GLOUCESTERSHIRE HOSPITALS NHS FOUNDATION TRUST SETTING THE AGENDA Some by inthefire

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									            GLOUCESTERSHIRE HOSPITALS NHS FOUNDATION TRUST


                                     SETTING THE AGENDA



Some time ago, governors highlighted the areas they felt to be of most concern to
them and their constituents. The attached list (Appendix 1) details the most popular
concerns as well as the list of remaining patient and staff concerns.

While it is true that we regularly cover many of the topics mentioned, it would be
good to collect your comments/concerns/feedback around the most pressing
concerns (for example, a number of people flagged A&E as an area of concern but it
would be more useful to know more specifically what about A&E is a cause for
concern – waiting times, threatening behaviour, parking and access, triage,
facilities?). This additional fleshing out of the subject areas will enable both the
Council and the Trust’s management to narrow our focus to the real issues.


Jane Hewin
Deputy Chair of the Council of Governors

The above message was emailed to Governors and some responses have been
received. Also attached, at Appendix 2, is a list of how each of the top eight topics
has been approached in the past and how it is proposed to tackle these topics in the
future. At Appendix 3 is a list of all questions from Governors that have been
discussed at Council meetings in the last three years, so Governors can see how
these questions have driven the agenda so far.

Governors are asked to comment on whether they are content with the approach
outlined in Appendix 2.

Margaret Pither
27 February 2008




Setting the agenda – top 8 topics
Council of Governors’ meeting March 2008
                                                                                 Appendix 1
SETTING THE AGENDA


Those attracting the most mentions were:

INFECTION CONTROL

    •    infection control Infection control/hospital acquired infection, MRSA, CDiff, TB –
         UK figures are terrible compared with other EU state systems
    •    Infection control/hospital acquired infection, MRSA, CDiff, TB
    •    Infection control
    •    Infection control

CLEANLINESS
    •    hospital cleanliness and hygiene issues (clean hands for staff, patients and
         visitors) – hospitals used to be cool, appear clean and smell of disinfectant, they
         are now over warm with visible dirt & an all too pervasive smell of body fluids
    •    hospital cleanliness and hygiene issues (clean hands for staff, patients and
         visitors)
    •    Cleanliness
    •    Cigarette butts
    •    Cleanliness

MATERNITY
    •    Maternity
    •    Maternity services-Uncertainty among staff re planned changes
    •    Maternity
    •    maternity – avoid one single enormous impersonal consultant led baby factory for
         the county, bigger than other EU states allow
    •    maternity


PARKING
    •    Lack of showers available for staff who are able to ride bicycles to work
    •    Availability of car parking spaces for staff
    •    Parking
    •    Parking
    •    Insufficient parking for oncology patients.
    •    Parking
    •    Parking



STAFF SHORTAGES
    •    would like more money & more clinical and support staff
    •    Additional hours worked over and above
    •    staff shortages/recruitment - the Trust is currently experiencing problems
         recruiting & HR don’t seem to know why or be able to fix things – we need staff
    •    staff shortages/recruitment



GOVERNOR ISSUES
    1.   what are governors for, what do they aspire to achieve – WHY ARE WE HERE ?
    2.   what are members for, what do they aspire to achieve
    3.   governor review
    4.    what are governors for, what do they aspire to achieve
    5.   what are governors for, what do they aspire to achieve
Setting the agenda – top 8 topics
Council of Governors’ meeting March 2008
A&E

    •   A&E – the most common experience & usually long, ugly & unpleasant first
        experience of hospitals
    •   A&e
    •   A&e
    •   A&E


NOT MENTIONED IN THIS SURVEY - MIXED SEX WARDS
    •   Bed capacity
    •   Bed shortages
    •   Not enough palliative care beds available for oncology patients.
    •   Insufficient hostel accommodation for patients having daily radiotherapy



