Questions and Answers from the North East Essex Local Engagement Forums (August 2013): Keogh Mortality Review outcome - Colchester Hospital University Foundation Trust Q1: Why is no feedback sought from the hospital from friends and family of the patient after the patient has died? A1: No feedback is sought regarding the care and experience of the individual. This is a good point. Sarah from Colchester Hospital University Foundation Trust will take this back to discuss how this might be implemented. Q2: How does ACE fit into the Colchester Hospital University Foundation Trust mortality rate especially inclusion of Clacton and Harwich Hospital? A2: Mortality rates are fed into Colchester Hospital University Foundation Trust SHMI (Summary Hospital-level Mortality Indicator) especially if admitted and discharged from Colchester Hospital University Foundation Trust within 30 days. Q3: Has feedback been received by Colchester Hospital University Foundation Trust from other hospitals under Keogh? A3: Yes, communication is 2-way. Engage in best practice, Colchester Hospital University Foundation Trust have been to visit The Hommerton with regards to a new A&E format. Q4: How is joined up care accomplished between departments and divisions within Colchester Hospital University Foundation Trust? A4: The patient s individual pathway is important to them. Pathways must be joined up internally and externally. Pathways may be complicated to hospitals but to patients they see themselves as being ill and want people to just know what is going on. Q5: Patients need to confidence to ask for assistance where needed. How can the hospital help with this? A5: Signage in all departments asking patients to ask for help would be beneficial. Q6: Is whistleblowing encouraged within Colchester Hospital University Foundation Trust? A6: Yes. This needs to be fed back to patients to assure them that staff are looking out for their needs. Using student doctors as a feedback source has proved successful as they have worked in many hospitals and are not caught up in the hospital hierarchy as yet. Junior doctors have presented to the Board about out of hours hospital care and some suggestions have already been implemented. Q7: What is the relationship with Colchester Hospital University Foundation Trust and the Unions? A7: Union relationships are very positive and Colchester Hospital University Foundation Trust received the backup of the Unions for the implementation of the new anonymous 1
whistleblowing telephone number that staff can utilise if they wish to report something untoward. Q8: What happens to the Whistleblowing calls? A8: All calls are logged with the Chief executive or Director of Human Resources for review and investigation. Calls remain anonymous if the caller requests. Q9: At what point is action taken to target a problem? A9: Datex is a reporting tool for staff to use to report incidents and concerns of which there are checked and prioritised daily. The Nursing Director and Medical Director review all Datex reports and recognise plans to solve those that are of high priority. Datex also enable Colchester Hospital University Foundation Trust to plot trends to recognise issues early. Q10: Why did the hospital recruit nurses from Spain? A10: There are not enough nurses unemployed locally especially when Colchester Hospital University Foundation Trust needed a large amount. Colchester Hospital University Foundation Trust support local recruitment of British nurses and there is a significant number that are employed throughout the year to accommodate natural employment journeys i.e. those staff members that move on naturally to other roles etc. Training opportunities via Colchester Hospital University Foundation Trust for Health Care Assistants to train as Associate Practitioners and then registered nurses are available. Language skills of Spanish nurses were tested before the offer of employment from an everyday English perspective but also from an English clinical language perspective. Q11: Do Colchester Hospital University Foundation Trust have nurses on zero hour contracts? A11: No. Caterers, Domestic Assistants and some Physiotherapists etc. are on zero hour contracts as this suits the job type. All nurses are on permanent contracts with extra staff on the bank register who cover available shifts and sickness. Some consultants are on long-term contracts or permanent locums as some departments are very hard to recruit into. Q12: What is the sickness rate at Colchester Hospital University Foundation Trust? A12: Target is 3.5%, Colchester Hospital University Foundation Trust currently running at 3.5%. Doctor sickness rate is very good but needs further work. Colchester Hospital University Foundation Trust do not execute return to work interviews. When staff members call in sick, they get a return phone call from a clinician offering assistance if needed. This process helps to get staff back to work quicker. Q13: The Colchester Hospital University Foundation Trust Patient Advice and Liaison Service is poor quality and needs improving. What is being done? A13: Colchester Hospital University Foundation Trust not aware of poor quality service being provided which included no email responses, answerphone messages etc. Sarah from Colchester Hospital University Foundation Trust will take back and investigate. Recommendation from LEF is to have Patient Advice and Liaison Service front of house i.e. at reception to the hospital. 2
