Annual Members Meeting 2013

We held our Annual Members Meeting on Wednesday 18 September 2013 in the Great Room at Preston North End Football Club.  

Here is a list of questions that were asked at the Annual Members Meeting, September 2013:

Has the Lancashire Teaching Hospitals addressed the latest government initiative of having more consultants and specialist doctors, on attendance at weekends and after hours.
I can confirm that for some time the hospital has been looking to work seven days a week.  This does not mean that all procedures are undertaken at the weekend but we have been progressively increasing the number and seniority of clinicians, both at the weekends and where there is a demand out of hours.  Each specific area has been risk assessed and the benefit of changing the service identified.  I suspect this will need to be a variable response depending on demand and even different admissions throughout the year, but it is something that is part of the long term strategy for the Trust.


Is there a possibility of a permanent cardiac consultant at Royal Preston Hospital being appointed soon?
I have asked the Medical Director to look into your question and confirm that we have three consultants in post within the Trust.  We also have a Locum Consultant who is fully qualified to provide consultant services.

Given the excellent work carried out at Royal Preston Hospital, in the early detection of bowel cancer through sigmoidoscopy/colonoscopy, is there likely to be increased capacity to carry out operations to meet the apparent increase in demand for sigmoid colectomies and other general surgery?
I confirm that the higher pick up rate for bowel cancer with the new screening programme was anticipated, and that we have expanded our specialist capacity.  We are confident that we will be able to deal with the earlier identified cases and hopefully the whole project should improve the impact on the outcome of this disease.


Patients who require wheelchair assistance to enter departments in the hospital grounds but outside the main building are unable to secure a porter.  Porters are not assisting patients who are wheelchair bound as it has been risk assessed against their duties.  Volunteers are placed in a difficult situation when this occurs as they are mostly the first members of the hospital that patients see and are expected to assist.  As a Trust, what alternatives do you have in place to ensure the patient has a transfer and to provide a service and acceptable pathway?
Porters will help patients and visitors where possible although clearly the portering staff are not based in the main entrance and requests are made through the helpdesk.  Porters will try to respond, however it cannot be guaranteed as it will depend on workloads.  If possible any requests could be pre-booked in advance, if this would help.


Letters are still not giving the patient the correct information.  Doctors’ names and personal diagnoses are on the letters and when they come into the hospital, have no direction and patients give the letters to the volunteers who are embarrassed for the patient when personal details are documented.  Example (erectile dysfunction).  Is this really necessary?  Urology Department is all that is required.  Doctors and consultants change, giving names can be a problem when patients are expecting to see a particular doctor.  The Consultants team and directorate department is all that’s required and where it is situated.  Example, Dr one and team, general medicine outpatient clinic.  The hospital with directions how to get there time and date.
We do not give personal diagnoses on appointment letters.  An example the information that goes out in our current letters is as follows:

Consultant:    Dr xxxxx or a member of his/her team

Date/Time of appointment:   xx xxxxxx xxxxxxx

Our letters then give details of the Reception Point further down the letter (eg. 'Your reception point is Main Outpatients') along with any specific instructions (eg. 'Please bring a list of your current medications').

Regarding the example 'Erectile Dysfunction' showing on an appointment letter:   none of our clinic resource options on Quadramed have this wording; however one of our Urology consultants does have a clinic called 'Mr HAQ ED Clinic'.   Our IT programmers advise me that any wording following the consultant's name (which in this case would be 'ED Clinic') should automatically be removed before the letter goes to print.   They are now investigating if there have been any technical errors in the system which are enabling full clinic names to transfer onto the actual appointment letters and will immediately rectify if that is the case.

As part of the Outpatient Reform work, a multi-disciplinary group (including staff and Trust Governors) was recently established to re-design our outpatient appointment letters as it was felt that the current layout/format is unclear and not standardised.  I am pleased to advise that a new layout was agreed that addressed these issues and our IT team are now finalising the programming work required to enable these changes.


