Jayne Black, Director of Operations Maidstone & Tunbridge Wells NHS Trust in attendance to answer questions

The Chairman welcomed Jayne Black, Director of Operations Maidstone & Tunbridge Wells NHS Trust and Colette Donnelly, Associate Director of Operations (Emergency Care) to the meeting.  Ms Black thanked the Committee for the invitation as it gave a welcomed opportunity to explain what the Trust has been doing.  There had been many big developments over the last couple of years not withstanding the new building at Pembury.  She had been in her role since mid March 2013, it had been a busy summer and lessons had been learnt partnership working alongside the community trust, Social Services and the new Clinical Commissioning Groups to get the health economy ready for the winter and to improve performance.  She had been impressed with the commitment of the staff who continued to learn and and address issues that arose.  The Accident & Emergency four hour target was a benchmark, a quality target.  Within that time they needed to ensure that the patient received the right treatment, the right amount, at the right place – i.e. on a ward or at home.  She admitted that they did not always get it right and not everyone was seen within the 4 hour target but there had been significant improvements in the last 6-7 months. Tunbridge Wells was currently achieving 88/89% and Maidstone 98/99% and as a Trust they were now fifth in the country after being in the bottom ten.  It had been acknowledged that patients needed to be seen by a senior doctor or nurse as quickly as possible in order to determine the next stage of treatment.  This had made a significant difference.  Internal standards were also set.  They had also worked closely with the South East Coast Ambulance Service (SECAMB) to achieve 15 minute turnarounds for patients brought in by ambulance and were currently the best in the South East at achieving this.  Quality assessment rounds were carried out by a senior nurse every hour.  Ms Donnelly advised that with regards to customer service, there was information for both staff and patients.  All staff underwent training and it was monitored through audit, the complaints system and the friends and family data set. 

The Chairman asked whether the benchmark of 4 hours was from arrival to treatment.  In response he was advised that it was a national target, within 15 minutes a patient should have been seen by a senior decision maker, predominately a doctor.  This was monitored on a daily basis and every week, and was at 95% most of the time.  With reference to the 15 minute turnaround for those patients brought in by ambulance, there were two dedicated bays, the patient would be brought in and assessed initially by a nurse then a doctor.  One doctor was allocated to the two cubicles so no one would be waiting in a corridor or an ambulance.  Assessment actually started with the paramedics; however this was not factored into the 15 minute turnarounds.  In response to a Member’s question Ms Black reported that they had a good working relationship with SECAMB; there was work being done on assessment at the paramedic stage - for example if called to a hip fracture, using diagnostic skills to assess and fast track them to the correct department rather than bringing them into Accident & Emergency.

In response to further questions she advised that Darenth Valley Hospital had been advised by SECAMB to observe the ambulance turnaround, this had been taken up.  If a patient could not be off loaded this was treated as a serious incident.  With regards to avoiding where possible sending the elderly and frail to A & E (Accident & Emergency), they were working closely with the West Kent Clinical Commissioning Group, East Sussex and Kent Community Trusts and SECAMB looking at more use of community hospitals and community team support at home.  Some work had already started with respiratory patients and assisted discharge.  They had worked jointly with the Kent Community Trust on a rapid response model: teams going in quickly to assess whether hospital admittance was needed, and doing their best to keep patients at home using Occupational therapists and doctors etc; but if admittance was needed considering whether a community hospital would be more appropriate.  With regards to mental health patients, there was a mental health nurse on duty and a psychiatrist on call.  As with any patient it was a question of getting the patient to the right place as quickly as possible. 

The Vice Chairman reported that he had attended A & E at Pembury in July and the targets referred to had not been met and he had not been pleased with the customer service shown him at the reception desk.  Ms Black apologised that he had a bad experience and assured him that delay was not an option and it was made very clear to staff that patients should be seen in a timely fashion.  She further advised that at Pembury minor cases were kept separate from more serious cases and that was adherence to a national recommendation.  She was glad he had not witnessed chaos, even when busy that should not be the case.  In July they had seen their busiest day, 240 patients, the average was normally around 200. She would take the details of this incident back and work with the team.  She reported that they monitored complaints and feedback and were putting together a customer care programme which they would be rolling out soon.  With regards to understaffing, a review had shown that they were particularly lacking middle grades.  They had also looked at the rotas and were placing extra staff on at known busier times.  Consultants had also looked at their rotas and were making themselves more available at those times such as the weekend and Mondays.  At the moment they were in the process of recruiting more consultants for A & E which would hopefully be in place by April 2014.  Other staffing levels should be up to establishment by January 2014.  Fortnightly forward planning meetings were now embedded.

Another Member had experienced being an ambulance patient and had observed that he had been dealt with within the 15 minutes and had a smooth experience and had been impressed with the concern and expertise shown by staff. 

The Vice Chairman asked whether the 15 minute target was made clear at A & E; whether there were feedback forms, and if so how were these distributed or offered to patients.  Ms Black advised that they were looking at how best to promote feedback forms and welcomed ideas and feedback.  She further advised that there were weekly emergency care performance meetings, and that day they had been discussing publishing ‘live’ waiting times on the internet and other useful information. 

The Chairman thanked Ms Black and Ms Donnelly for attending and would be taking the opportunity to invite them back at a future stage.  Ms Black in turn invited members of the Committee to come and observe the A & E department, and have a tour by a nurse or doctor.