic

ians

and

man

ager

s••

Cha

ngin

g th

is m

ind

set

may

tak

e C

hang

ing

this

min

d se

t m

ay t

ake

tim

eti

me

••W

e ha

ve a

n ob

ligat

ion

to m

anag

e W

e ha

ve a

n ob

ligat

ion

to m

anag

e fi

nanc

ial a

nd o

pera

tion

al r

isks

to

fina

ncia

l and

ope

rati

onal

ris

ks t

o th

e or

gani

sati

onth

e or

gani

sati

on

261

Our

ple

a O

ur p

lea

……

••C

onsi

sten

cy a

cros

s th

e w

hole

hea

lth

Con

sist

ency

acr

oss

the

who

le h

ealt

h ec

onom

y fo

r ec

onom

y fo

r ‘‘ c

onsu

ltat

ion

cons

ulta

tion

’’••

Def

ined

cha

nnel

s of

com

mun

icat

ion

Def

ined

cha

nnel

s of

com

mun

icat

ion

••B

alan

ced

repo

rtin

g in

clud

ing

posi

tive

B

alan

ced

repo

rtin

g in

clud

ing

posi

tive

ex

ampl

esex

ampl

es••

Rea

sona

ble

tim

e sc

ales

tha

t R

easo

nabl

e ti

me

scal

es t

hat

appr

ecia

te t

he h

uge

dem

ands

and

ap

prec

iate

the

hug

e de

man

ds a

nd

pres

sure

s on

sta

ff a

nd m

anag

ers

pres

sure

s on

sta

ff a

nd m

anag

ers

••A

gree

men

t of

pri

orit

ies

and

wor

k A

gree

men

t of

pri

orit

ies

and

wor

k pl

ans

plan

s

262

We

need

W

e ne

ed ……

‘‘ An

An

inde

pend

ent

inde

pend

ent

crit

ical

cr

itic

al

frie

ndfr

iend

’’

Who

can

hel

p us

mak

e a

real

dif

fere

nce

Who

can

hel

p us

mak

e a

real

dif

fere

nce

263

Scen

ario

Si

gnifi

cant

ch

ange

? C

onsu

lt –

yes

or n

o?W

hy?

How

?

Rev

iew

pol

icy

on

livin

g w

ills

for

patie

nts

Yes

Y

es b

ut

see

com

men

ts

in h

ow b

ox

Bec

ause

of o

bvio

us im

pact

on

pat

ient

s W

orks

hop

felt

that

this

was

a n

atio

nal

issu

e w

hich

sho

uld

disc

usse

d at

that

le

vel a

nd n

ot a

ppro

pria

te fo

r loc

al

agre

emen

t

Mov

ing

Rhe

umat

olog

y cl

inic

to c

omm

unity

se

tting

Yes

Y

es

Bec

ause

of v

isib

le c

hang

e to

pa

tient

car

e Fo

rmal

Con

sulta

tion

with

bot

h th

e A

cute

an

d P

CT

foru

ms

as p

art o

f Sta

tuto

ry

Pub

lic C

onsu

ltatio

n

Cha

ngin

g vi

sitin

g ho

urs

on a

war

d

Not

sur

e/de

pend

s on

nat

ure

of

chan

ge/w

ill it

re

stric

t or i

mpr

ove

acce

ss

Yes

, but

in

form

ally

in

firs

t in

stan

ce

Pos

sibl

e vi

sibl

e ch

ange

Te

leph

one

call

in fi

rst i

nsta

nce

from

YF

to C

C

Clo

sing

an

acut

e m

edic

al w

ard

and

re-p

rovi

ding

car

e in

a d

iffer

ent w

ay

Yes

Y

es

A s

igni

fican

t & v

isib

le

chan

ge to

pat

ient

car

e +

perm

anen

t cha

nge

Form

al C

onsu

ltatio

n (a

nd p

ossi

bly

Pub

lic C

onsu

ltatio

n if

the

inte

ntio

n is

for

perm

anen

t cha

nge

264

Scen

ario

Si

gnifi

cant

ch

ange

? C

onsu

lt –

yes

or n

o?W

hy?

How

?

