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Insight into QA

Wilf Forrow, HIRA member and campaigner for Cycle Hayling, provides these notes following HIRA's Public Meeting last night when Mark Cubbon, CEO of NHS Portsmouth Hospitals Trust presented to and answered questions from a 100 strong audience.

2020-02-12 HIRA Public Meeting 7:30-9pm Hayling Island:

Mark Cubbon. Chief Exec NHS Portsmouth Hospitals Trust. His Presentation notes as follows:

QA is Portsmouth’s largest employer, 7,700 people, including Engie, PFI services company of 700 odd, who provide many services such as cleaning and building, etc.

Also over 700 volunteers.

Services 675,000 people across Portsmouth southeast Hants (PSEH).

Less commonly known is that QA has several important specialist departments, including

  • stroke

  • cancer

  • renal (Wessex Kidney Centre), supporting 2.4 million people.

  • neonatal intensive care, top 3 in country (specialising in tiny babies, 25 to 28 weeks)

  • leading the UK in innovative robotic surgery, Maki robot, has treated 32,000 patients.

MOD are close partners. Joint Hospital Group (South).

Research partnerships are key, especially with University of Portsmouth.

Care Quality Commission CQC Nov 2019, rated good.

Good, “but not good enough, and always striving for better”.

“In some areas, we know we’re not there yet”.

Emergency Dept 40 years old.

Treating 16,000 more patients per year than 5 years ago.

NHS strategy has been to reduce hospital beds moving to healthcare in the community. The reverse has happened in practice, which is why QA has struggled.

Replacement Emergency Department will cost £60 million, which has now been secured.

Options for new ED (very complex trade offs, not yet anywhere near a decision):

  • extend current Emergency Dept.

  • use East car park

  • use North car park

25 to 30 years design life. Not just replacement, trying to improve model of care.

Parking has always been a massive issue, and will be affected, but commitment to not reduce.

Questions from the floor.

Q: Parking. Is it moving to free following Government's recent promise?

  1. Yes, but you know us much as us!

  2. PFI contract determines all parking, including charges, not NHS.

  3. Don’t know how it will work yet. PFI contract will have to be renegotiated.

  4. Or how they’ll stop imposters from abusing it for shopping etc.

  5. Parking is a major issue for patients, visitors and staff.

  6. We thank people for their patience, often at times of stress.

  7. It’s also harder to attract staff when they have to add extra time on top of a long shift.

  8. Aiming to not reduce overall car parking.

  9. May need a multi-storey, if we can get planning permission.

Q: Traffic and parking congestion is part of the problem. You can queue for half an hour for a space.

  1. Agreed, and we’re working very hard to find improvements.

  2. Eg Looking at traffic flow improvements

  3. Looking at staggering clinic times to reduce peak.

Q: Emergency Dept. CQC rating?

  1. Service is inconsistent and not good enough

  2. Looking at partners in community to reduce demand, length of stay

  3. Need better support for staff

  4. Plaudits are many, it’s the best part of my job when someone says how wonderfully they were treated.

  5. We’re working very hard to improve, but we know we’re not there yet.

Q: Smokers at entrance look awful, there’s still a Christmas tree outside?

  1. We made the difficult decision to ban smoking on the whole site.

  2. But we want partnerships , we don’t want to be enforcers.

  3. Some patients and some visitors react violently.

  4. So we’re trying to persuade people.

  5. Trained 100 no-smoking ambassadors

  6. Do offer alternatives- patches, etc

  7. Not many examples of other hospitals getting balance right.

  8. Others have tried security guards, but don’t want to do that.

Q: Pharmacy department is a disaster, one and a half hour wait, queueing outside door!

  1. Sorry! We know there have been issues, severe at times.

  2. Have robot dispenser, but it’s old, near end of life.

  3. When it goes wrong, have to revert to manual procedures.

  4. Can’t take any chances, wrong drugs or quantities can kill.

  5. New robot arrives March, operational September, maybe more central location.

  6. Pharmacy area far too small, need to expand.

  7. Looking for new and bigger location.

  8. But it has huge demands, servicing 1,000 general beds, 200 specialist beds.

Q: If robot makes an error, who is responsible?

  1. All robot prescriptions are double-checked by humans!

Q: Q: Discharge awful. Why so slow, causing unnecessary bed blocking. Sometimes up to 10 hours, just for someone to ask me if I’ve got somewhere to go, someone to care for me? Why, and when it’s waiting for medications, why can’t we get our own?

  1. Many checks needed, and legally required. Would be irresponsible not to do.

  2. But we do need communication better between departments and externally to care homes and other health providers.

  3. Drugs, trying to use technology to request drugs at time of doctor’s round, so prescription is instantly sent to pharmacy.

  4. As to your own pharmacy, NHS regs say hospital must complete all treatments properly. Not everyone can make it to their own. And some drugs not available from over the counter pharmacies.

Q: Acknowledge overseas nurses, but how to train and retain uk nurses?

  1. I was trained as nurse, so I know the complex demands we place on them.

  2. Uk has not been training enough nurses for years, based on projections that anticipated patients would be treated in the community, not in hospital.

  3. We have 50,000 to 60,000 nursing vacancies across uk.

  4. Working closely with universities to attract and train new recruits.

  5. More trainees this year, so in 3 years time there will be a pipeline.

  6. QA now 5% vacancy , was 16% a few years back.

  7. Brought in 200 overseas nurses, often very experienced, which is key.

  8. Want all trainees to want to come to QA, not because it’s close, but because it’s the best place to work.

  9. Starting an Apprentice program.

  10. Apart from anything else, recruiting and training our own nurses is saving a fortune on temporary nurses.

Q: Parking. Employees doing 12 hour shifts plus hour travel each end should parking get priority!

  1. Really difficult (see above).

  2. Looking at second park and ride site, amongst many other options.

Q: Other areas CQC to improve on?

  1. CQC rating system penalises multiple weaknesses disproportionately, so generally good or outstanding areas are dragged down if a couple of even minor things get rated as needing improvement.

  2. So it often makes us look worse than we really are, and everyone is absolutely gutted to get bad ratings.

  3. Consistency of performance is key. It’s no good being great 95% of the time if being poor for 5% drags you down.

  4. One area we were marked down on was training completions - was 70%, should be 90%.

  5. We know we need more beds, we’ve been told for years to plan for fewer, but the projections were wrong.

Q: Cycle Hayling, Robert Sebley. Given that parking is so awful, what are you doing to encourage cycling in? I’ve tried cycling in to visit my wife, but the entrance is dangerous and off putting, and bike parking’s not very good.

  1. We’re working to remove all barriers to cycling, along with all public transport

  2. Staff do want to cycle, need changing and shower facilities.

  3. More staff do try

  4. Doing employee bike purchase scheme

  5. Converting smoking shelters to bike shelters!

  6. Don’t know percentage of staff who cycle.

Q: Will the new Emergency Department be funded by PFI?

  1. Will the new Emergency Department be funded by PFI?

  2. No, not PFI !!!

Mark was extremely impressive and answered every question completely. He demonstrates passion and leadership. He got a huge round of applause.

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