Q14: What is the relationship between Colchester Hospital University Foundation Trust and the Voluntary Sector? A14: This has previously not been good. However Helen Parr at Colchester Hospital University Foundation Trust has taken on the role of engagement with patients and carers and is holding a workshop in September to gather what we know is happening now and will include representation from Senior Executives from Colchester Hospital University Foundation Trust. CVS and North East Essex Clinical Commissioning Group are to be invited. Q15: How were publics views sought? A15: This Newspaper, website, public members, staff, advertised in wards Q16: What form does real time patient feedback take? A16: Colchester Hospital University Foundation Trust still looking at this, Annual patient survey, Monthly friends and family test, Audit of complaints and themes Q17: Will the Care Quality Commission (CQC) be coming out of hours A17: CQC will be changing their approach Q18: Do Colchester Hospital University Foundation Trust talk to Out of Hours provider? A18: Through North East Essex Clinical Commissioning Group surge and conference call arrangements, as well as adhoc relationships. Q19: How is morale? A19: Overall think that it is good Q20: Has staff nurse levels/skill mix increased? A20: Full time nurses have increased by 100, qualified 60% HCA 40%. Identified that need 17 more nurses for maternity cover. 17 ward sisters in supervisory roles Q21: Spanish nurse recruitment, issue with the English speaking A21: Extra language courses are being made available Q22: Why were the nursing jobs that were recruited by going to Spain not advertised on NHS jobs? A22: The throughput of British nurses is enough to help with the natural loss of nurses within the acute sector such as from retirement and new employment prospects. The number of nurses required was so high that there is not enough available locally, hence going to Spain. Q23: Could the levels of paperwork that nurses have to complete be reduced? A23: Was general recognition that this has increased and need to ensure there is an appropriate balance Q24: Best practice examples nationally and internationally A24: Need to do more in sharing best practice recognise an area for improvement 3
Q25: How are you ensuring you improve/focus on identifying issue to avoid being caught out again A25: There were very few surprises, Peer review, Data pack/benchmarking Q26: How are you working with voluntary organisations? A26: Work is needed in this area Q27: How many of the people who died were preventable? A27: 5% Q28: How can primary care allow people to stay at home? A28: GP Contract, Out of Hours providers and Out of Hours doctors need access to GP notes Q29: Of the avoidable deaths, was the root cause looked at? A29: A random selection of cases were looked into Q30: The location of the league of friends shop is in a poor location A30: Colchester Hospital University Foundation Trust will look into this Q31: Quantity of disabled parking spaces is not appropriate A31: Extra spaces are being created where possible General Questions Q32: Why are Tendring patients given 9am appointments at Colchester Hospital University Foundation Trust? This is too early. A32: Services need to be patient centred and individualised. Q33: Is there a new drug available to epileptics to stop seizures occurring after an anaesthetic? A33: Not that we are aware of. Recommendation to join Epilepsy Action and the Epilepsy Specialist Nurse will be in post soon to answer such questions. Q34: Is the complaints process at Colchester Hospital University Foundation Trust run by solicitors? A34: No. All complaints are dealt with the Colchester Hospital University Foundation Trust internal Patient Advice and Liaison Service or by North East Essex Clinical Commissioning Group Patient Advice and Liaison Service. Q35: Access to my GP surgery is poor. I can never get an appointment and they do not have a patient participation group. A35: NHS England manages the GP surgeries, so these are the first port of contact or complaint, please come to the North East Essex Clinical Commissioning Group if you 4