Ces

satio

n of

sub

-fe

rtilit

y cl

inic

at

hosp

ital d

ue to

P

CT

not

com

mis

sion

ing

serv

ice

Yes

, vis

ible

ch

ange

Y

es, b

ut

with

PC

T Fo

rum

onl

y

Vis

ible

and

per

man

ent

chan

ge to

pat

ient

car

e Fo

rmal

Con

sulta

tion,

Usi

ng th

e lo

cally

ag

reed

pro

toco

l/tem

plat

e –c

onsu

ltatio

n sh

ould

be

betw

een

the

PC

T Fo

rum

and

th

e P

CT,

Acu

te T

rust

/For

um k

ept

info

rmed

Intro

duce

cha

rges

fo

r tak

e ho

me

drug

s fro

m A

&E

Not

agr

eed

No

Th

eore

tical

ly n

o vi

sibl

e ch

ange

as

som

e pa

tient

are

al

read

y ex

pect

ed to

pay

for

thei

r pre

scrip

tions

and

as

long

as

patie

nts

who

are

ex

empt

rem

ain

exem

pt

Info

rmal

rout

e in

firs

t ins

tanc

e –

YF

to

disc

uss

with

CC

with

pos

sibl

e fo

rmal

co

nsul

tatio

n if

deem

ed a

ppro

pria

te

Cut

out

patie

nt

clin

ics

due

to s

taff

shor

tage

s

Yes

, but

as

a re

sult

of a

cris

is

situ

atio

n

No

Vis

ible

cha

nge

but a

s a

resu

lt of

an

unex

pect

ed

cris

is s

ituat

ion

Impl

emen

t the

cha

nge

and

then

tell

the

Foru

m a

bout

this

, via

the

info

rmal

rout

e …

mus

t be

done

with

in th

e ne

xt d

ay o

r tw

o.

Mov

e to

an

outs

ourc

ed s

ervi

ce

for m

anag

emen

t an

d st

orag

e of

m

edic

al re

cord

s

Yes

N

o A

s lo

ng a

s it

has

no

sign

ifica

nt o

r vis

ible

impa

ct

in th

e w

ay th

at p

atie

nt c

are

is p

rovi

ded

Foru

m n

ot to

be

info

rmed

unl

ess

outs

ourc

ed o

vers

eas

265

Sc

enar

io

Sign

ifica

nt

chan

ge?

Con

sult

– ye

s or

no?

Why

? H

ow?

Mov

ing

to b

arrie

r pa

rkin

g fro

m P

ay &

D

ispl

ay –

No

chan

ge in

cha

rges

As

long

as

does

no

t adv

erse

ly

affe

ct d

isab

led

patie

nts

No

Not

sig

nific

ant c

hang

e Y

F to

info

rm C

C

Follo

w u

p rh

eum

atol

ogy

appo

intm

ents

to b

e ru

n by

con

sulta

nt

nurs

e

Mix

ed v

iew

s Y

es

Pat

ient

’s re

ason

able

ex

pect

atio

n is

that

they

will

see

doct

or

Arra

nge

for d

iscu

ssio

n pa

per o

utlin

ing

the

prop

osed

cha

nges

to b

e ci

rcul

ated

to

the

Foru

m u

sing

the

agre

ed te

mpl

ate

Pat

ient

info

rmat

ion

leaf

lets

to b

e re

view

ed

Mix

ed v

iew

s N

o, b

ut

esse

ntia

lly

depe

nds

on th

e na

ture

of

the

leaf

let

The

Foru

m h

as n

o in

tere

st o

r re

leva

nt e

xper

tise

in

revi

ewin

g cl

inic

al in

form

atio

n pr

ovid

ed to

pat

ient

s bu

t w

ould

be

inte

rest

ed in

re

view

ing

non-

clin

ical

in

form

atio

n

No

cons

ulta

tion

expe

cted

if le

afle

t in

volv

es m

edic

al in

form

atio

n –

how

ever

, Tr

ust w

ould

invo

lve

patie

nts

thro

ugh

othe

r PP

I ini

tiativ

es

266

Sc

enar

io

Sign

ifica

nt

chan

ge?

Con

sult

– ye

s or

no?

Why

? H

ow?

