Dr Harsent responds to BBC Radio Gloucestershire

29/01/13

Today BBC Radio Gloucestershire is broadcasting an interview with a senior member of staff who has expressed concerns about several issues within the organisation. Chief Executive, Dr Frank Harsent, was interviewed on the radio and on BBC Points West.  Please see below our response to the points raised: 

Overall/general comment

Dr Frank Harsent, Chief Executive, said: “I am disappointed that this individual feels that the best way to highlight their concerns about our organisation is to approach the media.  The fact that they choose to remain anonymous leaves me in the position of having to defend allegations on a broad range of issues without having specific details.”

The wider NHS
It is important to remember that our Trust operates as part of the wider NHS and we play our part within that structure. While we can understand that individuals may be frustrated with the complex systems that are in place throughout the health service, as a public sector organisation, it is our duty to implement these. Part of the success of the NHS as an institution is that we follow the same policies and procedures and share the same values.

The NHS is sometimes criticised for giving nurses and doctors too much paperwork. The introduction of the electronic screens in our wards that the individual refers to has actually significantly reduced the amount of paperwork required, for example, during the handover between shifts.

Listening to staff
I am always happy to listen to the views of staff, and I regularly talk to consultants whose views may differ from my own.  I would like to be clear that I have never disciplined any of them for expressing their opinions.  I refute the idea expressed that a culture of bullying and of not listening to staff exists in the organisation.

Patient nutrition and hydration
I am shocked and concerned to hear of the patient who felt that our nurses were too busy to feed her. The details provided are however, very sketchy and I would need to find out more about her individual circumstances.  I would like to investigate this further if I had more details of dates and times.

Indeed, as the GMC requires any doctor to bring directly to the attention of management any patients who they believe are receiving sub-optimal care.

What I can say is that we take the nutrition and hydration of patients very seriously. There is a comprehensive programme of hospital nutrition which takes into account the nutritional needs of individual patients; one example would be our soft food diets for people who have difficulty in swallowing. Involvement from our nutritionists begins when patients come into hospital, and includes weighing patients in order to pick up nutritional issues.

We have a red tray system whereby any patient who needs help at mealtimes is identified simply by the use of a red meal tray. Nursing staff, nursing assistants and volunteers concentrate on helping those individual patients.  We have protected mealtimes when wards close to visitors and only urgent clinical activity is undertaken, to help patients to eat their meals without interruption.

Mealtime inspections are also carried out as part of the Trust’s programme of audits to specifically ensure that patient nutrition is protected.

The clinical view and representation in the organisation
Clinicians are key members of the management of this organisation – not only at Board level where we have three members of clinical staff but also within our clinical divisions. 

Our four Chiefs of Service are all consultants - a radiologist, bowel surgeon, obstetrician and neurologist.  Working below them are specialty directors who lead in their own clinical areas.  Many of our general managers are also clinically trained in a range of professions.  At Board, the clinical viewpoint is central to our decision making and they are forthright in bringing their clinical understanding to our discussions.

All Executive Directors carry out visits to clinical areas on a monthly basis with the emphasis very much on being able to talk to staff on the front line and see our hospitals in action. We recently began night visits so that we can also talk to staff working late shifts.

Planning, guidelines and protocols
There are reasons that these need to be adhered to, to ensure consistency of treatment throughout the NHS. 

The individual concerned appears to have issues with job planning. The importance of individual job plans is understood by the General Medical Council for whom it is a mandatory part of a doctors’ continuous validation.

It is also crucial that we know how our consultants spend their working week so that we can plan our other clinical staffing around this.  Job planning and management systems are an important tool in delivering these priorities and managing the hospitals. They essentially help us to ensure that the considerable expertise of our staff is being used to maximum benefit.

Our staff and morale
It is important to recognise that we are in an extended period of austerity with measures including a pay freeze. I acknowledge that staff are feeling the impact of this, in common with other public sector organisations. 

However, I am absolutely clear that the quality of care provided to patients, their safety and their experience in our hospitals is of the utmost importance to us and to our dedicated and valued staff.

I know from the conversations I have had and from the feedback from patients and families, that the vast majority of our staff, including our managers, take great pride in their work and frequently go the extra mile for patients. This has been illustrated during the recent weather conditions when many staff volunteered to do extra shifts, some even staying the night.  I therefore refute the fact that our staff would ever see any patient distressed by leaving the moment their shift ended.

Following the 2011 staff survey, we acknowledged at the time that we were some way from where we wanted to be.  One of the actions has been to ensure frontline staff have been actively involved in looking at ways to make improvements to morale. As a Board we are convinced that motivated, competent staff provide better patient care and a positive patient experience. We await the results of the 2012 survey.

Recovery
I would like to reassure people that patients in our recovery wards are safely cared for with one to one care from highly experienced nursing staff at all times.  Sometimes our recovery areas are busy because people have taken longer than expected to recover. 

I would like to be very clear that if a patient was discharged from a recovery room, this would be following outpatient day surgery and certainly not for any complex surgery where the patient would naturally be admitted to their designated bed on the wards.

Operations and cancellations
When an operation is cancelled it is distressing and disruptive for patients and their families, which is why we endeavour only to cancel any operation in extreme circumstances.

It is rare for an operation to be cancelled because of a lack of beds. We may have to cancel an operation for a number of reasons:  a surge in the number of emergency cases; inclement weather may prevent staff or patients getting to the hospital or if a surgeon was unwell.

When planning our operations it is sometimes the case that we don’t always have a specific bed identified for that person to go into after surgery. If that is the case, then the decision to go ahead is always agreed with the surgeon. 

Bed management
With regard to bed issues in the winter, we do have a clear winter plan which includes the ability to open and close beds flexibly when and where they are needed, and this has been the case for several years.  To me it would be unacceptable if we could not do this. We endeavour to make the best use of our resources at all times.

External consultants
It is good practice, not only in the NHS but also in blue chip organisations to bring in external consultants. They can bring in specialist skills, new ideas and the capacity to manage complex change.

It is our responsibility as NHS leaders to make use of the skills and neutral perspective of external experts to enable us to work more efficiently and effectively.

Our objectives
The priorities of our organisation reflect that the experience of patients is our top priority and it is also important to say that these are developed with the input of a wide range of people including our staff, our Board and our Council of Governors.

Our organisation
We are a complex organisation, running two large acute hospitals, Cheltenham General and Gloucestershire Royal Hospitals.
As well as being one of the largest employers in the county, we see around 800,000 patients a year and provide specialist healthcare 24 hours a day, 365 days a year. We have more than 7,500 highly skilled and valued staff, and I am extremely proud of our staff and the commitment and care they show to patients.