January 31 2015 Latest news:
Saturday, January 11, 2014
Seven weeks ago, Dr Manjit Obhrai started work trying to lead the King’s Lynn Queen Elizabeth Hospital out of “special measures”. Reporter ANDREW PAPWORTH spoke to him about the progress made so far.
1. Has the hospital solved its chronic staffing shortage?
The hospital has met the minimum staffing requirements of having one nurse to every eight patients during the day and one to eleven at night for several weeks. However chief executive Dr Manjit Obhrai said recruiting specialist consultant doctors has been more difficult.
2. Are people being treated quickly enough in A&E?
94.6pc of patients are being seen within four hours – just 0.4pc away from the national target. It has not met the A&E waiting time target for the past year but Dr Obhrai is confident this can be overturned.
3. Is the QEH giving enough support to its workers?
Director of nursing Catherine Morgan said there has been a “complete overhaul of mandatory training”, with dementia training for nurses on induction increased to 50 minutes. Specialist external dementia training has also been scheduled for early 2014.
4. Are hospital executives and governors monitoring the situation effectively?
Executives began more frequent walks around the hospital in December 2013 after medical directors admitted the previous management had taken its “eye off the ball”. The hospital trust is also developing a new communication and engagement strategy, which is due to be in place by mid-January.
5. Are appropriate medical records being kept?
Reviews of the hospital’s existing documentation have been completed, with new and revised documentation implemented in areas such as overnight surgical admissions and revised elective surgical paperwork.
6. How are medicines being managed?
Weekly meetings now take place between the chief pharmacist, medical director and interim chief operating officer after concerns were raised by the Care Quality Commission (CQC) about the storage of medicines. The hospital is also looking to recruit more pharmacists.
7. How strong is staff morale?
Dr Obhrai said the hospital now feels different when he walks around because staff morale is better. Darren Barber, chairman of the hospital’s Joint Staff Committee (JSC) and secretary of Unison’s QEH branch, said staff could not be working any harder and that managers are listening to their concerns.
8. Is the healthcare community in West Norfolk rallying round to help the hospital?
28 “virtual beds” are being created in the community. Dr Ian Mack, chairman of the West Norfolk Clinical Commissioning Group (CCG), also holds regular meetings to monitor progress and has said he is confident improvements are being made.
9. Is this hospital getting any extra support and investment to come out of “special measures”?
The CCG has allocated £1.6m to the QEH from an overall £3.9m Department of Health grant to tackle winter pressures. The hospital is using the money to expand its under-pressure A&E department, with building due to be completed by March 9.
10. When will the QEH next be inspected by regulators?
Dr Obhrai said: “The CQC could come at any time and make an unscheduled visit. We have got to ready for it and provide evidence of what we have done – they will walk around and find out for themselves.”
When Dr Manjit Obhrai set out to walk around the wards of the King’s Lynn Queen Elizabeth Hospital (QEH) to discover what was working well and what needed to change, one would have expected him to be nervous about what he might find.
Only a few weeks before he started his new job on November 25, the Gayton Road hospital had been placed in “special measures” after a Rapid Response Review (RRR) showed major concern in four areas.
In particular inspectors from the Care Quality Commission (CQC) highlighted worries about supporting workers, monitoring the quality of services and said staffing was not at the required level.
On top of that, the QEH had not met the four-hour waiting time target for accident and emergency since December 2012 and faced tough financial problems – amid the pressures of a growing elderly population in West Norfolk.
Yet Dr Obhrai, who was brought in by healthcare regulator Monitor to lead the turnaround, said: “Going round the wards was quite a salutary experience.
“It was nice to see to see some of things you are told are happening actually were.”
Perhaps the biggest and most noticeable change was in the level of staffing, which previous hospital trust chairman Kate Gordon said was one of the QEH’s underlying problems.
A sustained recruitment drive, which has included employing nurses from Portugal, means the hospital has now met the target on having one nurse to eight patients during the day and a one-to-11 ratio at night for several weeks.
In November 2013, it recorded a net change of 40.85 full-time equivalents (FTEs) for registered nurses and 28.80 FTE healthcare assistants.
But that is not the only area where significant progress has been made.
The CQC previously criticised the QEH for not giving staff the support they need – but new director of nursing Catherine Morgan said there had been “a complete overhaul of mandatory training”.
For example dementia training – which staff said used to be too rushed – has now been significantly increased, with scenario-based activities delivered across the hospital.
Changes to A&E procedures, such as having someone going round the beds to check discharges are being made in a timely fashion, mean the waiting time target is nearer to being met.
Yet although Dr Obhrai is confident the QEH has met most of the goals set by the CQC in terms of being compliant in the four warning areas by December 31, he said: “In a couple of areas, we are being very frank about where we have struggled.” That has included the recruitment of more specialist consultant doctors, such as in accident and emergency.
To ensure it has cover the QEH has recruited three locum doctors – who work in place of a regular doctors when a hospital is short-staffed – but is still looking for people more permanently.
Dr Obhrai that medicine management was also a challenging area. Implementation of improvements is being delayed because the hospital is still trying to recruit to new pharmacists.
The trust’s most recent integrated action plan also showed that, as of mid-December 2013, it was still not on target to improve communication channels after the previous management was criticised for taking its “eye off the ball”.
It aims to have a new communication and engagement strategy in place by mid to late January.
Yet despite the challenges, Dr Obhrai said: “Walking around the hospital, it feels better than it did previously.”
In particular he said it was noticeable to nurses, doctors and patients that wards were better staffed and that morale is improved.
“Clinicians understand the situation we’re in and want to work through it. Patients need to be reassured that if they come into hospital they will be treated well.”
How do you think the QEH is doing? Write, giving your full contact details, to: The Letters Editor, EDP, Prospect House, Rouen Road, Norwich NR1 1RE or email EDPLetters@archant.co.uk