Intro

duce

new

ch

emot

hera

py

serv

ice

prev

ious

ly

prov

ided

at

Ham

mer

smith

Yes

N

o E

xten

sion

and

impr

ovem

ent

to p

atie

nt s

ervi

ce

Initi

ally

info

rmed

via

the

info

rmal

rout

e (Y

F to

CC

) C

ould

be

need

for c

onsu

ltatio

n w

ith th

e Fo

rum

at H

amm

ersm

ith if

this

cha

nge

resu

lts in

a re

duct

ion

of th

eir l

ocal

se

rvic

e C

ease

non

-urg

ent

surg

ery

for 3

m

onth

s du

e to

sh

orta

ge o

f fun

ds

Yes

, but

as

a re

sult

of a

cris

is

and

likel

y to

be

tem

pora

ry

Mix

ed

view

s P

ossi

ble

chan

ge to

pat

ient

ca

re a

nd lo

cal s

ervi

ce

Initi

ally

info

rmed

via

the

info

rmal

rout

e (Y

F to

CC

) but

allo

w th

e po

ssib

ility

to

ask

for p

rogr

ess

repo

rt an

d ex

plor

e ot

her a

ltern

ativ

es

Rev

iew

sec

urity

po

licy

on a

cces

s co

ntro

l int

o ke

y de

partm

ents

Dep

ends

on

scop

e an

d im

pact

of

revi

ew, i

f no

visi

ble

chan

ge

then

not

si

gnifi

cant

Yes

, po

ssib

ly

Cou

ld im

pact

on

patie

nt

acce

ss to

hos

pita

l are

as,

visi

ble

chan

ge

Con

sulta

tion

usin

g ag

reed

te

mpl

ate/

prot

ocol

Cha

nge

in p

olic

y on

sta

ff un

iform

s

No

No

Not

sig

nific

ant t

o se

rvic

e al

thou

gh v

isib

le

267

Sc

enar

io

Sign

ifica

nt

chan

ge?

Con

sult

– ye

s or

no?

Why

? H

ow?

Follo

w u

p de

rmat

olog

y ap

poin

tmen

ts to

be

man

aged

in

prim

ary

care

Yes

Y

es

Sig

nific

ant v

isib

le c

hang

e C

onsu

ltatio

n vi

a di

scus

sion

pap

er,

poss

ibly

in s

uppo

rt of

Pub

lic

cons

ulta

tion

Tem

pora

ry

cess

atio

n of

an

tena

tal a

nd p

ost

nata

l car

e du

e to

st

aff s

horta

ges

Yes

N

o Te

mpo

rary

and

driv

en b

y cr

isis

situ

atio

n In

form

For

um

Clo

sing

6 b

eds

on

a su

rgic

al w

ard

Yes

Y

es if

pe

rman

ent

chan

ge

Vis

ible

long

term

cha

nge

to

serv

ice

Dis

cuss

ion

pape

r

New

app

roac

h to

ou

t of h

ours

em

erge

ncy

surg

ery

in

colla

bora

tion

with

E

alin

g H

ospi

tal

Yes

Y

es

Sig

nific

ant c

hang

e D

iscu

ssio

n pa

per

268

Notes of the Workshop held at West Middlesex University Hospital on 25th February to discuss the process of Consultation between PPI Forum and local NHS Trusts in the development of services. Present: Apologies: Francis Brown, WMUH Forum John Hunt Andrew Butcher, Workshop Facilitator Niall Fitzgerald Clive Casey, Hounslow PCT Forum Jean Doherty Cherna Crome, Chair WMUH Forum John Dimond, Hounslow PCT Forum Tony Foster, WMUH Forum Yvonne Franks, WMUH Director of Nursing Bob Hardy-King, Scope FSO Joe Johnson, WMUH Patient Involvement Manager Basil Mann, WMUH & PCT Forum John Murphy, Deputy Chair, PCT Forum 1. The event was introduced by AB who welcomed attendees to the

workshop. 2. AB presented a Health Community Perspective to the workshop: • Period of rapid change in the NHS – considerable investment, pressure to

improve performance, work in new ways • Focus on delivering better care, more effectively and economically • Should all be positive, but inevitably changes in one organisation can

impact on an another, and change is not always easy • Strong drive to involve patients and the public in development of the health

service – very positive and adds real value to the work that is done • Not always easy – views differ and there is also sometimes the need for

short term or immediate action which makes wide consultation very hard to achieve

• There are three broad strands of public involvement i. PPI strategy which seeks to involve patients in the planning

and implementation of change; ii. Formal consultation on major service change iii. Formal role of the PPI Forums in monitoring and advising on

the work of each Trust. • As the PPI forum has a statutory role and is an established group, it brings

a real opportunity to provide external input to service change in a more flexible way. However, with its monitoring role it is important that terms of engagement are agreed – for both parties’ sake. We should be seeking clarity on

iv. The Forum’s role in decision making on service change v. Criteria for consulting with the Forum vs either public

consultation (which would involve them) or more minor changes in which they should be kept informed in one way or another AND

269

vi. Who makes this decision? i.e. do we need to consult on need for consultation

vii. How autonomous can a Trust be in making short term operational decisions when they need to be made quickly?

viii. To what extent should consultation affect Trust decisions and how is this fed back?

ix. What comeback does a Forum have if their views are not adopted?

• In other words how do we set the rules to prevent surprises, minimise the incidence of dispute about process and bring some sort of uniformity to the process between the various Trusts and their Forums?

