To receive a presentation by the Chief Executive and Chief Nurse of Royal Berkshire NHS Foundation Trust on the Royal Berkshire Hospital Quality Report 2020/21 and current issues of concern. A copy of the Royal Berkshire Hospital Quality Report 2020/21 is attached.

Steve McManus, Chief Executive Officer, and Eamonn Sullivan, Chief Nurse, The Royal Berkshire Hospitals NHS Foundation Trust, attended the meeting and addressed the Committee and answered questions on the Royal Berkshire NHS Foundation Trust Annual Quality Accounts 2020-2021 and in particular some areas of concern that had been raised by Councillors as set out below:

The Quality Accounts was just one vehicle for improvement, it was fairly restrictive both as a document and in terms of its completion and if there were areas that weren’t in the Accounts it didn’t mean they weren’t being addressed.  Because of the disruption over the previous 15 months due to the Covid-19 pandemic the process of completing and publishing the document, which usually took six months, had been compressed into six weeks.  As a result, the priorities from the previous year had been rolled over into the current document.

Health Inequalities

Concerns had been expressed by Councillors in respect of health inequalities specifically for those with learning disabilities.  This was an area of priority focus for the Trust and partnership work had been started with Public Health with £300k being allocated to the issue over the coming three years to better inform the hospital about how to deliver services.  Part of this money had been used to make a joint appointment of a consultant in public health to bring expertise in public health collaboratively into the organisation.  During the pandemic the Learning Disability Team had remained in the hospital and as services were disrupted or delayed they maintained a register so that they would be ready to recommence care when restrictions were lifted.  Work was being carried out to look at how staff were trained with £30k being allocated to this issue; the aim was for this to have been completed by the end of quarter three in the current year.  As the hospital functioned on a 24 hour basis work was also being carried out to strengthen the out of hours service for those with learning disabilities.

Over the previous four years the Trust had actively moved away from seeing itself as an acute hospital to being part of the community, changing the way facilities were used so that there was a focus on self-intervention and prevention.  The redevelopment of the hospital site, as reported at the meeting on 20 January 2021 (minute 18 refers), provided an excellent opportunity to improve what the hospital could bring to Reading and Berkshire.  Potential redevelopment would start in 2025 so it was important work took place with the Council to ensure it was right for the wider community.

Impacts of Covid and rehabilitation - Including for those with long-Covid

Clinical teams had been innovative around preventing the effects of long-Covid.  Patients who had come into the hospital with Covid, and were able to manage at home, were sent home with oxygen monitors and the hospital then kept in contact with them on a daily basis as it was found that outcomes for patients were improved significantly if they stayed at home.  A virtual service was currently being provided for patients and the hospital and been one of the early adopters of a long-Covid programme and was becoming a research active organisation to discover how support could be given to those suffering from the long-term impact of Covid.  The hospital had also been one of the first to set up a long-Covid clinic, which was largely therapy driven, and had treated 700 patients.  Paediatric long-Covid would be consolidated by the BOB ICS with the service being brought together over the whole area.

Nationally and locally there was a focus on patients with Covid but, there was widening inequality with non-Covid patients.  During the second wave of Covid the hospital had maintained a significant level of service and had used other facilities to create Covid free environments.  Performance prior to the pandemic had been good and coming out of the pandemic at the end of March 2021 there were 2,800 people waiting more than a year for their planned treatment, this had decreased to 1,140 by May 2021.

With regard to performance in respect of cancer treatment, a decision had been made early in the pandemic to maintain as much cancer treatment as possible.  Some treatment had been moved to the independent sector but during the second wave this had been moved back to the hospital.  Cancer services had therefore been maintained throughout the pandemic and at the end of May 2021 the two week wait standard from a GP referral to being seen as an outpatient was 94% compared to a national figure of 93%.  For the 31 day cancer standard, the wait time between the meeting at which the patient and doctor agreed a treatment plan and the start of treatment, nationally the figure was 96% with the hospital at 95%.  For the 62 day performance standard, which was from the point of being referred by the GP to receiving definitive treatment, the national standard was 85% and the hospital was at 84.3%.  In respect of diagnostics such as access to CT and MRI scanning, nationally endoscopy had come under pressure, the national standard was that 99% of people should receive their definitive diagnostic within six weeks, the percentage for the hospital was currently 96%.  Again, services had been maintained and the independent sector had been made use of.

