Thursday 11 December 2014


Merger note on an Electronic Patient Record/digital hospital

Having an Electronic Patient Record across both hospitals has been billed as a substantial benefit of the merger of the Royal Surrey and Ashford and St Peters. This blog seeks to help understanding of the extent to which it will be realised, when, and its cost and benefits

A digital hospital

A merger project is considering the broader matter of how to achieve a digital hospital within which a fully (or partially) paperless electronic patient record would be part. It will include electronic communications with outside bodies e.g. GPs. It will facilitate immediate access to accurate and comprehensive information for all a patient’s carers in the merged Trust and allow electronic communication with GPs and other carers e.g. community clinicians.

To date
·         Systems in USA have been seen albeit they are generally, at their core, billing systems and very complex and expensive to adapt to UK NHS practice.
·         A baseline review has been completed of systems in use in both Trusts
·         workshops involving large numbers of clinicians have been held.

The way forward has been agreed.

 Way forward

·         Each Trust uses different systems and in the first 12 months after merger the best of each will be installed across both e.g. a very good system comprising a simple electronic patient record is in use in St Peters.
·         In the first 2 years of merger harmonisation and documentation of core processes (administrative and clinical) will be achieved. This is an essential and very difficult first step for implementing any IT (IT is generally not very flexible and needs to be told what the process is and then demands that everybody abides by it or, alternatively, the chosen IT is already built on the basis of standard processes and everyone has to adapt). Achieving this in one Trust which is used to its processes is difficult enough – doing so across two merging Trusts is very challenging (but necessary irrespective of IT).
·         After the above has been achieved there will be a better understanding of how to progress to a digital hospital.

It will thus be two years after merger before any proposal on to how to proceed to realising a fully digital hospital will be formulated and a full business case with costs and time lines produced. Costs could be around £10million or more.

Summary

In the first two years of merger harmonisation of existing systems and of clinical and administrative process will be the focus. Whereas the ambition will be to create a digital paperless merged Trust, it will be at the earliest 2 years after merger before the way forward will be determined and a Full Business Case with cost and time lines produced for approval.

Does this need a merger?

A merger is not necessary to achieve a digital Royal Surrey - the hospital would need to achieve that in the future anyway since it is presently somewhat behind the pack. However merger will release funds which would make a digital hospital feasible in a shorter time frame and it is expected (albeit without substantiation) that costs will be smaller if spread across two hospitals rather than one.

Friday 5 December 2014

The proposed merger.

A good deal of Governors' time and that of the hospital Executive and Board is being devoted to the application to merge with Ashford and St Peters. The timetable has slipped a little but the hospitals hope that, if approved, the merger will come about in the middle of next year. Approval is required by several central bodies and of course by both hospital Boards and by both sets of Governors.

I chair the Royal Surrey Merger Working Group of Governors. The WG's task is to assist governors     
  • in understanding the processes such as the legal grounds on which governors can turn down the proposal,
  • in keeping in touch with what is going on
  • in interpreting various voluminous and complex documents
  • in ensuring the hospital meets its legal responsibilities to inform the public (and staff) and take account of any concerns and to ensure they undertake 'due diligence' in all aspects of  the business case for the merger i.e. they do it properly in a well researched and honest way.
The main advantages foreseen for the merger are
  • a secure financial position of being in surplus avoiding the possibility of both hospitals otherwise slipping in to deficit
  • '7 day working' in a number of specialties
  • improved cancer services from an increased catchment area
  • the creation of a digital merged hospital including electronic patient records
  • more research projects.
The Merger WG is critically examining these matters as details emerge and I will report what I can in my blogs.

My main concern at the moment, which is shared by most governors, is that far too little has happened about communicating with the public and Trust members and about formally capturing and taking account of their views. I and one other governor  represent the Royal Surrey governors on a so called Stakeholder Committee which draws together internal staff members and representatives of external bodies to advise on communications. I have made known my opinion that too much effort is being devoted to producing and updating a strategy for communications and too little in actually doing it - time ticks on!! I shall continue to make this point.

Friday 16 May 2014


RSCH wins top award

In an earlier blog I reported that the Royal Surrey was one of 5 hospitals in the running for a prestigious CHKS award (CHKS is one of the two big companies which run information services for UK hospitals – Dr Forster is the other). It is great to report that RSCH has just been announced the winner of the national Patient Safety Award for 2014 for outstanding performance based on a range of indicators including hospital-acquired infections and mortality. It was also awarded a CHKS Top 40 Award for best performing trusts across the UK based on 22 indicators of clinical effectiveness, health outcomes, efficiency, patient experience and quality of care.

Friday 2 May 2014

Royal Surrey plans merger

Today the Royal Surrey announced that it intends to merge with Ashford and St Peters. The two Boards and Executives have agreed to proceed with creating a full Business Case.

Legally no merger can take place without both sets of Governors formally approving (by a  majority). Thus as a Governor I will have a vote. At the moment I am not opposed to a merger albeit I need more details of the advantages to patients. As I get my head around the detail and can judge what is reality and what is aspiration or spin I will report here.

I represent the Trust members in Guildford and have already made the point that some meaningful process for consulting Trust members (and the wider public) must be devised. If I am to vote in a way representing the Trust members who elected me and the public in Guildford then I need to know what they think.

More to follow.

Thursday 10 April 2014


Two bits of good news

The first bit of good news is that the Royal Surrey is one of five hospitals shortlisted for the CHKS Top Hospi­tals programme patient safety award 2014. The CHKS Top Hospitals awards celebrate the success of healthcare providers and are given to acute organisa­tions for their achievements in healthcare quality and improvement.