3. CC then presented a PPI Forum perspective She explained that patients were only interested in being consulted in changes which had a clear and obvious impact on the service provided by the Trust. She added that patients were not interested in behind the scene changes (move to a new contractor) which had no obvious change on the service provided. CC added that the Forum had no interest in being consulted on changes which related purely to medical matters. She then outlined the three key components of the relevant Legislation Section 11 of the Health & Social Care Act 2001 which related to Trusts having to consult over changes to services. 4. YF then presented a short PowerPoint presentation about the value to

patients/ NHS of effective consultation (See attachment to email) 5. There followed some round table open discussion regarding

definitions/criteria/approach to consultation. That discussion identified four key components which needed to be incorporated into any base criteria.

• That there has been a visible change to patient care? • Consideration is given as to whether the proposed change is a result of a

planned or crisis event? • Is there time to consult and is it practical to consult? • Has the issue of confidentiality been taken into account?

6. The following additional points were made during the further open discussion;

• There were concerns that some changes were being rushed through • In deciding whether or not it is appropriate to consult, should weight be

given to whether the change is temporary or permanent? • One delegate suggested that it might be helpful for the Forum to attend an

event with NHS managers to launch an agreed consultation process, to improve relationships and show NHS Staff that the Forum are there to help them.

270

• It was suggested that we have to reach a position where NHS managers feel comfortable using the Forum as a resource.

• The Workshop felt that it would be helpful to develop a common template with a structured approach to setting out the paperwork that would sent with the relevant consultation documentation. One delegate said that this template should only be one side of A4 and it might be helpful to code the template according to the priority of the issue being consulted. The Group agreed that the documentation should be sent from the respective named PPI Lead to the Forum Chair with a copy to Scope. A deputy would take on this role in periods of absence/holidays etc.

• One delegate said that there could be a time lag in receiving information via the Scope route and he did not want to lose the existing communication channels of the Trusts informing the Forum of upcoming changes and seeking feedback both formally and informally.

• One delegate suggested that the template Consultation documents which would be sent by the Trust for comment are given sequential number and placed on lists which Forum members could then peruse and decide which issues to read and comment upon on.

• One delegate said that we needed to draw a distinction between a long term planned significant change where Forum input was required and changes that occur as a result of a crisis situation. He said that he did not want to be informed of these sorts of changes.

• There was general consensus that the information should be copied to Scope who are best placed to disseminate the information to the necessary parties.

7. The Workshop then worked as a single group considering a set of specific

NHS scenarios/service changes to try and identify when it was a significant change that required consultation, why it was considered appropriate to consult in that instance, and how the consultation process should actually be managed. A copy of the scenarios and the answers provided during the workshop is attached.

On the basis of the discussions and the exercise to assess the need for consultation for the various scenarios in Paragraph 7 above, it was agreed that the Trust would prepare a draft protocol to define how and when to consult with PPI Forums. This would be circulated for consideration by the group within two weeks, prior to wider discussion within Trusts and Forums. It would be a concise and practical document setting a clear framework and approach rather than lengthy and detailed terms of reference.

271

1C From: Johnson Joe Sent: 04 March 2005 17:51 To: 'Cherna Crome' Cc: [email protected]; [email protected];

[email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; [email protected]; Franks Yvonne; '[email protected]'; 'Robert Hardy-King'; 'Daisi Ogunro'; '[email protected]'; 'Andrew Butcher'; '[email protected]'; [email protected]

Subject: Consultation Workshop - 25th February 2005 Dear Cherna I am grateful to you and your Forum colleagues for your thoughtful and constructive contributions to last week's Consultation Workshop. I thought that the event went very well. I am pleased to attach for your consideration and comment, copies of the following documents. • Copies of the minutes from the Workshop • Copies of the completed consultation scenarios which we discussed on the day • A copy of my presentation to the Workshop • A draft protocol on how the Trust should consult with the Forum As you know, a number of additional papers (protocols used by other Trusts) were circulated last week which are not all available in electronic format. The general consensus from our discussions was that these documents appeared to focus on consultation processes at a different level and are therefore of limited value in terms of informing the specific work that we are undertaking (Consultation arrangements between NHS Trusts and Patient Forums). We would welcome your feedback and it would be helpful if you could provide me with a single response on the draft protocol by 25th March 2005. I am conscious that you away on leave and for the sake of expediency, I have therefore copied this email and attachments to your Forum Colleagues. Please note that we have arranged for a copy of this email and the attachments to be sent to Mel Collins in the larger font as requested by John Murphy. We do not hold email addresses for all of those who attended the workshop and I would grateful if your colleagues in SCOPE could arrange for a copy of this email and attachments to be forwarded to them. Kind regards Yvonne Franks Director of Nursing & Midwifery West Middlesex University Hospital 020 8321 5583 Secretary: Laila Rhout 020 8321 5599

272

Notes of the Workshop held at ...