What is the Trust doing to ensure the 125 buses that accessed Chorley Hospital is reinstated?  A petition with hundreds of names has been produced.
The Trust was not advised on the change to the 125 bus service operated by Stagecoach, which has stopped calling into the grounds of Chorley & South Ribble Hospital.  Lancashire County Council (LCC) has confirmed to the Trust that it is a commercial service and as a result, LCC has no control over the service.  Apparently, Stagecoach changed for reasons of punctuality of the service and use.  The Trust is not aware of any access problems to the Chorley & South Ribble Hospital site.  The Trust has contacted James Mellor, Commercial Manager of Stagecoach, in order to raise the issue.


When the winter vomiting bug invades in the near future, will we have sufficient bed capacity to cope at both Preston and Chorley Hospitals and what plans are in place to cope?
As in previous years, we have developed a robust winter plan in preparation for anticipated levels of increased demand over winter.  We are also working with our local clinical commissioning groups and other partner agencies to develop plans over this period and to allow us to better understand what facilities may be available within the community.


The newspapers tell us that many hospitals do not have as many nurses as they should have.  Does this apply to Lancashire Teaching Hospitals?
Although the number of nurses on duty at any given time may fluctuate due to the needs of the patients they are caring for, we do have established levels of staffing to deliver excellent care.  There are times when we may not have this number of nurses, such as in the event of short notice sickness absence, however we undertake an immediate risk assessment of the clinical environment and move staff as appropriate.  We also undertaken a robust review of nurse staffing levels each year and make any necessary investment.


You noted that our Annual Report 2013 lists the provision for bad debt as 1.6 million, compared with £39,000 in 2011/12.  As you rightly pointed out, this is a significant increase.  As we were preparing our year end accounts, we allowed for the following disputed NHS invoices:

Breach vehicles                    £639,000

Gynae Oncology charges      £389,000

Drugs charges                      £1,117,000

As you will appreciate, this was based on our best understanding of the situation at the point of which the accounts were prepared.  I am pleased to be able to confirm that, since the publication of our accounts, the invoices relating to the gynae oncology charges and drugs charges have now been paid.  The only bad debt for 2012/13 therefore is that relating to breach vehicles.

The £639,000 is owed to Lancashire Teaching Hospitals NHS Foundation Trust by Primary Care Trusts (PCTs)/Clinical Commissioning Groups (CCGs) in respect of the provision of non-emergency patient transport: this activity being the subject of a Service Level Agreement between the PCTs/CCGs and Lancashire Teaching Hospitals for 2012/2013 and 2013/2014.

The breach vehicle which costs £360,000 per annum is deployed to transport patients being discharged from the Emergency Departments at Chorley & South Ribble Hospital and Royal Preston Hospital and also the patients who require transfer between our two sites, within the 4 hour target.


Have the Trust been able to agree and sign the contract to provide specialist services given the reduced moneys on offer?
We are still in discussion around the contract for specialist services.


 When will partner and stakeholders be able to contribute to the reconfiguration of service process?
There is a very clear process to follow whenever any organisation considers large scale change which includes consultation with local Overview & Scrutiny Committee as well as all other stakeholders.  We have recently appointed a Strategy and Development Director, who will commence in post during February 2014.


What is the Trusts view and thoughts about less NHS money being allocated to this area given that we have some of the worst stats regarding health inequalities in the country?
We are naturally concerned about any reduction in funding within the local area and we will work with our partner agencies to ensure the most effective use of this funding for the good of our local population.


You can have great services but if patients can’t get to use them it is useless.  Disabled parking places are used for other services, buses have stopped going into the hospital grounds and staff not understanding that a disabled person can’t walk the length of the hospital are a few of the problems faced trying to attend an appointment.
The car parking staff do monitor the used disabled car park places and will ensure penalty notices if the appropriate badge is not visible.  If you are aware of any particular areas which are abused please advise the car parking staff.

The appointment letter should indicate which is the most appropriate place to park.  We are currently reviewing the letters that we send out from Lancashire Teaching Hospitals NHS Foundation Trust.