OTHER STAFF ISSUES

    •Lack of changing facilities for staff
    •Increasing levels of aggression/verbal abuse from some members of the
     public/visitors
   • Dealing with aggressive /abusive relatives visitors
   • Outcome of Agenda for change - both in timeliness and band which staff from
     many groups report is below the national average and below that received by
     neighbouring organisations
   • Agenda 4 Change Banding & Arrears Payment
   • Increasing burden of process & paper work, monitoring and audit
   • Complaints /incidents -stress of investigations
   • Opportunities for Training & Development
   • management - good management is the key to everything – we need major
     improvement (see length of list of areas of concern) - the lack of staff concerns
     below might indicate a reluctance for staff to believe that the Trust really does
     value them & their opinions
   • Future of cgh
   • Closure
OTHER PATIENT ISSUES

    •   Patient’s walking around the hospital and outside (in public areas) wearing only
        night clothes, some of which is see through and often carrying drainage bags etc
        which causes offence to some.
    •   Patients smoking outside main entrances
    •   Elderly
    •   elderly care – this sector will expand massively due to our ageing population (self
        interest-includes me) – lets get ahead of the game now
    •   palliative care – it is all very well allowing people to die at home, but most people
        want to die nearly at home in professional hospital care & easily accessible by
        friends & family- it is often less traumatic for both carers & patients than death at
        home
        In-patients
    •   Outpatients
    •   Transport
    •   Hearing Aids
    •   Hearing aids
    •   Hearing aids
    •   Overcrowded waiting room for oncology
    •   Long waits for chemotherapy treatment in overcrowded conditions. These
        patients may have a 200 mile return journey
    •   Having to travel from oncology to main office to get parking docket processed.
        Patients are often too ill to walk that far.

Setting the agenda – top 8 topics
Council of Governors’ meeting March 2008
    •   Blue Spa Cafe is too far away from oncology for ill patients to access. Volunteers
        not always on site to fetch meals for patients.
    •   Serious concerns about nutrition on the days patients have to attend oncology
        due to lack of facilities. This day may start by leaving home at 7am and finish by
        arriving home at 10pm.
    •   No letters between clinicians being copied to patients.
    •   Unacceptable waits for radiotherapy treatments due to lack of capacity.
    •   Waiting times – UK figures are poor compared with other EU state systems
    •   complaints handling – apologise for shortcomings & ensure that ALL learn from
        them, improving with every complaint-see Japanese approach to system/group
        faults – we currently treat complainants coming from personal tragedy & trauma,
        as nuisances or threats
    •   Complaints handling
    •   18 weeks rule, patient choice and choose and book
    •   Hospital closures - Winchcombe, Lydney, Dilke, Bourton
    •   rationalisation of services that will happen as we move forward that could be
        examined.
    •   closure
    •   Future of cgh
    •   does cutting costs mean cutting corners/where's the additional government funds
    •   private sector "treatment centres"




Setting the agenda – top 8 topics
Council of Governors’ meeting March 2008
                                                                                                                                Appendix 2
                                           GLOUCESTERSHIRE HOSPITALS NHS FOUNDATION TRUST


                                                             SETTING THE AGENDA

                                                               TOP EIGHT TOPICS

          TOPIC                                         HISTORY                                           FUTURE PLANS

1.   Infection Control          •   discussion prompted by Governor questions – March Members’ Seminar, date to be agreed, 2008
                                    2006
                                •   presentation and Infection Control Annual Report – Dr
                                    Rob Jackson, DIPC, May 2006
                                •   Infection Control update report – January 2007
                                •   Infection Control update report – March 2007
                                •   Infection Control Q&A session run by Dr Jim Stone, new
                                    DIPC – May 2007
                                •   Infection Control Annual Report – September 2007
                                •   confidential Infection Control report – September 2007
                                •   Annual Meeting item on Infection Control – September
                                    2007
                                •   Governors invited to Infection Control workshop with
                                    national Tsar
                                •   Infection Control Progress report – November 2007
                                •   a Layman’s Guide to Infection Control – written by Dr
                                    Jim Stone – November 2007
2.   Cleanliness                •   Paper and discussion, January 2005                       Presentation on Bioquell cleaning at May 2008
                                •   Governors’ invited to the launch of the ‘Cleanyourhands’ meeting.
                                    campaign, 2005
                                •   Frequent information about hospital cleanliness included
                                    in 1. above, in particular compliance with hand hygiene
                                    policy reported in Infection Control reports to each
                                    meeting.


