Trust Board Meeting 02 March 2017

Transcription

1 Trust Board Meeting 02 March 2017 Title of the paper: Agenda item: 11/46 Guardian of Safe Working Quarterly Report (October 2016 January 2017) Lead Executive: Paul Da Gama, Director of Human Resources / Mike Van der Watt, Medical Director Author: Trust aims : Dr Richard Burridge, Guardian of Safe Working / Lynn Hull, Medical Staffing Manager Double click on the box to mark as appropriate: To deliver the best quality care for our patients To be a great place to work and learn To improve our finances To develop a strategy for the future Purpose: The aim of this paper is to provide assurance that junior doctors are working safely within the trust Link to Board Assurance Framework (BAF) PR1 PR2 Failure to provide safe, effective, high quality care (insufficiently robust and embedded quality governance and risk management) Failure to recruit to full establishments, retain and engage workforce Previously discussed: Group Date Workforce Committee 21 st February 2017 TEC 15 th February 2017 Benefits to patients and patient safety implications Doctors working safely enables them to provide safe care to their patients Recommendations For information and assurance

2

3 Agenda Item: 11/46 Trust Board 2 March 2017 Guardian of Safe Working Quarterly Report (October 2016 January 2017) Presented by: Paul Da Gama, Director of Human Resources / Mike Van der Watt, Medical Director 1. Purpose 1.1 The New Junior Doctors Contract (2016) contains within the Terms and Conditions of Service the requirement that the Guardian of Safe Working (GOSW) prepare a quarterly report to the trust board containing information relating to the safe working of doctors within the trust. 2. Background 2.1 New Junior Doctor Contract implemented from August Dr Richard Burridge appointed GOSW for WHHT in August 2016 in line with NHS Employers guidance New Junior Doctor s Contract (2016) replaces the Hours Monitoring process of the 2002 Terms and Conditions with a process of individual exception reporting for doctors when they work beyond their contracted hours Exception reports are processed by educational supervisors and if required time off in lieu or payment is offered. Outcome is fed back to the clinical supervisor to arrange Time off in lieu and discuss any ongoing issues with work schedule with trainee Process overseen by GOSW who can intervene in any disputes and request a Work Schedule Review if there are recurrent exceptions reported by the same trainee or in the same clinical area GOSW can impose fines if specific breaches of the Terms and Conditions of Service (TCS) occur where doctor safe working has been compromised Money from fines is held by the GOSW and the use of the fines is agreed between the GOSW and the Junior Doctor Forum. The GOSW has an obligation to ensure the fair distribution of financial penalty income, to the benefit of doctors in training GOSW required to produce quarterly report to the trust board and share with the Local Negotiating Committee An Annual aggregated report is to be included in the trust quality account

4 2.2 Implementation of the new TCS at West Hertfordshire Hospitals NHS Trust: Initially six Obstetrics and Gynaecology trainees moved onto the new TCS in October There have been no exception reports to date from this group From December 2016 to Jan 23 rd when the figures for this report were compiled there have been 59 exception reports from the Foundation Year One (F1) doctors Exception reports mainly relate to being required to start earlier than contracted for consultant ward rounds, and late finishes due to excess workload There has been a large variety in frequency of reporting from junior doctors There has been variable engagement from Educational Supervisors in the new process To date all exceptions have been managed with Time off in Lieu offered to doctors and no compensation payments have been made There have been no significant exceptions which have resulted in a GOSW Fine Some areas of ongoing discrepancy between contracted hours and the expected hours of F1s have been highlighted There is work ongoing to review the work schedules for these trainees to make adjustments so the contracted work schedule better reflects the actual expected hours of work 3. Analysis/Discussion 3.1 High level data: Number of doctors/dentists in training (total): 239 Number of doctors/dentists in training on 2016 TCS (total): 59 Amount of time available in job plan for GOSW per week: 2 PAs/8 hours per week Admin support provided to the guardian (if any): None specific to role support from Medical Staffing, specifically Ferkhanda Ahmed and Lynn Hull Amount of job-planned time for educational supervisors: 0.25 PAs per trainee

5 3.2 Exception reports (with regard to working hours) Exception reports by department Specialty carried over raised closed outstanding from last report Obstetrics & n/a Gynecology ST3 and above F1 Medicine n/a F1 Surgery n/a Total n/a Exception reports by grade Specialty carried over raised closed outstanding from last report F1 n/a F2 n/a n/a n/a n/a CT1-2 / ST1-2 n/a n/a n/a n/a CT/ST3+ n/a Total n/a Exception reports (response time) It is not currently possible to interrogate the exception reporting system to provide accurate data on this. This feature is expected in future updates. In general once supervisors have set up an agreement with their trainees about handling exception reports they have been completed within a week. The rest of the exception reports have not been completed of those, 8 have breached the 7 days to complete the Initial report and of those 8 reports, 4 have breached the 14 day period (as of 23 Jan 2017) There have been ongoing efforts to engage Educational Supervisors in the process of handling exception reports. Most have engaged well. There remain some who have not yet met with their trainees despite several reminders from the GOSW. He will continue to pursue this. 3.3 Hours Monitoring Exercises October 2016 January 2017 (for those doctors on 2002 TCS) Hours monitoring exercises (for doctors on 2002 TCS only) Specialty Grade Rostered hours Monitored hours Banding WTR compliant (Y/N) Cardiology F % No Gastroenterology F % No Cardiology SHO 44 N/A 50% * Gastroenterology SHO 44 N/A 50% *