What is the view of the Nursing Director on the published Liverpool Care Pathway report and its recommendations?
Our Board of Directors has discussed this issue at our meeting in July 2013 and a full analysis of the Liverpool Care Pathway report and its recommendations have been undertaken and plans are in place for the delivery of end of life care training.


Two of my elderly neighbours have been taken into Chorley this year to A&E, and after being seen, very, very well I must say, have been sent home between 1am and 3am,to an empty house in the middle of the night, is this normal practice?
We have an internal standard which states that we should not discharge in-patients home after 10pm at night, this however does not apply to patients attending the Emergency Department or the Assessment Units.  As I am sure you will appreciate, we cannot admit a patient who has no medical need just to avoid sending them home.  Clearly the nursing and medical teams within these departments will undertake an assessment to ensure the discharge is safe, in any situation where there is concern that it is unsafe to discharge the patient home, the team will look for alternatives such as short term social services crisis support.  If no safe solution can be found, then an admission will be made on social grounds.

Clearly if you were able to provide more detail we could investigate the particular episodes for you to ensure our teams followed policy.


Dehydration has been regularly in the NEWS.  Is this a problem within our Hospitals?  If so, how can “members” help to eradicate this problem for patients?  Could I be of any help with volunteering to hand drinks out?
Your offer to volunteer is gratefully accepted and with your permission we will pass your details to our volunteers co-ordinator.  Preventing dehydration is very important and requires ward staff – nurses/doctors and physiotherapists to be vigilant in encouraging patients to have a drink regularly and to offer drinks regularly.  This is particularly important for patients who cannot take their own fluids e.g. a patient who is unable to lift a cup or a patient with dementia who forgets to drink.  We have implemented an “Intentional Rounding” process across the organisation which is designed to ensure that all patients are seen by a carer at least once an hour and that patients are encouraged to drink or helped to have a drink as part of the “intentional round”.


‘Do you agree that the experience of pain is subjective or not objective?  So, why are patients who are suffering from chronic pain told that “according to the clinical protocols, you can’t possibly be suffering as much as you claim!  (My personal experience at Chorley in January 2013)’.
I agree that pain is subjective, though at times there may be some objective measurements, and I would like to apologise on behalf of the staff who have said this. We teach our staff to accept pain as described by the patient and to use recognised pain assessment tools to record this objectively.  Some of these tools use different methods to quantify or triangulate information, with a view to helping different clinicians to reach a consistent “pain score”.

Our pain team have been holding regular teaching sessions for the nursing staff as well as junior and senior doctors. This has led to real improvement in pain management, as shown by the recent survey of inpatients at Lancashire Teaching Hospitals NHS Foundation Trust (307 in patients, over two days)


What plans are there for a CT scanner for trauma (equipment bought with LEP campaign money).  Are they to have the same equipment at Chorley?
We have no plans to install a CT scanner for trauma at Chorley & South Ribble Hospital.  Royal Preston Hospital has been designated the major trauma centre for Lancashire and Cumbria  and is considered to be an appropriate setting because it has an established and high performing emergency department; it provides the region’s services for a number of specialisms often required for good trauma care including neurosurgery and plastics; and it is well placed geographically with good motorway access.


Given that 1 in 5 in Chorley & South Ribble have been identified as carers, what plans do you have to work with the CCGs and local authorities to provide support to them that if a carer falls ill it could lead to a double cost across the NHS?
The provision of support for carers is generally undertaken by other agencies, and the NHS Choices website provides some detailed information on this area, including a guide to care which discusses practical help, support and advice.  This can be found at:  Hopefully this website will be able to assist with your question in more detail.


Can you confirm if Chorley and District Hospital is not on the list of closures?
We can confirm that there are no plans to close Chorley and South Ribble Hospital


Why are more and more patients being sent to PRI for X-rays, MRI scans when Chorley and South Ribble Hospital has the facilities.
Patients are not generally transferred from Chorley and South Ribble to Royal Preston Hospital for routine x-rays or MRI scans, because as you rightly note, the facilities are available at Chorley.  We do transfer patients for specialised PET-CT (positron emission tomography-computed tomography) scans and this is due to the fact that the scanner at Royal Preston Hospital is the only one in Lancashire.