Setting the agenda – top 8 topics                                                                                                    Page 5
Council of Governors’ meeting March 2008
3.   Maternity                  •   presentation on Maternity Services and Governors’ Presentation at May 2008 meeting
                                    question on Maternity Service – March 2006
4.   Parking                    •   paper and discussion on Green Travel Plan – May 2006 Presentation at March 2008 meeting
                                    followed up via Matters Arising in July, September and
                                    November 2006
5.   Staff Shortages
6.   Governor Issues            •   Paper and discussion on ‘Roles & Responsibilities’ –
                                    January 2005
                                •   various papers on constituency meetings and schemes
                                    for staff members – September 2005
                                •   discussion on Governor Development – November 2005
                                •   discussion on Governor Development –January 2006
                                •   workshop run by Sue Slipman, Director, FT Network,
                                    February 2006
                                •   discussion of Governor opportunities, site visits and
                                    website communication – January 2007
                                •   Effectiveness Review 2007 – final report – November
                                    2007
7.   A&E                        •   Members’ Seminar, December 2008                       Presentation at July 2008 meeting
8.   Mixed Sex Wards            •   paper and discussion – January 2008




Setting the agenda – top 8 topics                                                                                             Page 6
Council of Governors’ meeting March 2008
                                                                                               Appendix 3
                       GLOUCESTERSHIRE HOSPITALS NHS FOUNDATION TRUST


                           QUESTIONS SUBMITTED BY GOVERNORS 2005-2008

  DATE                                            QUESTION                                    GOVERNOR/
                                                                                                     S
March          Is the Trust taking patients from other areas to help them to ease their Dawn Adams,
2005           waiting list initiatives and if so, does this increase our local waiting lists Public,
               which are themselves borderline? If this does happen, which specialties are Cotswolds
               involved?

March          Can an update be provided on what effect the new nursing and cleaning              Rita Holmes,
2006           infection control procedures at CGH and GRH are having on ‘hospital                David Beard,
               acquired infection’? In a further move to reduce such infections, are there        Public,
               plans to restrict visiting hours and visitors per bed - as is taking place in an   Tewkesbury
               increasing number of Trusts ?
                                                                                                  Geoff    Fox.
                                                                                                  Public,
                                                                                                  Cheltenham

                                                                                                  George Tarte,
                                                                                                  Staff, Other
March          What is the future direction and operational procedures for the Maternity          Rita Holmes,
2006           Services in Cheltenham and Gloucester? How will the independence of the            David Beard,
Confidenti     Cheltenham Maternity Services be altered should the proposals for the new          Public,
al             unit at GRH be implemented and what effects will it have on those who              Tewkesbury
               would currently book in Cheltenham [Can you identify how many Patients
               will be affected?.]                                                       Geoff    Fox.
                                                                                         Public,
                                                                                         Cheltenham

                                                                                                  George Tarte,
                                                                                                  Staff, Other
May 2006       1.      What decisions taken by the GHNHSFT Board have been                        Diane
                       influenced by the Council of Governors?                                    Cresswell,
                                                                                                  Dawn Adams,
               2.      What is the useful purpose of 'Members' of the Trust?                      Public,
                                                                                                  Cotswolds
               3.      What useful purpose do the Governors provide to the Trust? is this
                       Council of Governors just a window-dressing QUANGO?

November       4.      Would the Trust clarify the philosophy behind the expansion of             Rita Holmes,
2006                   treatment options at the Battledown Ward??                                 David Beard,
                                                                                                  Public,
               5.      There appears to be some turmoil in the Trust’s approach to                Tewkesbury
                       ‘hospital acquired infection’. What is the Trust’s long-term position
                       to effectively reduce such infection and counter future infective
                       agents??

               6.      In the light of the current national concern with respect to the
                       expenditure on, and numbers of surgical procedures for, the
                       removal of tattoos what is the current position within our Trust?




