Agenda item

1.

Question from Councillor Tim Harman

The ageing population puts additional pressures on a whole range of public services including health care.

Can the Trust outline it's plans for coping with the input of this trend on Heath services locally to ensure that that a high level of care is maintained

Response

We take into account demographic growth and age specific admission rates in our capacity planning. Our commissioners, in partnership with us and other providers of health and social care in the county, are developing a broader range of services in the community to reduce the requirement for admission to an acute hospital.

In a supplementary response, Doctor Pearson explained that national policy was that community based services would deal with any growth, but there was in fact a trend for increasing demand, which was the reason that capital plans had been bought forward.  Community based planning was more sensitive to development but the Trust were now working more closely with planning authorities. 

2.

Question from Councillor Helena McCloskey

A couple of weeks ago, the Sunday papers reported that some NHS Trusts were using money set aside for building maintenance to keep essential services running. To what extent is the trust relying on money earmarked for other purposes to do the same?

Response

We have a capital programme of around £10m per annum for building maintenance and equipment.  This budget is contributed to from surpluses in our budget at the end of the financial year.  The expenditure through our capital programme is reported monthly in public through our Board papers (see response to question 11).

In a supplementary response, Professor Chilvers accepted that the hospital environment was a factor in how patients assessed their overall experience.  She regularly visited both sites and it had been her experience that if a small issue was reported, it was quickly addressed.  Whilst some areas, of both sites, were less than perfect, she had no concerns about the safety of buildings and equipment.

3.

Question from Councillor John Payne

Within our hospitals there are pockets of excellence in both nursing and medical provision. Unfortunately, this level of care is not universal across the Trust. What do you consider to be the root cause of this disparity of the provision of healthcare?

Response

We are committed to providing consistent high quality care across our services.  The reasons for variation in care are multifactorial.  Individual human behaviour and quality of leadership are likely to be the most significant factors.

In a supplementary response, Dr Pearson confirmed that the Mission Statement and Vision had been developed with staff.  She felt that it was less of an issue about penetration of the objectives, but more of an issue that anyone could have an ‘off’ day and in fact the challenge was to identify where this was a routine occurrence.  Clinical teams were getting better at working together, sharing experiences and learning from each other. 

4.

Question from Councillor John Payne

The relentless privatisation of services in the NHS has always been a concern to me. Every contract, whether it be for patient transport, portering services, catering, screening etc,etc are undertaken by private companies for one reason, and one reason only  - profit. Could you please explain how the NHS with it vast resources is incapable of providing these cores services at lower cost?

Response

Some functions can be more cost effectively provided by providers for whom the function represents their core business.  Whenever we believe we can provide a resilient and cost effective service without detracting from our other core functions, then we will tender for those services, to ensure the NHS gets best value for money.

In response to a supplementary question, Dr Pearson advised that the Trust had relatively few private contracts and gave the example of the administration of parking; this was not an area in which a great number of NHS staff had specialist knowledge and through a private contract the Trust was able to benefit from this specialist knowledge without incurring any of the associated overheads.  It was important to note that quality indicators, as well as cost, formed part of each tender process 

5.

Question from Councillor John Payne

Project 2000 saw the introduction of the Graduate Nurse. I would like to suggest that we no longer have a continuum of skills at ward and clinic level. How do you respond to the suggestion that skill levels on the wards are now polarised, with Clinical Nurse Specialists at one pole and Nursing Assistants at the other?

Response

We carefully assess the skill mix of nursing staff on the wards using the national Keith Hurst tool.  You will be aware that there are national proposals to change nurse training. It is also important to recognise that other clinical staff also contribute to the clinical skills available to patients on our wards and these can vary from ward to ward

The introduction of the Nursing Associate role would offer a new route into nursing for those with a good level of skills but not at degree level; which was welcomed as a positive move.  The Trust had been in discussion with the University of Gloucestershire about providing such a course, given that people tended to stay on in places where they had undertaken training.  Nursing Associate training would include an apprenticeship route. 

6.

Question from Councillor John Payne

What is the future for Cheltenham General Hospital? I would suggest that the hospital is under-used, and that that is a deliberate policy. For example could you provide an update on the refurbishment of Hazelton Ward following the roof collapse, about 12 months ago.

Response

We are committed to the future of both of our hospitals.  We will share with you our ideas for the development of the Cheltenham General site which include the area previously occupied by Hazelton Ward.

