Annual Members Meeting
Meeting held on Wednesday 18th September 2008, Education Centre, HomertonUniversityHospital NHS Foundation Trust
Present:
Michael CassidyChairman
Nancy HallettChief Executive
Dr John CoakleyMedical Director
Pauline BrownDirector of Corporate Development
Anna AndersonFinance Director
Eli KernkrautPublic Governor
Joe LobensteinPublic Governor
Suri FriedmanPublic Governor
Patricia BennettPublic Governor
Helen ScherPublic Governor
FlorenceOsaigbovoPublic Governor
Sarah WeissPublic Governor
Doug HizaPublic Governor
Katie Lloyd-ThomasPublic Governor
David GriffithStaff Governor
Paul CannonStaff Governor
Helen CugnoniStaff Governor
John BennettStakeholder Governor
In attendance:
Andrew PannikerDirector of HR & Environment
Guy YoungDirector of Nursing
Tracey FletcherChief Operating Officer
Sadhna ChandPublic Involvement and Information Manager
The meeting was also attended by approx 85 public and staff members.
Apologies:
Geoffrey RivettPublic Governor
James TorrPublic Governor
Andrew WilliamsStaff Governor
Minute taker:
David BridgerHead of Governance
1.Chairman’s welcome and introduction
The Chairman welcomed the attendees to the 5th Annual Members Meeting.
2.Reviewing the year and looking into the future
Dr John Coakley, Medical Director addressed the members. He presented a review of the year and future developments.
He reviewed the numbers of patients seen and treated in 2007/08 with particular reference to specific performance targets.
Dr Coakley highlighted developments over the past year in the following areas:
- Bariatric surgery
- Allergy services
- Scanning services
- Visiting policy
- Dignity code
Areas for further development included responding to findings of the patient survey including the use of the new patient experience tracker.
Dr Coakley also highlighted future developments including investment in new buildings and services particularly the fertility unit, single sex wards in surgery and the planned maternity and special care baby unit.
He closed with reference to Healthcarefor London review and highlighted that Homerton has been nominated as the hospital for the Olympics in 2012.
3.Annual Accounts
Anna Anderson, Director of Finance presented highlights from the annual accountsfor 2007 – 08, outlining the Trust’s income and expenditure. She also presented the Annual Audit letter on behalf of the Audit Commission the Trusts external auditors.
She highlighted that the Trust had generated a surplus of £7.5m.This had been achieved through income above plan in:
- Education and training
- Income from PCT’s
- Extra £3 m in march
The surplus is being used for hospital improvements
- Extra spend on equipment, decoration
- Pay for Perinatal development without borrowing
She then outlined challenges for the forthcoming year 2008/09. Including:
- 3% savings to be made - Department of Health requirement
- Plan for £2m surplus – Monitor requirement
- Capital spend - £11m, Perinatal, fertility & other
- Challenges such as financial discipline and code to secure all income due.
4.Membership report
Pauline Brown, Director of Corporate Developmentpresented the membership report. She presented membership data highlighting membership composition, growth, ethnicity, and age.
She highlighted areas of membership involvement including:
- Informing members through lectures such as bowel screening and the alcohol and drugs service.
- Consulting members in developments such as the perinatal centre and patient environment action team.
Membership priorities for 2008/09 were then presented and included targets for a larger, more diverse, inclusive and informed membership
5.Guest lecture
Dr Paul Wallman, Consultant Emergency Physician presented a piece featuring the work of Accident and Emergency services provided by the Homerton.
6.Results of governor election
Michael Cassidy, Chairman presented the results of the governor elections.
Elected:
Doug Hiza, Public Governor
Dr Helen Cugnoni, Staff Governor
Re-elected:
Sarah Weiss, Public Governor
Outgoing:
Dr Mary Britton, Staff Governor
Katie Lloyd-Thomas, Public Governor
One vacant seat remains for a Public Governor (Outer)
The Chair thanked the outgoing governors for their contribution and involvement.
Questions from members to the Board of Directors and Governors:
Q: The Prime Minister has recently thanked the NHS regarding the recent announcement of reductions in MRSA I note from your presentation that the Homerton has had 9 cases in the past year are numbers of these cases at the Homerton increasing or decreasing?
A: Homerton remains one of the best performing Trusts in the country for MRSA and C diff and is cited by the Department of Health as an example of best practice.
Q: The problems of mixed sex wards are a religious and moral issue not a political one, even with separate sex bays on the same ward the issue remains owing to the sharing of bathrooms. What assurances can the Trust provide regarding the use of bathroom facilities and that when the opportunity arises to have single sex wards this will be taken.
A: We acknowledge your concerns regarding the use of bathrooms. The Trust has recently created two single sex surgical wards, Halley for males and Thomas Audley for females.
Q: The Trust has a very serious issue with regard to parking when people are attending outpatients appointments, can the Trust not use the HackneyHospital site for additional parking?
A: Unfortunately the HackneyHospital site is not owned by the Trust. Parking and transport remain high priorities for the Trust and we continue to work with the local authority and transport providers on this issue.
Q: Could the Trust comment on the delay in building works as part of a presumed PFI where the delay was due to the contractor going bust at the start of the contract?
A: Fortunately they went bust at the very beginning of the build resulting in an anticipated delay of 3-4 months later than scheduled. This will not impact on patients or income.
Q: With regard to the surplus funds available to the Trust could the surplus not be used for instance to employ more nurses and prevent any ward closures?