Scenarios 25.2.05.doc

25.2.05 Forum consultation.ppt...

05 03 Draft Protocol for PPIF ...

273

1B From: Johnson Joe Sent: 24 February 2005 14:06 To: Franks Yvonne; 'Andrew Butcher' Subject: Bob Hardy King papers for Workshop 25 February 2005 Yvonne/Andrew FYI Just received from Bob Hardy-King ... I have not had a chance to look at the attachments yet. Joe -----Original Message----- From: Robert Hardy-King [mailto:[email protected]] Sent: 24 February 2005 12:58 To: Simon Martin; Clive Casey; John Dimond; John Murphy; Mohinder Singh Batra; Satvinder Buttar;

Tony Foster; Andris Vanagas; Basil Mann; Cherna Crome; Francis Brown; Jean Doherty; John Hunt Cc: [email protected] Subject: Workshop 25 February 2005

Dear ALL,

Provisional agenda for the day...

working together.doc

Copy of estminster Protocol.d

Protocol.doc

Please find attached a copy of the 1. Provisional Agenda, 2. Draft West Middlesex Hospital protocol 3. Agreed Mayday protocol 4. Agreed Westminsterguidance Hope to see you all tomorrow. Bob

Bob Hardy-King Community Liaison Officer Forum Support Organisation 113-123 Upper Richmond Road Putney London SW15 2TL Tel: 020 8780 6238 Fax: 020 8780 1373

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Protocol of Co-operation between the Mayday Healthcare trust and the PPI Forum.

STATEMENT OF FUNCTIONS

The PPI forum has a statutory role to represent the interest of the public and

patients/clients of the Mayday Healthcare Trust NHS.

TENETS

1. The PPI Forum membership should be consulted in the planning and

development of health care services provided by the Mayday

Healthcare NHS Trust to the people of the London Borough of

Croydon.

2. The PPI Forum membership will monitor the quality and efficiency of

the health services provided by the Mayday Healthcare NHS Trust to

the residents of the London Borough of Croydon.

3. The PPI Forum membership will seek the views of the Trust’s

patients/clients including minorities and hard to reach parts of the local

community.

4. The PPI Forum membership will monitor the efficiency and

effectiveness of PALS and ICAS.

5. The PPI Forum members will report findings, views and concerns to

the OSC of the Local Authority, to the Commission for Patient and

Public Involvement in Health (CPPIH) and to the Mayday NHS Trust as

well as the Strategic Health Authority.

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METHOD

I. PPI Forum members require access to information

II. PPI Forum members will need to be involved in the consultation

process at all stages in the planning cycle.

III. PPI Forum members will require access to Mayday Healthcare NHS

Trust premises.

IV. PPI Forum members will require access to data of patients/clients

complaints.

V. PPI Forum members will need to be involved in the setting of the

required standard and quality of facilities plus the services being

offered by the Mayday Healthcare NHS Trust to the people of the

London Borough of Croydon.

RESPONSIBILITY OF THE MAYDAY HEALTHCARE NHS TRUST.

a) The Mayday Healthcare NHS Trust to supply adequate and timely

information to the PPI Forum within 20 days according to the Health

and Social Care Act 2003.

b) The Mayday Healthcare NHS Trust will support the visits of PPI Forum

members to the Trusts premises and facilities.

c) The Mayday Healthcare NHS Trust will ensure that all their personnel

will cooperate with PPI Forum members’ visits to the Trust services

and facilities.

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RESPONSIBILITIES OF THE PPI FORUM MEMBERSHIP.

d) PPI Forum members shall at all times offer courteous and constructive

criticism to the Mayday Healthcare NHS Trust in their declared aims

and endeavours to provide a comprehensive and developing health

care service to the people of the London Borough of Croydon.

e) Members of the PPI Forum will act as a conduit between the Mayday

Healthcare NHS Trust and its consumers, the people of the London

Borough of Croydon.

f) PPI Forum members will respect the confidentiality of both staff and

patients/clients.

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1

This guidance has been formulated jointly by representatives from the following

organisations:

• City of Westminster Health Overview and Scrutiny Sub Committee

• North West London Strategic Health Authority

• St Mary’s NHS Trust

• Central and North West London Mental Health Trust

• Westminster Primary Care Trust

• Chelsea and Westminster Healthcare NHS Trust

• St Mary’s NHS Trust PPI Forum

• Westminster Primary Care Trust PPI Forum

• Central and North West London Mental Health Trust PPI Forum

• London Ambulance Service PPI Forum

• Voluntary Action Westminster

• NHS Direct

This guidance will be reviewed annually by the Health Overview and Scrutiny Sub

Committee, having sought views from all signatories.