        Governors’ Question 2005-2008                                                               Page 7
        Council of Governors meeting March 2008
March          1. Patient Visitors.                                                             David Beard,
2007                                                                                            Public,
               In the light of the current climate surrounding Hospital Acquired Infections Tewkesbury
               and ward discipline for Patient Visiting, we would wish the Trust to revisit
               these topics. It is well-documented that a major consideration in the fight Geoff Fox.
               against Hospital Acquired Infection is the Patient Visitor. The tight control of Public,
               visitor numbers and hours of visiting should help to eliminate the Cheltenham
               importation of opportunistic organisms [now acknowledged as being
               widespread in the Community] into a vulnerable environment. Regardless
               of patient/visitor social or ethnic groupings we would suggest a further
               reduction in visiting hours, the obligation of only two visitors per patient at
               any one time, all visitors to clean their hands with alcoholic gels [or soap
               and water] prior to entering the ward and senior ward Staff to be given Trust
               support/mandate to insist that visitor disciplines are adhered to. Apart from
               instructive ward posters a further improvement could be that all admitted
               Patients be given comprehensive written instructions as to the visiting
               regime and why adherence is so important. At the present time, the Patient
               Information Leaflet ‘Into Hospital and Home Again’ is woefully inadequate in
               addressing ‘Visitors’ and their relationship to Acquired Hospital Infections.

               2. Supplementary Question concerning the wearing of overalls by
                  Healthcare Staff.

               Letters and comments constantly appear with respect to the wearing of
               overalls by Healthcare Staff outside the hospital precincts. This concern
               has recently escalated by utterances from the Health Overview and
               Scrutiny Committee. We would enquire as to what steps the Trust is taking
               to address this problem - with the provision of facilities for Staff to ensure
               that a change of clothing is possible on leaving and entering the hospital
               environment ? Whilst being assured that Department guidelines are being
               followed at present [hospital clothing being covered off hospital premises],
               should we not consider a more robust, comprehensive and relevant
               approach with a system that will diffuse the problem permanently ?

May 2007       1. The NHS Confederation has called for more Managers to increase the Cllr.                 Tina
                  commercial efficiency of each NHS Trust. Our Trust is a semi-                 Franklin,
                  autonomous mutual organisation adopting the mores of private                  Appointed,
                  orientated companies subject to commercial scrutiny; these bodies             Cheltenham.
                  invariably reduce managerial staff when efficiency and competitive            Dr.       David
                  demands arise. The present and future position of the Trust with respect      Beard
                  to the NHS Confederation’s statement would be appreciated together            Public,
                  with an indication of what influence money saved [or spent] on                Tewkesbury.
                  managerial re-organisation, in the current keenly contested environment,
                  would have on the provision of care for the Patient.


               2. The relationship between Patientline and various hospital managements
                  has led to the pressure to allow mobile telephones to be used by
                  Patients. Such communication has led to concerns about the
                  infringement of Patient privacy, intrusive ring-tones, Staff inability to
                  monitor use of mobile telephones, the unacceptable cavalier use of
                  camera telephones by Patients and visitors [media intrusion into a
                  confidential environment] and unquantifiable damage to sensitive
                  equipment. Will the Trust comment on these matters and will the Trust
                  be considering the use of mobile telephones anywhere on hospital
                  premises - especially in areas dedicated to Patient treatment ?


        Governors’ Question 2005-2008                                                             Page 8
        Council of Governors meeting March 2008
             3. Recent widespread media comment surrounding the post-birth care of
                  Maternity Patients and their offspring, has highlighted local disquiet
                  about our regime at CGH and GRH and the ancillary problem of minimal
                  medical attendance. Confining our comments to CGH [providing the
                  maternity services for our two constituencies and taking into account
                  concerns voiced to ourselves], we would wish to know if our overworked
                  midwives need additional staff to help council and instruct post natal
                  mothers, or whether the present financial constraints preclude adequate
                  post natal care or is there a policy to ‘jettison’ mothers as soon as
                  possible after birth to release beds ? Further, clarification of the current
                  status of the maternity services at CGH and the present time-
                  frame/financing thereof, would be appreciated.