In terms of staff, the Council, and others such as the university, had provided support in respect of psychological and mental health support; staff were tired, but due to the support they had received were resilient.

Investment had been made in the digital environment so that information would be more accessible, particularly going forward and dealing with the impact of long-Covid.  A patient portal had been set up and channels had been expanded so that services could be offered in different ways and there were different ways for patients to engage with the hospital.  Reducing the number of people coming to the hospital would also reduce the amount of traffic coming to the hospital and the resulting carbon impact.  More services were also being provided further into the community and more use was being made of digital services.  With regard to staff working, the hospital wanted to learn from other public sector organisations about how to get the balance right in terms of flexible working but the value of face-to-face work was recognised due to the type of work that the hospital did.  Hybrid working and flexible working would feature in the future, but this would be approached with care.

Links to Primary Care, Lifestyle Services and Adult Social Care to prevent NHS need

One of the legacies of the pandemic had been the agility of decision making and the quality of improvement processes that had been put in place during the first the pandemic.  The challenge now was to put these into quality improvement processes moving forward. 

Being part of the Health Infrastructure Plan (HIP) 2 meant that work was being carried out with 40 organisations, coordinated by the Department for Health, and had provided the opportunity to share knowledge and experience.  Two areas that were being shared were, the need to be a highly digital organisation and the built environment which was being worked on in partnership with the university.  The university was looking at how the hospital could be used as a live laboratory when thinking about sustainable buildings and a sustainable environment.

Cancer and A&E Services

An area of concern across the whole of England was around waiting times in Accident and Emergency.  Normally there was a 3% increase in people attending A&E each year however, between May 2019 and May 2021 this increase had been 16%.  This was a challenge for patient flows and work was being carried out with colleagues in the community, the ambulance service and primary care colleagues on how the community could be supported to access emergency care.  Although there was a steady flow of patients being admitted to the hospital there had been an increase in ambulatory patients who were accessing services for urgent care, but care that was less time critical.  This formed a piece of ongoing work and support was being given by the Council’s Adult Social Care Team.

With regard to services for children, a £4.5m investment had been made into the children’s emergency department which had been made larger and provided a much more appropriate environment for children. 

Hydrotherapy Service

Steve McManus explained that when he had first arrived in post at the hospital in 2017 there had been proposals to close the hydrotherapy pool, he had met with a range of stakeholders to look at options and in early 2017 the decision had been reversed.  However, the CCG had needed to make a decision about the long term viability of water based therapy treatments and it had been agreed that the pool would not be closed until there was some form of alternative provision in place and that any hydrotherapy service did not need to be on an acute hospital site.  The Commissioners had carried out a review of the commissioning arrangements for hydrotherapy and the decision was made to move to an Individual Funding Request (IFR) approach which would reduce the numbers accessing the service, as reported at the meeting on 20 January 2021 (minute 19 refers).  In the last year that the pool was open, prior to the pandemic, 217 patients had been referred to use the service.  With a further reduction in users as a result of the IFR approach and a commitment from the commissioners to find an alternative, as well as a commitment to make some difficult financial decisions, to bring the hydrotherapy pool back into use at the hospital would cost £1m; £750k to bring the pool back into use and £250k to maintain the pool (the revenue from non-NHS users at its best had been £20k).  To close the pool had not been an easy decision but work would continue with the CCG and there was a commitment to providing an alternative service for both adults and child.  Meetings would continue with user groups and some of the engagement would continue into July 2021.

The Committee discussed the presentation and concern was expressed about the IFR approach to the hydrotherapy service and that alternative provision had not been put in place before the pool had been closed.

Resolved –    That the position be noted and Steve McManus and Eamonn Sullivan be thanked for attending the meeting.