Annual Report and Accounts 2012/13 - Royal Devon & Exeter Hospital

2. Our Trust Royal Devon and Exeter NHS Foundation Trust 29
Annual Report and Accounts 2012/13
Stewardship
At the same time as navigating the
RD&E through an increasingly complex
external environment and coping
with the year-on-year constraints
on our finances, the organisation
faced a prolonged winter period with
attendances at an unprecedented
high. Reluctantly, but in the interest
of patient safety, the Board decided
that priority had to be given to
emergency and urgent patients and,
as a consequence, routine surgery was
cancelled or restricted for a significant
period of time. This had a knock-on
effect over a period of months on the
Trust's Referral To Treatment (RTT)
targets for admitted patients and
resulted in a backlog of patients who
had already breached the 18 week
target. The Trust's failure to achieve
the 18 week RTT target for admitted
patients placed the Trust in a position
in which it was at risk of regulatory
intervention by Monitor.
Targets are clearly important but the
Board knew that behind the statistics
were real patients having to wait an
unnecessarily long time to receive the
treatment they required. The Board
took the view that it would ensure
that substantial effort was placed
on managing down the backlog of
patients but to do this in an ethical
way, namely to treat those who
had waited the longest first and
those whose conditions necessitated
more immediate treatment. The
Board approved a plan, agreed with
Monitor, to manage the backlog into
a treatment list that was sustainable
and it is expected that this would be
cleared by the autumn 2014. As a
consequence, the RD&E was placed
on amber-red rating by Monitor.
The Board was mindful that tackling
the backlog of patients who had
breached the 18 week RTT target
involved a great deal of hard work
and dedication by staff to ensure
that patients were being treated in a
timely way. In examining some of the
causes of the RTT backlog, the Board
considered what lessons it needed
to learn to prevent a similar backlog
occurring in the future. Performance
information has continued to evolve
over the course of the year reflecting
changes in the governance structures,
greater clarity about what information
was useful to the Board (particularly
in triangulating data and making
connections between financial
information and quality of service)
and in some of the detail presented to
the Board (particularly on the Ward to
Board reporting) and subsequent “drill
downs”. Over the next year the Board
will continue to develop and refine the
performance information it receives.
The Government’s plan for health
and social services is for more care to
be delivered close to home, thereby
reducing the demand on hospital
services and residential care. As
in other parts of the country, our
partners are still in the early stages of
developing this approach and therefore
there has been no reduction in the
demand for our services. Rather, there
was a 14% increase in the numbers
of very elderly patients coming
through our doors over the last year
– particularly in the period October
2011 to May 2012 and an increase
in the complexity of their cases. This
placed real strains on our systems, and
had significant knock-on effects for
our elective patients, particularly in
orthopaedics, surgery and cardiology,
at a level not seen before. At the same
time, we experienced problems in
discharging patients who were ready
to leave hospital but required ongoing
care, in a community hospital or other
community setting.
Public health data confirms there will
continue to be a significant increase in
the number of very elderly people in
Devon. These demographic changes
coupled with the wider changes
in the healthcare and social care
system means the pressures we are
experiencing are unlikely to recede in
the short term. Enabling patients who
are able to move out of the hospital
in an appropriate way, and ensuring
that the wider health and social care
community develop alternative services
to reduce the demand on our services,
remains an issue that we will continue
to address, working closely with our
CCG and local authority partners. On
the basis of this analysis, and the need
to ensure the Trust did not add to the
backlog of patients not hitting the RTT
18 week target, the Board decided
to progress:
• The redesignation of Lowman ward
from a surgical day case/admissions
unit to an inpatient medical ward
and the recruitment of a permanent
staffing complement
• The purchase of a 48-bed
modular unit and recruitment of a
permanent staffing complement.