Agenda item

KCH report on acquisition of the Princess Royal University Hospital (PRUH) and Denmark Hill hospital performance including Emergency Department (ED) is attached.

5.1  King’s College Hospital NHS Foundation Trust (KCH) representatives: Mike Marrinan, Medical Director and Briony Sloper, Emergency Head of Department presented on the emergency department at the Denmark Hill site and the acquisition of Princess Royal University Hospital (PRUH).

5.2  The Medical Director explained that the KCH is short of nurses at PRUH but it is hard to appointment. He reported that Orpington Hospital was scheduled to close but KCH expressed an interest and opened an elective care orthopedic unit. This has proved popular, particularly as acute admissions had been impacting on elective planned procedures. He emphasized the inexorable increase in emergency admissions.

5.3  He reported that there is a small pilot with elective gynecology operations moving to the PRUH from King’s College Hospital at  Denmark Hill . This is a response to rising demand and  increased admissions adversely impacting on planned care. He said that KCH are now looking at the elective gynecology service changes as part of a much wider plan for the entire KCH Trust.

5.4  The Head of the Emergency Department explained that the emergency departments are seeing an increase in patients arriving by ambulance, increasing numbers of patients needing resuscitation and an increase in admissions from  major incidents.  Patients are illler and staying longer which is creating pressure on the system. KCH are looking at ways to avoid increased admissions and have been successful in this as the proportion has not grown. One way of doing this is to undertake more tests, but this takes more time.

5.1  A member asked why there has been a shift towards more high dependency patients and the underlying cause. The Head of the Emergency Department said that there had been an increase in older people with chronic diseases, more co- morbidity, and more patients who are poorly. The member asked if population increase and bigger increase in the elderly population is a factor and she agreed that  this is factor in more significant acuity. The Medical Director responded that local Southwark admission rates are declining; however KCH as a whole is seeing admissions rates going up. Kings College Hospital,  Denmark Hill, is a tertiary centre for a big area.  Southwark Clinical Commissioning Group and KCH are working well on local issues and we are now looking at he bigger issue of decompression.

5.2  A member asked if the number of newly arrived people who are not registered with a GP is static or going up. The Medical Director said that numbers were static. 80% of patients at King’s College Hospital, Denmark Hill, are from Lambeth and Southwark.

5.3  A member referred to the committee report that  that indicated that some people were going to A & E who might be able to access better care via local GP hubs or via  the 111 service. The Medical Director commented that multifaceted issues are driving the A & E pressures however he emphasized that that it is the rise in admissions that is the problem: there are not enough beds so A & E backs up.

5.4  The Head of the Emergency Department reported that A&E s had input from a number of bodies to improve,  including CQC & Monitor. She referred to the recent Safer Faster Hospital exercise which focusing on the emergency pathway for a week at the King’s College Hospital, Denmark Hill ; this is now going to be done at the PRUH. This is a very intensive exercise. 

5.5  A member asked of plans for improvement would be combined, and actions were measureable or quite broad. The Head of the Emergency Department responded that there are some quick fixes, like phones and wireless, however some are more complex, for example appointing a consultant decision maker, and some are about increasing physical capacity and include providing more beds. 

5.6  The Medical Director was asked why complaints at the PRUH had gone down but were now going up. He explained that there is more capacity to accept and process complaints ; KCH had added a PALs so it is easier to report .There has been a change in culture , it is now more collaborative rather than ‘command and control’. He explained that hospital staff were  reluctant to put down adverse incidents, however KCH encourage this as both adverse incidents and complaints can expose problems and help make changes. PRUH has been the worst performing A & E for 6 months or so.

5.7  A member asked more about the culture and he explained that there has been lots of input from KCH and the NHS director noticed a change. There is now better engagement from consultants. The CQC noted that consultants were over satisfied, whereas the nurses are doing well but struggling and using difficult systems and the Junior Doctors were feeling unsupported. He explained that prior to KCH acquiring the PRUH staff were unsure if the hospital was going to be asset striped and it was understaffed. KCH radically increased the staffing.

5.8  A member asked how long it would take to see an improvement and the Medical Director said that there would be 15 months of difficulty before the PRUH was fully up to speed.