A: Unfortunately the surplus cannot be used to employ more nurses as the money is not available after this year and therefore is to be spent on hospital improvements.
Q: The surplus for 2007-08 was 7.5 million. What was the planned surplus?
A: The planned surplus was 2 million.
Q: The surplus the Homerton made, where is it going, is the Government taking it to use for the development of super hospitals? The government plans to downgrade smaller hospitals, is this going to happen to the Homerton?
A: We certainly do not expect the Homerton to disappear, things change between successive governments as they always change but the local population needs the Homerton. The money is to be reinvested here to improve services for the community.
Q: I am a public member of the Trust and fortunately have not had to use the services of the hospital but please pass on my appreciation to your staff for the work they do. With over 2200 staff working here could you tell me what your vacancy rate is and how much use of agency staff there is?
A: The vacancy rate is about 13% but this varies from dept to dept. The rate has remained consistent over the past few years at around 10-13%. Where required we do use agency staff but try our best to use our bank staff in the first instance before going externally.
Q: Could you tell me what you think the impact of the proposed polyclinics will be on the Trust? How much capital will be taken away from the hospitals with these developments?
A: Unfortunately at this early stage it is very difficult to know what impact there will be. It is more likely to impact on City and Hackney PCT however for the Homerton it is most likely to impact on our outpatient services. We are always talking to the PCT regarding the best place to treat patients.
Q: What role do members have to play?
A: Members have many roles. Some do not wish to have active involvement whilst others have interests in specific departments and services. We have a register of interests and use members to get involved in a wide range of areas.
Q: Is the hospital going to get the latest laser equipment for prostatectomies?
A: Our urologists are very keen to start a laser service and we are looking into it as we are very keen to develop our services.
Q: Last year my wife had cardiac problems and she was not followed up and did not get an appointment letter. The service we received when we have come in has been very good.
A: We acknowledge that there are some post issues in this area and we are looking into it.
Q: Why has there only been one membership newsletter in a year? This is not good enough if we want to be informed.
A: There has been one newsletter since April and there will be one after this meeting. This year we have published more stories in the press and local media. We can now contact some members by email.
Q: It is nice to hear when patients are discharged appropriately but how many are discharged inappropriately or with a misdiagnosis?
A: Our readmission rates, which are one way of measuring inappropriate discharges, remain fairly constant.
Q: Is there enough money in the PCT to prevent illness and therefore prevent people from coming into hospital?
A: We are very keen to work with local GP’s. Preventative medicine is funded primarily by the PCT and they are actively talking to us, which is the right approach.
Q: Does the hospital have systems in place to investigate when things go wrong?
A: If something adverse happens we always investigate and review care.
Q: I am very impressed with the treatment I have received over the past few weeks I was seen and treated within two weeks
The Homerton is doing very well.
Q: Why not reintroduce a card that has data on it such as hospital number and other details to help identification?
A: We endeavor to improve information flows and obviously the more information we have the better. The Electronic patient record indicates to us when you have been with us before. When treating an unconscious patient the worst thing to do is to assume they are someone they are not.
Q :How is it possible to achieve and how can you guarantee the 4 hour wait in A&E?
A: The challenge is there and situations like a major incident mean you cannot always guarantee the 4 hour target will be met. Normally we can guarantee 98% of patients will be treated and discharged within 4 hours. The 24 hour primary care service has helped with this and the senior nursing staff are constantly looking at ways to improve things.
Q: Are staff subject to violence and abuse?
A: Fortunately we do not have much violence or abuse to staff. The majority of abuse is due to stress of their condition, lack of communication and having to wait to be treated. Most situations are predictable so we aim to inform patients to prevent situations becoming a problem. The enforced 4 hour waits have actually helped to address this problem.
Q: Would it be possible to de-centralise diagnostic medicine to people working under Gp’s for example for cardiac diagnosis?
A: There are initiatives in primary care which attempt to speed up patient’streatment through earlier diagnosis.
Q: A policy of never turning patients away from A&E is admirable. However patients will continue to attend for unnecessary reasons, can you comment on the impact of services such as NHS direct in reducing these things happening?
A: The evidence that NHS Direct is working to reduce such visits to A&E is thin however it is good for the public to have direct access to medical staff. Visits to GP’s are up 15% year on year.
Q: Regarding maternity cases women need to be seen promptly and GP’s can often only see by appointment and therefore these cases often go to A&E
A: We have a very good obstetric and gynaecology service at the Homerton and we work with them and GP’s to provide our service.
Q: What effect has the 4 hour target had on doctors in delivering care to patients?
A: We don’t chase the target we endeavor to deliver high quality timely care.
Q: You hear about ambulance services sending people long distances and not to the nearest hospital, is this a problem at the Homerton?
A: We work closely with the London Ambulance Service and the Jewish emergency ambulance; we also have links in training and education.
Q: If a patient comes into A&E on their own there is no space for parking, what is the Trust doing about this type of issue?
A: Unfortunately we are a landlocked site and we are unable to add more spaces, weekends tend to be better. The council pay and display can be used by visitors to the hospital. Whilst we accept transport access to the Homerton is poor the forthcoming Olympics may go someway to address this issue with improved transport links. We need more direct buses to the Homerton. We are open to suggestions to improve the situation
Q: Could we have pedestrian access to Median Road which would provide easier access to the bus routes there?
A: This could be looked into and may need to be bought up with the council.
Q: I would just like to say that the Homerton is the best, it is a good hospital and all the Drs and nurses are great.
A: Thank you very much; we will pass that message on.