Please note that this guidance is intended to be used in conjunction with Home Office

guidelines on consultations and other relevant guidance in this area.

July 2004

Questions about this document should be referred to:

Chris Neill Senior Committee and Scrutiny Officer Cabinet, Committee and Scrutiny Support City Hall 64 Victoria Street

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2 London SW1E 6QP Email: [email protected] Tel: 020 7641 2783

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3 HEALTH SCRUTINY IN WESTMINSTER APPENDIX A Joint Guidance on Consultation On 11th May 2004, representatives from local organisations with responsibilities for

health service provision in Westminster met to agree how they would consult on and implement change for the benefit of local people. This guidance draws on consensus

views reached at the meeting . It is intended to offer guidance to NHS Trusts and the

City Council in situations where consultation may be considered necessary.

1. Legislative Requirements

1.1 Trusts have dual obligations, under the terms of the Health and Social

Care Act 2001, to engage and involve local people in the planning and

delivery of health services (Section 11); and to formally consult with the

Local Authority Overview & Scrutiny Committee(s) (Section 7) when

making proposals for ‘substantial change and variation in Services’

1.2 Local Authority Health Overview and Scrutiny Committees have a

complementary role to play in the scrutiny of local health care provision

and in expressing public opinion on behalf of the Local Authority when

NHS proposals for substantial change and variations are made. Should

the overview and Scrutiny Committee decide the process was not

conducted appropriately or that it is not in the best interests of local

people, they may refer the matter to the national Independent

Reconfiguration Panel.

1.3 A further requirement of the legislation is that NHS Trusts are obliged to

provide information to the Health Overview and Scrutiny Committee, in

pursuit of their public duties, within a given timescale of 28 days

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4 2. Principles for ‘substantial ‘ change or variation

In considering whether any proposal constitutes a substantial variation or

development the health service provider may consider (together with the

examples and indicative criteria set out below):

1. The scale of the change (including changes to the model of care)

2. The cost of the change and impact on local people

3. Policy implications, especially in cases where the change might

represent a deviation from current policy and

4. The view of PPI Forum Members, if one has been expressed.

Examples and indicative criteria for the term ‘substantial’

Matters might usually be referred to the Overview and Scrutiny Committee if the

proposed development or variation affects Westminster residents as either current and/or potential service recipients or carers of service recipients and if, as part of

the change, one or more of the following applies:

1. A major new service is being provided:

2. A large scale service is being closed or discontinued; 3. A major expansion or significant reduction of service is planned;

4. A change to the location of an existing service;

5. A change in the management and/or provision of a service as between

primary, acute and specialist care settings;

6. A major change to the way in which access to a service is gained;

7. A major expansion or restriction in the degree of choice offered to patients

about the location and nature of a service; or

8. The imposition of charges where none had previously applied

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These legislative requirements should be placed in the context of a continuous process of discussion and consultation – from the informal (e.g. advice on local

changes) to formal (e.g. potential referrals to the Secretary of State) stages. Attached is

a diagrammatic presentation of the process – leading from basic information on services

>public involvement> formal consultation.

What is anticipated is that most issues in respect of service changes will come as no

surprise, as continuous dialogue should allow for influence at all levels. On

occasions, as health service provision boundaries do not merely relate to a single Local

Authority areas, there will be a need for joint consideration of more strategic and

specialist services by a number of authorities. The Department of Health may advise

authorities that they must form joint committees

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How should we consult? Having considered that the proposed change is substantial, the health service provider

should seek to:

1. Provide early information on the proposals for formal public consultation to

enable the Committee to comment, if it wishes;

2. Allow sufficient time by providing reasonable notice for a meeting of the

Overview and Scrutiny Committee to be convened, to consider the proposal and

prepare a response;

3. Consult with the Overview and Scrutiny Committee (via Cabinet, Committee and

Scrutiny Support) and with the public in the context of the wider general duty

placed on all NHS bodies by section 11 of the Health and Social Care Act 2001

to involve and consult actual and potential service recipients, or their

representatives, on:

a) The planning of the provision of services;

b) The development and consideration of proposals for changes in the

way services are provided; and

c) Proposals for decision affecting the operation of services

Via the Cabinet Committee and Scrutiny Support office, the Overview and Scrutiny

Committee will aim to:

1. Give full consideration to the proposal and documents submitted by the

health care service provider

2. Engage Patient and Public Involvement Forum (PPIF) Members as

patient representatives as far as possible;

3. Make arrangements for joint scrutiny of proposals in cases where

(Westminster) is considered the lead authority but residents in other

boroughs are affected by the change, to avoid duplication of

accountability;

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4. Convene a meeting and give an indication of the Committee’s views as

soon as possible.

