The Great Western Hospital - what do you want to know?

Swindon's GWH is dogged by questions about size, treatment procedures and costs. So the Chief Executive Lyn Hill-Tout has come up with answers to the most Frequently Asked Questions put to her



1. Question: How come the hospital is still too small? You have opened two new wards and there are still patients being cared for on trolleys?

Answer: The Great Western Hospital was planned over 10 years ago, before the expansion set out in the NHS Plan (which was published in July 2000) and the NHS Bed Enquiry, which recommended bed occupancy of 82%. When we moved into the hospital we had 587 beds (including those in the local community - for example Savernake). Since moving to the hospital we have increased beds and now have 648 (including the same ones as counted before in the community). The main reason for bed shortages (at certain times of the year) is because we are treating more patients, who are coming to us from further away. In times of peak demand we do not to close our hospital to emergency admissions. If we cannot safely discharge patients and we don’t have beds available, then we put additional beds into ward areas. The Treatment Centre, which opens in Spring 2005, has an additional 128 beds and we will be able to stop having to accommodate additional patients on wards. Importantly, given our expected patient numbers for next year, we are planning to keep some wards and theatres vacant so we have capacity for future expansion.



2. Question: Every time you get busy you have to cancel operations - why don’t you plan for busy times so you don’t have to cancel operations?

Answer: We do plan for busy periods. For example, in the period after Boxing Day we reduce elective operating. Throughout the year we work closely with GPs, community health and Social Services to offer appropriate alternatives to patients being admitted to hospital. The new Treatment Centre will enable us to separate the care of elective (planned) patients from patients who require emergency or urgent treatment. This will minimise cancellation of planned operations and improve efficiency in the Treatment Centre.



3. Question: Why, when you have so much space, is car parking such a nightmare. Why don’t you just make the car park bigger?

Answer: This is a difficult problem. When the hospital was built we had planning permission for 1100 car parking spaces. As required by the Government’s Green Transport Policy and planning permission we had to implement a range of green transport measures (bus subsidies, park and ride, car sharing) to restrict the number of visitors and staff coming to the hospital by car. We have implemented all these measures and, in fact, have already achieved the "modal shift" targets (getting people out of their cars) required of us in 2008. We feel we have done all we can to encourage people not to bring their cars to the hospital site. However, for some of our visitors and staff there is no practical alternative. We are therefore in discussion with Swindon Borough Council about increasing the numbers of car parking spaces.



4. Question: Why are you overspending this year when you have done so well in the past?

Answer: This year we are using more Agency staff - both nursing and medical than before and we have budgeted for. We have been very successful in recruiting more staff. However, there are still areas where we do not have the staff we need. Unfortunately, if we obtain staff through an agency the cost is very high - it can be up to 4 times more expensive than a member of staff we employ. We are also overspending on our budget for digital hearing aids. We were given a fixed amount of money to issue improved digital hearing aids to patients - the demand for these has outstripped the funding we were given. There have also been a number of cost pressures, which we could not foresee, for example late changes to accounting rules and the full cost of changes to staff contracts which were not fully funded. We have plans to ensure that we reduce this overspend by the end of our financial year (31st March).



5. Question: How much do you spend on recruitment every year and why do you have such trouble attracting staff?

Answer: We spend approximately £400,000 every year on advertising. This is less than 0.3% of our £132 million budget. There is a national shortage of some of the qualified staff we need, for example midwives. Nationally, there are increases in training planned. However, it takes several years for the additional staff we need to be trained. In Swindon we are fortunate to have virtually zero unemployment and this very competitive labour market also affects our ability to recruit staff. We are doing all we can to recruit more staff. We run a variety of successful initiatives such as Return to Practice which is designed for qualified staff who have not been working in health care for some while and need to update their skills before returning to practice. We plan to open our Academy in Winter 2005 and this will provide local training for a number of organisations. We believe this will help with recruiting and retaining staff.



6. Question: Why as a brand new hospital did you only get two stars and not three and what do you have to do to get your three stars next time?