I understand cutbacks are being made in the physiotherapy department.  Is this not a false economy?  Good physio input will surely help to maintain wellbeing and independence for the patient and in the future help to create healthy financial savings for the Trust.  My husband has had an enormous benefit from the few visits to the department in respect of his Parkinson’s disease.
Firstly, it was lovely to hear of your husband’s positive experiences within our hospitals, and we agree that effective physiotherapy is a real help to aiding patients’ recovery.  We have recently undertaken a skill-mix review of all allied health professionals with a view to improving the level of service that we provide.  Please be assured that the reviews we undertake are designed to enhance the provision of service, although it may be that this has resulted in a different mix of staff within each area.


Has the work within the newly created clinical commissioning resulted or is likely to result in any major changes to the services provided?  If so, which services, and is the current position reported anywhere on your website/information?
There are a number of new organisations within the health economy and a number of developments have taken place recently, for example around vascular services and the major trauma centre.  The Local Area Team of NHS England and the confederation of Clinical Commissioning Groups across Lancashire will ultimately determine the service provision in the local area through their commissioning decisions, but at this time no major changes to services are anticipated.


The parking situation at Royal Preston for outpatients and visitors has never improved.   I understand that a multi-storey car park had been proposed but objections from residents meant that it was never carried through.  Is this proposed?
Car parking is a complex issue with changing volumes of patients, staff and visitor vehicles on a daily basis.  We generally are aware there is a peak on a Tuesday, Wednesday and Thursday early afternoon.  The car park staff do attend to direct cars to vacant spaces.  We monitor the car park daily and, at the moment, it is just about balancing, mainly as a result of staff parking off site at the other facilities.  You are correct in stating that an extension of a multi-storey car park was applied for about five or six years ago.  The planning permission was recommended by others, but was eventually turned down by the Planning Committee of Preston City Council.  The Trust is currently exploring options to increase both patient, visitor and staff parking on the Royal Preston Hospital site.  Clearly, there will be a cost for any additional spaces.


How are you preparing for the extra demands on A&E with the pending winter and do you welcome today’s announcement regarding publication of nursing levels.
Every year, like other colleagues in the Health Service, we produce a winter plan which is designed to provide a framework for dealing with the pressures that you rightly note occur at this time of year.  We do this in conjunction with a number of partner agencies, which include the local Clinical Commissioning Groups.  We are also engaged with organisations such as Lancashire Care and Lancashire County Council to better understand and predict what health resources will be available outside the hospital environment.


Who looks after patients who are impaired in feeding, washing, dressing and eating at Chorley Hospital when there are no staff e.g. not enough nurses?  E.g. a 84 year old patient having surgery and has only the use of one arm.  No help given at ALL – luckily he was only in for 3 days.
It is very difficult to comment on individual cases through this process as an in depth review of a patient’s care would be required.  On admission to hospital, all patients should have an assessment of their health and wellbeing needs based upon the activities of daily living which includes eating, drinking, washing and dressing, using the toilet.  Through this assessment, a plan of care is agreed with the patient and any requirements for assistance are identified e.g. a patient who needs help with eating and drinking would have a blue tray ordered so that the need for assistance is quickly identified by all staff when giving out meals.  If a ward team need more support at meal times then arrangements are made to provide additional support.


Why are wards in Chorley & South Ribble Hospital being closed?  (Adlington Ward for example).
The Trust has been successful in securing funding from the Department of Health to support environmental improvements in wards caring for patients with dementia.  A total of £1,014,288 funding has been allocated to the Trust, which is one of the highest allocations nationally and will support improvements in 6 ward areas across both hospital sites.  As the building work may be noisy and disruptive for patients, it is necessary to empty ward areas to allow the work to be completed.

The answer to the question - How many people attending A&E during the pressured times spring/winter were not residents in Chorley and South Ribble and Preston. Contains a graphic which cannot be reproduced on the website at this present time.