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Agenda item

Epsom & St Helier Planned Cuts + Update on Disrepair

Minutes:

James Blythe introduced the report by explaining that there has been an improvement in performance in the emergency department which is defined as patients seen or admitted within 4 hours. However, this remains a challenge as the hospital is busy. As a result, St Helier continues to work closely with agencies such as housing and families to get people out of the hospital when appropriate. It was noted that this challenge is not unique to St Helier. St Helier is also working with Surrey health providers to overcome the issue of patients presenting with mental health conditions.

St Helier is planning to have mostly eliminated waits of over 65 weeks for treatment by the end of September 2024. The majority of long waits are for gynaecology, where the Trust saw a 30% increase in referrals following Covid. Positively, all cancer performance standards were achieved in May 2024 and 86.4% of patients received a diagnosis within 28 days.

James Blythe explained that St Helier and the NHS are in a difficult financial position. St Helier is expecting to report a deficit of £51.7m at the year end, however even this will require 6% gross operational cost savings. This is aimed to be achieved through efficiency rather than just cuts. St Helier are not planning to withdraw services or worsen access to care. For example, recruitment has improved which has saved money as there are less short-term staff members. There are also more mental health bank nurses used rather than agency staff. St Helier are also using private patient sites which can generate income and prevent cuts and savings elsewhere. James Blythe reiterated that not all savings have been found yet and that 6% is a challenging target.

Although the capital budget available is quite small, the intensive therapy unit is being refurbished and will be opening soon. In addition, new steel ceilings are being put in for new ventilation units. There has also been investment into new x ray equipment and refurbishing the lifts. Councillors are invited to visit the site. It was noted that there must be a balance between adding new services and refurbishing existing services. 

The government announced on 29/07/2024 that there would be a full review of a hospital building programme. James Blythe stated that St Helier did not know any more about this review than what has been put into the public domain. However, St Helier is targeting 85% of services to stay at St Helier if there is a new hospital built. It was noted that there will be challenges regardless of the outcome of the review and if there is a new hospital built.

Steph Sweeney explained that the Care Quality Commission (CQC) inspected the maternity service in August 2023 and published a report in February 2024. St Helier’s overall rating was changed from ‘good’ to ‘requires improvement’ while the rating for how safe the maternity services are was changed from 'Good’ to ‘Inadequate’. The report also published 8 ‘must do’s’ as well as lots of ‘should do’s’.

There are now regular meetings chaired by executives in which a robust action plan is discussed. To address safety and standards there is now a dedicated triage phone line to ensure residents get the correct information. In addition, new doors and blinds were fitted to improve privacy and dignity. Every team was also asked for feedback following the CQC report. Positively, the maternity care at Epsom and St Helier was scored number one in London and within the top ten nationally in the annual CQC patient experience survey.

 

In response to questions, James Blythe and Steph Sweeney confirmed that:

-The 6% savings refers to running costs.

-Rather than the service getting worse between CQC reviews, St Helier had stood still while expectations had moved forwards. Provisions in place in 2019 judged to good were judged to require improvement in 2023.

-There are a huge number of reasons why discharging patients can be challenging. It could be due to transport or medication etc. However, the biggest challenge is elderly patients with dementia.

-The robust action plan put in place ensures mandatory training and care records are kept consistently up to date.

-The CQC could come back at any time. It will be unannounced. Before than St Helier will ensure training and policies are in place.

-There is bespoke leadership training for ward managers.

-The CQC audit is anonymous, although PALS encouraged residents to provide feedback. It is therefore unknown if feedback from black and ethnic minorities has improved. At a future meeting St Helier could try to provide more data about who have been asked to provide feedback.

-St Helier will provide clarification on why the % of neonatal medical staff to have completed additional training (not part of the CQC’s recommendations) has gone down at a future meeting.

-Discussions are being held about current unmet need in regards to where the first community unit should be in southwest London.

 

Cllr Peter McCabe stated that Merton opposes removing services from St Helier but praised all the staff for their compassion and support.

 

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