Answer: We have received two stars for three consecutive years. This score is out of a possible rating of 0 (worst performing) and 3 (best performing) and is awarded by the Healthcare Commission. The results for year 2003/04 were issued on the 21st July, 2004. We achieved 8 out the 9 key targets. The key target which we underachieved on was the number of patients who waited over 12 hours in Accident and Emergency Department before they were admitted. We had 6 patients last year who waited over 12 hours and missed the target by 0.05%. There are a number of areas where we perform well and a small number - for example A&E 4 hour waits, the time taken to treat breast cancer patients and the achievement of reducing Junior Doctor Hours where we were performing badly. Recent monitoring shows that we are improving in all these areas.



7. Question: Are you working towards Foundation status and what do you think of Foundation hospitals?

Answer: Currently, only Trusts who are three stars are permitted to apply to become Foundation Trusts, so this opportunity is not open to us at the moment. However, it is the Government’s intention that all Acute Hospital Trusts will achieve Foundation status by 2008. Our aim is to provide high quality, effective clinical services by people who are well trained and motivated. We will carefully monitor the benefits to the early Foundation Trusts, and will then decide how Foundation status will benefit our patients and staff and when we should pursue this.



8. Question: Is the Private Finance Initiative an expensive option providing a poorer service with your private sector partners creaming off profits from the taxpayer/NHS.

Answer: Since the relevant enabling legislation was introduced in 1997, 27 new hospitals worth £1.8b have been built under PFI. The private sector has supplied a wide variety of services since the NHS was formed - everything from buildings to medical equipment. In principle, PFI is no different. It simply extends the scope of the services being provided by the private sector.

One of the reasons in favour of PRI was to eliminate the cost and time overruns of traditional procurement. According to a report published by the National Audit Office last year, 78% of projects are now delivered on time and 76% to budget. This contrasts to the 73% delivered late and 70% delivered over budget under the old conventional procurement.

The Great Western Hospital was delivered on time and to budget.

The cost of private capital and the profits made by private sector companies can be outweighed by the freedom that PFI affords suppliers to innovate because they are no longer bound by the heavily prescriptive input specifications that characterise traditional procurement. The transfer of risk from the public to the private sector means that the hospitals are able to focus on the delivery of excellent patient care.

Without PFI the Great Western Hospital would not have been built. We are now able to care for patients in an excellent environment and the working conditions for our staff are greatly improved from those of the Princess Margaret Hospital. Private providers such as CSL have expertise in providing non clinical support services such as catering, cleaning, estate management etc. This enables NHS staff to concentrate on providing clinical care. What we have to ensure is that we, and our patients, are receiving high quality services from CSL, for the best possible value for money.



9. Question: Are social services to blame for all your delayed discharges problems?

Answer: No, Social Services are not to blame. Ensuring a patient’s discharge is properly arranged involves a number of people and agencies. What health and social care have a responsibility to do is to ensure the arrangements are seamless and meet the needs of the patient and their carers. In Swindon we have chosen not to use the additional "reimbursement" funding to fine Social Services but have used this money to provide services to assist the transfer and discharge of patients.



10. Question: How come complaints have gone up when you have moved to a brand new hospital - are services getting worse?

Answer: We encourage feedback on our services and therefore do not see rising complaints as necessarily a bad thing. What is more important is that patients, users and staff know how to make their views known and we act upon them. Services are not getting worse and we have hard evidence that, in fact, services are improving. We see approximately 300,000 patients each year and approximately 0.1% of our patients formally complain. Unfortunately, despite our best efforts, we do not get things right for all our patients and when things do go wrong we try to learn lessons for the future.

The creation of a new hospital is exciting, but also raises expectations of both patients and all the staff who work to provide the clinical and support services. In general, The Great Western Hospital has met almost all these high expectations. However, there are aspects which disappoint some people. Both the Trust and Carillion are keen to capture these points and regularly scrutinise comments that patients and staff make in order to plan improvement programmes and provide solutions within allocated resources. For example, food temperature was raised as a complaint in the early days of the opening of the hospital and this has been addressed by changing food serving procedures at the ward level. This has largely eliminated complaints about food temperature.



11. Question: Do you have MRSA in hospital?

Answer: MRSA is prevalent in both the Community and hospital and is of major concern both locally and nationally. The reduction of this infection continues to be a priority for the Trust.