6 * The response rate to this exercise was below 75% so no statistically valid figures are available. ** The response rate to this exercise was below 75% but no issues with shift lengths or breaks were reported and the rota has historically been compliant 3.4 Work schedule reviews As the new TCS are still new, there have been no formal Work Schedule reviews between October 2016 and January However, several areas have been highlighted where there are recurrent exceptions and a review process has commenced: F1 Cardiology Ward Rounds commence before the contracted 0900 start and F1 doctors are expected to attend having prepared for the round. This has been highlighted by various exception reports and is a known issue which predates the new TCS (this formed part of the reason for the F1 Cardiology Hours Monitoring Exercise - see above). This issue has been highlighted to the newly appointed Clinical Lead for Cardiology and we await a plan to adjust the scheduled work schedule for doctors working in F1 Cardiology F1 Gastroenterology Ward Rounds commence before the contracted 0900 start and F1 doctors are expected to attend having prepared for the round (often starting at 0745 to achieve this). Again this has been highlighted by various exception reports and is a known issue which predates the new TCS (this formed part of the reason for the F1 Gastroenterology Hours Monitoring Exercise - see above). There have been no exception reports about this problem since 15th December 2016 so the assumption is that this has been resolved internally within the department. Certainly it is not being raised by the trainees. A discussion with the Gastroenterology team is planned as part of a review of the F1 working hours before the next placement change in April 2017 to ensure these issues have been resolved given the issues in the past with this post F1 Surgery (Vascular in particular) There have been historic challenges with these posts and work load, including frequent late afternoon consultant ward rounds. Prior to the commencement of the new TCS an agreement was made with the F1 Vascular trainees for a system of locum payment for additional hours worked to support the vascular service. Ongoing discussions have taken place and a twilight F1 slot has been created to try and make it possible for the F1 doctors across surgery to finish their shift on time. These shifts are locum posts and so are not always filled. Some exceptions refer to days when there is no Twilight F1 booked which is inevitable. Some occur despite this, and a meeting with the F1 Surgery doctors took place at the beginning of their placement to encourage them to ensure work is handed over to these twilight doctors and to minimize the need to stay late. This issue is not yet resolved but ongoing work is being done between Medical Staffing and the surgical division with input from the trainees to find the best solution. 3.5 Locum bookings As this report relates to predominantly the new TCS (2016) the decision was taken to focus the locum bookings data to O&G ST3+ and F1 posts to maintain context. As more doctors move onto the new TCS, locum usage from those areas will also be included.

7 i) Bank Specialty Numbers of Spend hours worked O&G ,721 F1 s 128 4,492 Total ,213 ii) Agency Specialty Number of Spend hours worked O&G 29 54,641 F1 s 51 1,800 Total 80 56,441 Vacancies Specialty Month 1 Month 2 Month 3 Number of shifts uncovered O&G ST3* 4 part of 4 4 month F1 s These two F1s were on restricted duties so on calls covered by locums 3.6 Guardian Fines There have been no Guardian fines to date 4. Issues arising / Actions taken to address issues 4.1 Issues arising: As it stands the Guardian has not identified any areas of specific concern in relation to safe working hours amongst the Obstetrics & Gynaecology ST3+ and F1 doctors. There has been one exception report highlighting a shortage in staff on 2 days when an F1 was moved onto night shifts to cover an empty slot on the rota. This left their colleague alone covering Vascular Surgery as the F1. This was highlighted as an

8 immediate safety concern by the trainee although on reviewing the report there were no significant breaches of the TCS and no fines were due. The trainee is discussing the situation with their team As mentioned above there are some outstanding issues with F1 cover to surgery, particularly vascular, as well as the cardiology and gastroenterology teams having ongoing expectations of their F1s to start before their contracted time. 4.2 Actions taken to resolve issues There have been ongoing meetings between the surgical division, medical staffing and the junior doctors around the issues in F1 surgery and there has been engagement in this process, although there do appear to be ongoing challenges for the F1s in this area so this dialogue will have to be ongoing The F1 cardiology start and end times have been highlighted to the newly appointed clinical lead for cardiology and there is confidence that any changes necessary to ensure the working pattern of the consultants matches that of their juniors There is an ongoing challenge of gaining full engagement from all educational supervisors in the process of exception reporting. It has been raised that there can be a challenge when educational supervisors are viewing reports of trainees working in other specialties from their own. However it is clear from the TCS that this responsibility lies with the Educational Supervisor, not with the Clinical Supervisor. It may be that if this remains an ongoing challenge, we make a local arrangement for clinical supervisors to take on this work. The guardian will continue to prompt and offer support to those supervisors who have thus far not engaged in the process. 5. Summary & Recommendation 5.1 Overall there have been no significant exceptions resulting in a Guardian Fine and it is the view of the Guardian of Safe Working that there are no significant issues in regard to the safe working of the junior doctors working on the new TCS at present. Some areas where changes are needed have been highlighted and there is ongoing work to facilitate these. 5.2 The Committee is therefore asked to note this report for information and assurance Paul Da Gama Director of Human Resources Mike Van der Watt, Medical Director March 2017