experience little success. North East Essex Clinical Commissioning Group are encouraging all practices to create active patient participation groups. Q36: My practice patient participation group (PPG) is not effective; we have no meetings apart from the occasional questionnaire that is sent out. A36: North East Essex Clinical Commissioning Group not only wants all practices to have a patient participation group but we also want them to be effective. North East Essex Clinical Commissioning Group representatives have taken details of this individual case and will pass back to Anthony West for investigation Q37: Why is there not a service for Post-Traumatic Stress Disorder (PTSD) in NEE? The STAR service in Tendring is available as a support group for Mental health as an interim for Phycology appointments within secondary care. STAR is not specialised to deal with PTSD. An individual has been waiting for a Phycology appointment since October 2012 and a clinically led service to help with coping mechanisms would be beneficial. Health in Mind is short term help and patients are unable to access Health in Mind if they already access Community Mental Health Services. A37: North East Essex Clinical Commissioning Group representatives have taken details of this and will pass back to Mental health Commissioners for more information especially about service provision and waiting times for Phycology. Q38: What is commissioning? How do people decide on what money is spent on? A38: North East Essex Clinical Commissioning Group receives public money from central government and spends accordingly as the health of the population depicts. Gaps are identified using Public Health knowledge and trends, demographic details, statistics and presentations that are included in the Joint Strategic Needs Assessment document. Q39: Who is in charge of commissioning in the North East Essex Clinical Commissioning Group? A39: Dr Shane Gordon is our Chief Clinical Officer and Dr Gary Sweeney is the North East Essex Clinical Commissioning Group Chairman, we also have a Board of Executives. The difference now between North East Essex Clinical Commissioning Group and PCT is that NHS England commission GP services therefore North East Essex Clinical Commissioning Group have less commissioning areas that before. The Health economy has become more complicated as there are now more organisations who commission services for health, these needs to be communicated more effectively. Q40: How does the North East Essex Clinical Commissioning Group seek help and good work from charities and churches? A40: We need to outreach more. Our patient groups are a start. North East Essex Clinical Commissioning Group need to be involved more in the communication of where voluntary sector funding comes from as North East Essex Clinical Commissioning Group provides some of this. We have our Health Engagement Forum etc. but we are aware that more needs to be done. Q41: Why is there not an A&E department at the Clacton hospital? A41: The Clacton site is not fit for A&E purpose. A&E is also not always the most appropriate place for healthcare so we need to educate patients towards the best option 5
for their individual needs such as the use of Minor Injuries Units, Out-of-Hours GP surgeries or a GP appointment the following day. Q42: Issue raised about a local GP surgery A42: It was encouraged that NHS England involved in this issue as outside scope of the North East Essex Clinical Commissioning Group. Q44: An issue arose about people not being able to get through to Colchester Hospital University Foundation Trust Patient Advice and Liaison Service, and them not returning calls or emails came up A44: - North East Essex Clinical Commissioning Group Patient Advice and Liaison Service to will look into this query Q45: Someone raised an issue about not enough GPs in their practice A45: North East Essex Clinical Commissioning Group gave the patient the number of Jenni Speller to talk to about this at NHS England. NHS England are coming to the next Local Engagement Forum where this could be raised again directly Q46: An issue was raised about how Colchester Hospital University Foundation Trust could work more closely with the voluntary sector around support available after discharge A46: Colchester Hospital University Foundation Trust noted (See above) they plan to work more with the voluntary sector moving forward. Q47: Colchester Hospital University Foundation Trust does not have a carers liaison support worker as they do in Chelmsford hospital A47: North East Essex Clinical Commissioning Group Carers Commissioner aware of this and looking into it already Q48: Although patient feedback is sought by Colchester Hospital University Foundation Trust on discharge, feedback from carers is not sought and in particular feedback from family/carers at end of life is not sought, even though people may very much want an opportunity to share their story A48: North East Essex Clinical Commissioning Group Carers Commissioner aware of this and looking into it already and will fit into a wider piece of work on services for Carers 6