We have a number of policies for the management and containment of MRSA in hospital and this infection is proactively managed in high-risk areas such as ICU, SCBU and the elective orthopaedic ward, Woodpecker. All new staff receive training on control of infection in addition to regular training of existing staff. We work closely with Carillion Services (who clean the hospital) to ensure standards are maintained and improved. We have also worked closely with the National Patient Safety Agency (NPSA) to develop a national toolkit for improving compliance with hand hygiene and a hand hygiene awareness week is planned for mid September. Our priorities, in accordance with the national directive include increased surveillance activity to collect and collate more meaningful data, which can be used by the clinical teams on the wards to inform their practice.

The National Audit Office has recently highlighted the lack of good national data collection systems to enable comparative and meaningful data to be provided. Locally, we have secured funding from the Department of Health (DOH) to pilot such a system, being 1 of just 9 NHS Trusts participating on this scheme. The DOH will be providing an evaluation report early 2005.

The current national comparative benchmark for MRSA defined by the DOH, is "numbers of MRSA Bacteraemias per 1000 bed days". The figures for 2003 have recently been published and our local bacteraemia rates are one of the lowest within the South West and extremely comparative UK wide. However, we are not complacent and one of the Trust’s Key performance Indicators is to reduce the acquisition of MRSA further year on year.

However, The Great Western Hospital’s record regarding MRSA infection is very good and reflects the standards of general cleanliness in the hospital. All Carillion Health housekeeping and catering staff are trained in infection control measures and have extensive protective clothing and equipment provided to ensure they can meet the highest standards of infection control. Additionally, Carillion senior staff join in Infection Control and Clinical Risk Committee meetings in order to ensure the support services remain right up to date with best practice on developments in the control of communicable diseases, such as MRSA. Where it is shown that new best practice involves an investment in equipment or a need to change procedures, we adopt these new ways of operating in order to provide improved services to the Trust and its patients.



12. Question: Why do you recruit overseas nurses?

Answer: Overseas recruitment has been a very successful initiative for us. However, it is only one aspect of the Recruitment and Retention Strategy. We welcome experienced overseas nurses who bring an extra dimension and diversity to our workforce. The Department of Health has issued guidelines for overseas recruitment and we ensure we follow these.



13. Question: Why are you supporting the development of the University of Bath Campus on the Coate site when this is not supported by some of the local population?

Answer: Whilst we would not wish to comment on the wider advantages/disadvantages of the location of the Campus, which will be part of the overall planning process, we do feel able to speak on the benefits to the hospital. Briefly, these are:

• Recreational facilities - our staff would be able to utilise those on the Campus.
• Recruitment and Retention of hospital staff - we could provide more education locally and retain/attract staff. The University would also provide access to student labour.
• Shared estate infrastructure - the Campus could provide temporary accommodation and we could utilise their facilities, for example training facilities outside the academic year.
• Key worker accommodation - provision of local, low cost, accommodation would help us to attract staff.
• Green Transport - potential to develop shared Green Transport schemes.
• Research - adjacency would offer potential academic research into healthcare developments.

14. Question: You have a number of volunteers - how do you ensure you use their skills appropriately?

Answer: The utilisation of volunteers within the Trust is guided by the five year Community Liaison & Voluntary Services Strategy.

The process starts at interview when great care is taken to identify the skills and competencies held by the prospective volunteer. They are then guided towards selecting a role which both utilises their skills and meets their own motivational needs.

Annual "phone chat" appraisals are now undertaken for all volunteers and these help to follow up on the appropriateness of the original or current placement. It helps us explore the views of the volunteer and respond accordingly, either with a change of placement, role or further training - or indeed all three.

Role descriptions can also be modified, in consultation with the manager of the placement area, to include skills specific to the individual volunteer. For example, a retired midwife who is now a volunteer shows new mothers how to bath their babies. She has been deemed competent by the ward manager and the role description, including this tasks, bears her name.

Prospective volunteers can also make contact to offer specific skills. This can sometimes, where appropriate, lead to the setting up of new services such as the Breast Feeding Support volunteers who came to us via the Sure Start project.



If you have any further questions call the Communications Officer Chris Birdsall on 01793 604431 or mail him at: Chris.Birdsall@smnhst.swest.nhs.uk