5. Consider separately so far as it is able the nature of the substantial

change and the efficacy of the consultation process, considering whether

in the latter case:

a) Consultation has been inadequate in relation to the content or time allowed’ or

b) The reasons given for not consulting are adequate, in cases

where for example there is a perceived risk to the safety or

welfare of patients or staff.

6. Commit to full and open communication with the health service

provider and other stakeholders throughout the process.

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Practical Considerations As part of this process, the health service provider will aim to reach a common understanding as to whether consultation with the Overview and Scrutiny Committee

should take place by endeavoring to:

1. Give early notice of a proposed substantial development or variation in

service and:

2.. Seeking the view of the Chair of the Committee (via the Cabinet

Committee and Scrutiny Support Office) as to whether he or she believes

the proposal entails a substantial variation.

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DRAFT

WORKING TOGETHER

West Middlesex University Hospital NHS Trust and

West Middlesex Hospital Patient and Public Involvement Forum

This agreement sets out how the two organisations will interact. The purpose of the agreement is to create clarity and understanding so communication and interaction is more effective. 1. West Middlesex Hospital Patient and Public Involvement Forum ( the

Forum)is invited to have representatives on some or all of the West Middlesex University Hospital NHS Trust ( the Trust) Support Fora and the Governance Committee. The attending representative(s) shall represent the patients’ views, as currently understood by the representative, and not from the perspective of the individual attending.

2 The Trust shall provide details and a ‘hard’ copy of papers, where they

are available, in advance of any such meeting.

3 The Trust welcomes the attendance of Forum members at its public Board Meetings. Meeting papers will be sent to the Forum Support Organisation (FSO) who will arrange for their distribution to the individual Forum members who have agreed to attend.

4 The Trust will endeavour to be represented at Forum meetings as

requested.

5 When a Trust representative attends closed Forum meetings, the representative shall answer questions where they can, but shall not be expected to answer all questions on the spot, but shall provide an answer within 20 working days in line with the requirements of the Freedom of Information Act 2000 and The Patients’ Forums (Functions) Regulations 2003 Sections 5 and 6.

6 When a Trust representative attends closed Forum meeting, to speak

on a particular subject(s) the representative shall answer questions on the agreed subject(s), but shall not be expected to answer on other subjects, but shall provide an answer within 20 working days in line with the requirements of the Freedom of Information Act 2000 and The Patients’ Forums (Functions) Regulations 2003 Sections 5 and 6.

7 When a Trust representative attends a Forum meeting in public, the representatives shall not be expected to answer questions asked directly by the public. Any questions asked by the public should be asked via the Chair of the Forum. It should be made clear to the public that it is the Forum meeting in public and not that of the Primary Care Trust.

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DRAFT

8 The Trust will allow a period of at least four weeks, when possible, for the Forum to consider its response and to reply. The Forum will undertake to respond within this timescale.

9 Any direct communication with Trust staff should be made only by the

Chairman or Vice Chairman of the PPI Forum, with the exception of previously agreed and established communications routes. All other contact will be with the Trust PPI Manager through the FSO.

10 The Forum can call for meetings with members of Trust staff in order to

address items in their work plan, or any other items that can be considered Forum business, such as issues stemming from a press story. Any such meetings shall be co-ordinated through the FSO and the Patient and Public Involvement Manager of the Trust.

11 All Forum work items relating to the Trust should be undertaken in

accordance with current legislation and with consideration of the internal ‘ Handbook for PPI Forum Members’ issued by the CPPIH’.

12 The Trust will advise the Chairman of the Patient and Public

Involvement Forum of key issues and events within Trust. 13 The Trust shall provide information to the Patient and Public

Involvement Forum such as press releases, annual reports and other defining documents.

14 The FSO and the Trusts Patient and Public Involvement Manager will

arrange visits to the hospital in order to allow for Forum members to familiarise themselves with the layout, organisation and key individuals within the hospital.

15 The PPI Forum agrees, without prejudice, to discuss any proposed

media release relating to the actions or services of and provided by the Trust, prior to its release.

Both the Trust and the Forum recognise that it will be necessary to review this agreement on a regular basis to take account of the developing relationship between the two organisations, and other developments in the wider PPI agenda. Signed …………………………………………………………………….. (on behalf of the Trust) Signed ……………………………………………………………………… (on behalf of the Patient and Public Involvement Forum) Date ………………………………………………………………………….