7

Question from Councillor John Payne

Many of the companies providing domestic, catering and nursing services employ a significant number of overseas staff. What measures does the Trust take to ensure to employment status of the staff, and in particular what checks are carried out to ensure nurses are appropriately qualified and state registered?

Response

All employees, whether they are temporary, permanent or agency members of staff are subject to the 6 standard employment checks as set by NHS Employers. These checks include:

Identity

Right to Work

Criminal Record Check - Disclosure and Barring Service (Previously CRB)

Professional Registration

References

Fitness to Work (Occupational Health Clearance)

In addition to our own checks, we make every effort to utilise agency staff from agencies that belong to national buying solution frameworks, approved for the NHS (such as CCS, LLP, HTE).  Providers registered under these frameworks are obliged to carry out the standard 6 employment checks on all of their workers and are audited independently to assure us, and the framework, of this compliance.

8

Question from Councillors Max Wilkinson and Nigel Britter

What is the staffing situation with regard to therapists? I'm particularly interested in those dealing with stroke victims (physiotherapists, occupational therapists and  speech therapists)?

Response

Within the Trust we employ  44 occupational therapists (38.4wte) and 68 physiotherapists (59.08 wte).  Although our clinical teams do include speech and language therapists they are employed by Gloucestershire Care Services so we cannot provide numbers for this staff group.  The number of therapists available for patients with stroke has recently been increased as we were aware that we were not meeting best practice in this area.

9

Question from Councillor Max Wilkinson

What is the use of bank staff as a proportion of employee hours? Does the figure differ between Glos Royal and Cheltenham General? Please give the figure requested for each of the past five years.

Response

For January 2016, Nurse bank hours represented 4.5% of the total hours worked. The figure for HCAs was 13%. There is not a significant difference between the sites.

10

Question from Councillor Max Wilkinson

Are there any staff shortages in specialist consultants, such as cancer care?

Response

We currently are experiencing difficulty recruiting to consultant roles in specialties where there is a national shortage, most notably radiology, histopathology and acute medicine

11

Question from Councillor Max Wilkinson

Please outline the current state of the Trust's finances.

Response

The financial position of our organisation is reported monthly in public.  A link to the financial report for February is attached.

March Main Board Finance Report

In a supplementary response Dr Pearson explained that not only was it easier to manage a surplus rather than be in deficit, but a surplus enabled the capital programme to be built-up.  The number of agency staff had needed to be increased which accounted for the increased expenditure and therefore, the reduced surplus.  There was growing concern, nationally, about the level of expenditure on agency staff and it was envisaged that a cap would soon be imposed.  It was stressed that the Trust did not make the decision to use agency staff lightly, but instead, chose to use agency staff where they were needed to ensure safe staffing levels on wards.  The Trust had good relationships with the agencies which they used and had an agreed framework which limited what they paid agency staff.  Agencies allowed the NHS to respond to ebbs and flows in staffing levels.      

12

Question from Councillor Chris Ryder

There appears to be ongoing issues with regard to patients, often elderly being discharged from hospital when perhaps being medically unfit, or just having to cope on their own without suitable care in place, sometimes leading to re-admission.  What new procedures would you put in place to prevent this happening?

Response

We are working with partner health and social care in Gloucestershire to extend the availability of community based services that are able to support individuals following a discharge from hospital.  Availability of community based services 7 days a week is a priority for us.

In response to a supplementary question Dr Pearson explained that a plan had been developed collectively which was owned by the health system rather than one organisation.  This was transformational and had reduced the barriers between organisations but a frustration as that some community based services were not available 7 days a week. 

In responses to a further question, Dr Pearson suggested that today alone 100 people who were fit for discharge, had not been discharged as staff were not satisfied with the care provision that was in place.  Contact continued beyond discharge for some patients (stroke patients for example) but for some it moved to other community based services.

13

Question from Councillor Nigel Britter

Due to ongoing difficulties of parking at Cheltenham General Hospital experienced by local residents many of whom are elderly would the Trust agree to ease the situation by allowing the 99 bus service to stop and pick up / drop off at the Arle Court Park & Ride site?

Response

It is not within our gift to determine where the park and ride operators pick up and drop off.  The 99 bus is operated by a different provider from the Arle Court Park and Ride.  This is something we will take into consideration when the contract is retendered.

In a supplementary response Dr Pearson reiterated that the 99 bus service was funded by the Trust who had awarded the contract to Stagecoach, but Stagecoach did not operate the Arle Court Park and Ride and therefore were not able to access it to pick up/drop off.   Important pick up and drop off sites would be identified when the contract was retendered.