CHKS has 25 years of experience in the analysis of hospital data and the RSCH is one on many hospitals which uses them for data analysis. Awards are made on the basis of an analysis of over 20 publicly available datasets including hospital acquired infections, mortality, emergency readmissions after critical operations. Every NHS acute trust in the UK is included.

Results will be announced at the CHKS Top Hospitals programme awards event in London on 13th May.

The second bit of good news is that Royal Surrey’s Wisley and Ewhurst wards are two of five hospital wards to become the first in the country to receive an Elder Friendly Quality Mark in recognition of the sup­port staff give to older people.
 
The Quality Mark is run by the Royal College of Psychiatrists and was developed in part­nership with organisations including Royal College of Physicians, Royal College of Nurs­ing and British Geriatrics Society. It has been established to encourage hospital wards to become involved in improving the quality of essential care of older people and to recog­nise good care provision, as identified by patient feedback.

Monday 31 March 2014

Eye Clinic Good News

The hospital Board has approved the Business Case for a new Eye clinic. This is good news. Building work will start in the Summer and, although this will cause some inconvenience, all should be completed by the end of the year. The new clinic will involve filling  in the open courtyard to the left of the existing area to create more consulting rooms and rooms for eye tests and a much expanded and better waiting area. There will be more nurses and support staff and another consultant. When I was elected a governor the first thing I did was visit the Eye Clinic and talk to patients because I knew the conditions and the length of waits were unacceptable. I wrote a report to the Chief Executive at that time and so I am particularly pleased to see that this poor service to patients is being so positively addressed. Meanwhile the hospital continues to try and improve services within existing conditions and patients tell me that things are better.

The hospital. is to hold a series of Patient Forums for the Eye Clinic to keep everybody up to speed. The first, which I attended on 27 March, was very good. There was not a good turn out from patients but hopefully that will change to reward the staff for their efforts.

Thursday 13 March 2014


Palliative Care

The Royal Surrey palliative care team won the "Multidisciplinary Teamwork Award" at the International Journal of Palliative Nursing Awards in 2012. Now the team have also been short-listed (i.e. are in the top three) for the "Innovation Award" at the International Journal of Palliative Nursing Awards in 2014. A great tribute to a great team.

Also The Royal Surrey/St Lukes has achieved the European Society of Medical Oncology (ESMO) accreditation as a "Designated Centre for Integrated Oncology & Supportive Care". Currently there are only 7 such accredited centres in the UK.

Tuesday 11 March 2014


 Hospital gets grant to improve maternity facilities

The Royal Surrey has been successful in a bid for money from the Department of Health to improve the ‘birthing environment’ at the hospital.

The grant, worth £508,000, will be used to complete the refurbishment of the delivery suite and to build en-suite facilities in all rooms. The money will also enable an upgrade of the current high dependency unit (HDU) with improved facilities for partners to stay.

In addition, the hospital will add a new high risk area for ladies with complex needs who want a home-from-home environment, with the availability of a birthing pool, but in the safety of a fully equipped delivery suite.

All good news for an area where the recent Care Quality Commission report found to be outstanding.

Saturday 8 March 2014


Care Quality Commission trial ratings

As a result of the Mid Staffs debacle the Care Quality Commission revamped its inspections making them longer, more detailed and with more clinical inspectors. They tested out the new regime in a number of hospitals including the Royal Surrey: see my blog of 18 December. The resulting report was generally good with some areas needing attention.

The CQC intends to publish ratings for all hospitals over the next year or so. So, from those 18 who were subject to the test inspections, the CQC sought volunteers to be trial rated. Royal Surrey agreed and the trial ratings have just been published. They are below.

   

 
 
 
 
 
 
 
 
 
 
Royal Surrey County Hospital NHS Foundation Trust
 
 
 
 
Safe
Effective
Caring
Responsive
Well Led
Overall
 
 
Accident & Emergency
G
UA
G
G
G
G
 
 
Medicine
RI
G
G
G
G
G
 
 
Surgery
G
G
G
G
G
G
 
 
Critical Care
G
G
G
G
G
G
 
 
Maternity & Family Planning
G
G
O
G
O
G
 
 
Paediatrics
G
G
G
O
G
G
 
 
End of Life
G
G
G
G
G
G
 
 
Outpatients
G
UA
G
RI
RI
RI
 
 
 
 
 
Overall
G
G
G
G
G
G
 
 
 
 
 
 
 
 
 
 

 
The ratings are Outstanding (O), Good (G), Requires improvement (RI), Inadequate and Unassessed (UA).

The Royal surrey was thus overall rated Good for all aspects of care.

Outpatients was the main area requiring improvement with the Eye Clinic being particularly criticised (see some of my earlier blogs. A Business Case to rebuild the Eye Clinic is due to be presented to the Board at its next meeting and hopefully, at last, work will start to create a clinic for which the hospital can be proud.

Checks on cleanliness and maintenance

 I coordinate a team of Governors who undertake checks on cleanliness, maintenance, hygiene etc. (see earlier blog). In the last 5 months we have checked

·         Out Patients 1, 2, 5, 6, 7, 8, 9 and 10

·         Patients Lounge, front entrance and main corridor including WCs

·         Radiology including X-ray, ultrasound, CT, Interventional Suite

·         EAU (Emergency Assessment Unit)

·         Short Stay Surgery and Elective Surgery

·         Physiotherapy

·         Phototherapy

·         Rehabilitation and Occupational Therapy

·         HASTE and MRI

·         Day Surgery

·         Nuclear Medicine

 

Whereas we have found some areas where cleaning needs to be improved, where maintenance attention is required and where clutter was unacceptable, overall the checks have shown all features to be pretty good and some departments to be excellent and believe me we look for dust and dirt in every corner! Our reports are sent to senior staff responsible for all these aspects and are taken very seriously with follow up action which we intend to check. The hospital has made clear that it appreciates what we are doing and that is good.