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Provisional agenda for the day

10.00 Arrive and Coffee

10.05 Welcome and introductions Andrew Butcher

10.10 Health community perspective Andrew Butcher

10.20 Statutory context for consultation Joe Johnson

10.30 The PPI Forum perspective Cherna Crome

10.40 The value to patients/ NHS Yvonne Franks

10.50 Open discussion re definitions/criteria/approach to consultation

11.15 Coffee

11.30 Introduction to workshop group sessions Andrew Butcher

11.40 Group working

12.15 Feedback from groups and discussion of protocols Andrew Butcher/All

12.55 Discussion of next steps and close Andrew Butcher

1.00 Lunch

---END---

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DRAFT

Draft at 3 March 2005

Protocol for Consultation between NHS Trusts and PPI Forums on Service Developments

This paper proposes a framework for agreeing how and when PPI Forums are consulted on service developments proposed by NHS Trusts. It is based on discussions at a collaborative workshop on this subject attended by members of West Middlesex University Hospital (WMUH) NHS Trust, WMUH PPI Forum, Hounslow PCT PPI Forum and Scope. Once this protocol is agreed it will form part of the Terms of Engagement adopted by Trusts and their respective PPI Forums. Context Trusts have an obligation to involve members of the public in the development of services and where ‘substantial’ changes are proposed, to consult formally with local Health Overview and Scrutiny Committees. It was agreed that in addition to these two requirements, it would be helpful and appropriate to engage directly with PPI Forums in the implementation of service change. More particularly, there are instances where formal consultation is not required but the input of the PPI Forum during the planning stages is important in the context of its monitoring role and of value in providing an external perspective. It is also critical in helping the PPI Forum to work in a well-informed and collaborative way with the Trust. This protocol sets out the basis for consultation and communication with the PPI Forum in a flexible manner, without precluding informal dialogue. It is therefore important to distinguish this from the other aspects of involvement mentioned in the previous paragraph, as follows: General involvement of patients and public Trusts operate a wide range of schemes to involve patients and the public in the long term development of services. WMUH for example is setting up a PPI Reference Group which oversees and co-ordinates the various forums for PPI. These involve formal patient liaison groups as well as participation by individual patients (including PPI Forum members) within specific service planning groups Formal Consultation Formal consultation with Overview and Scrutiny Committees will anyway involve PPI Forums in the consideration of ‘substantial’ proposed changes characterised as follows:

1. Introduction of a major new service 2. Discontinuation of a major service 3. Major expansion or significant reduction of service 4. Change to the location of an existing service 5. Change in the management and/or provision of a service as between

primary, acute and specialist care settings 6. Major change to access to a service 7. Variation in choice offered to patients about location of a service 8. Imposition of charges where none had previously applied

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DRAFT

Draft at 3 March 2005

Consultation with PPI Forums This is the subject of this protocol which sets out to define how, when and on what basis to consult with PPI Forums on proposed service developments, in as practical and simple manner as possible. In particular it proposes:

1. Criteria for when the PPI Forum should be consulted on a change rather than merely kept informed

2. How the decision is taken on whether to consult on the basis of these criteria

3. How consultation is managed. 1. Criteria for consultation The workshop proposed a number of criteria as a basis for assessing the need for consultation. These were then tested on a number of hypothetical scenarios which have been recorded as a matter of record. The key criterion for consultation with the PPI forum is: • Are the proposed changes to the service, tangible/visible to the patient? If so, secondary criteria relating to the practicality of consultation are • Are the proposed changes a result of crisis or contingency operational

management, thereby making it impractical to consult? • Are the proposed changes long term (including contingency short term

changes that become permanent)? In the case of changes which do not require consultation with the PPI Forum, the Trust will inform the Forum as soon as is practical. 2. Decision on whether to consult On the basis that the criteria above are used to decide on the need for consultation, this decision will be taken jointly by the Trust PPI lead and the Chair of the PPI Forum. Proposed changes will be tabled at a monthly meeting except where they require more immediate consideration in which case the Trust PPI lead will contact the PPI Forum Chair by telephone. Both of these people will nominate a deputy in the event of their absence for a period of time for holidays etc. The proposed change and the decision on consultation will also be recorded in an exchange of emails between the Trust PPI lead and the PPI Forum Chair, copied to Scope. 3. Consultation process

Once it is agreed that consultation with the PPI Forum is required, the process will be as follows: • Numbered consultation paper (max 2 pages) summarising the proposed

changes, the context, timing, options and recommendations to be sent by email to the PPI Forum Chair for distribution to Forum members, copied to Scope

• A single composite PPI Forum response to be sent by email within seven days to the Trust PPI lead, copied to Scope

• Once the Trust decision on the way forward has been made, it will be communicated immediately to the PPI Forum Chair, with the option for further discussion at the next PPI Forum meeting.

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PLEASE NOTE THIS MEETING WILL BE WEBCAST.

Documents

Transcript of PLEASE NOTE THIS MEETING WILL BE WEBCAST.