July 2007    This is a request for a written response.                                  Rita Holmes,
                                                                                        David Beard,
             Recent reports from the Healthcare Commission and the Department of Public,
             health urge an early demise of mixed sex wards – the latter are considered Tewkesbury
             to erode Patient dignity and privacy. Excepting ICU, Medical Assessment
             and the Day Bed Units, could the Trust prepare a written schedule of mixed
             sex wards, where there is no adequate separation of male and female
             Patients, currently in use at both CGH and GRH.

July 2007    1.       The head of the over-ambitious NHS IT Programme [Mr Granger]               David Beard,
                      has resigned. The considerable disruption that this has created            Public,
                      alongside the recent comments in the responsible Press by                  Tewkesbury
                      numerous GPs and at the BMA Conference concerning the ‘Choose
                      & Book’ system, leads to the inevitable question as to what                Geoff Fox.
                      impact(s) there may be on the Trust. Will these difficulties have          Public,
                      short/long term problems for GHFT and if so what will they be?             Cheltenham

             2.       Internal surveys of the Changing Facilities at CGH [excluding
                      Delancey] and GRH have indicated that there may be between 270
                      – 300 lockers [small and large] for the Staff at each establishment.
                      The distribution is between 17 – 18 rooms, again at each hospital.
                      Some of the lockers were unusable and a proportion were for the
                      exclusive use of Theatre Staff. Showering facilities were at best
                      dismal. If it is ever the intention of the Trust [as a further infection
                      control measure/mechanism to enhance well-being] to provide
                      Clinical Staff with the ability to change clothing when commencing
                      work and when leaving for home, when does the Trust anticipate
                      that adequate Changing Facilities [and showering opportunities] will
                      be provided at both hospitals?

September    We would wish to enlarge our enquiry concerning Mixed Wards in the light            Rita Holmes,
2007         of the recent letter from Maggi Lewis. The response from Mrs. Lewis was in          David Beard,
             reply to our request for information on this topic at the Council of Governors      Public,
             Meeting held on the 16th. July.                                                     Tewkesbury

             1. We are informed that the Trust ‘…continually monitors and audits the
             mixing of sexes within ward areas…’ How often do these audits occur and
             does the ‘snap’ audit on March 2007 illustrate a variable picture ? Further,
             what mode of continuous monitoring is adopted ?
             2. May we have the results of the March 2007 audit together with those of
             the last six months ? A résumé of the outcomes of future audits would be
             appreciated by Governors.
             3. It is noted that there were equal numbers of male and female Patients in
             mixed wards at the time the letter from Maggi Lewis was written. What
             variation in numbers and gender would there be during the winter period ?
             4. How will the mixed ward situation at CGH be affected by the closure of
      Governors’ Question 2005-2008                                                               Page 9
      Council of Governors meeting March 2008
            Delancey and the subsequent completion of St. Luke’s Phase 2 ?
            5. Will the glazed partitions approved by the Board recently, be regarded as
            a permanent fixture - for how long - or of a temporary nature ?
            6. Considerable disquiet has been voiced concerning the admission of
            oncology Patients to mixed wards. We would welcome clarification of the
            current and long-term policy of the Trust with respect to this matter.
            7. In view of the stated aim of the present Government to eradicate all
            mixed wards [Tony Blair 1996/’97], we would appreciate an indication of the
            Trust’s future stance in achieving this governmental aim.

January     From the Annual Report 2006-2007, we note that there has been Rita Holmes,
2008        ‘completion of a programme of Surgical Ward improvements’ at CGH, and Public,
            that ‘£1.5M has been invested in the refurbishment of a ward in the Tower Tewkesbury
            Block’.
                                                                                       Geoff Fox.
            What is the difference between ‘improvement’ and ‘refurbishment’? What Public,
            has been the cost of the former, and what plans exist for refurbishment of Cheltenham
            wards at CGH?

            No. 2.
            For the coming financial year, newly qualified nurses have been awarded a
            1.9% pay award. It seems unlikely that this will make much of an impact on
            the average debt of more than £7000 that each has incurred during
            qualification.

            In the financial year ending 31.3.07, it appears that some Executive
            Directors received pay awards of between 8 and 10%. Can this be justified,
            and what effect is it likely to have on nursing staff morale.




     Governors’ Question 2005-2008                                                         Page 10
     Council of Governors meeting March 2008

								
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