In the run-up to the Election, I promised that with Parliament having such long holidays I would spend several weeks a year work shadowing in local public services, businesses and charities. I think it’s really important for MPs to keep in touch with what’s going on in their constituency and hear first hand from people working at the coalface what challenges they face and what impact Government policies are having.
So I've spent this week at Mayday (soon to be renamed Croydon University Hospital). Chief Executive Nick Hulme kindly put together a programme that meant I got to see most parts of the hospital.
I spent Monday morning with him in various management meetings and the afternoon with a matron who is responsible for two elderly care wards. One of the meetings in the morning was about the Trust's application to become a Foundation Trust, which would give it greater financial and managerial freedom. This application is very important. The Secretary of State has said he wants all trusts to become Foundation Trusts. If Mayday's application isn't successful, it will be merged with another trust. I believe it is very important that Croydon has its own trust focused on providing services to the residents of this borough rather than being lumped together with some other part of London. One of the tests the Trust has to pass is about engagement with the local community - staff, patients and local residents can become members and help to hold it to account. If you are interested in the quality of local health services, you can become a member here.
On Tuesday morning I was with one of the Assistant Directors of Nursing and in the afternoon I was with the human resources and organisational development team. I was very impressed with the NHS Jobs website - all jobs in the NHS are advertised on one website, making it much easier for people to find work and saving each Trust a fortune in advertising. This is something other parts of the public sector should look at. The Trust is also running a really good project with the Job Centre Plus and a charity called CITE to help local unemployed people get into work. And I also learnt about Mayday's volunteer programme - over 260 local residents give some of their time to help at the hospital, including one person who has been giving up their Sunday morning for 38 years. If you'd be interested in volunteering, you can find out more here.
On Wednesday morning, I got a look at the way the Trust is using technology to improve patient care and then spent the afternoon in A&E. Some of the technology is really impressive and is driving improvements in patient care - the robots that run many of the tests in pathology; a new MRI scanner that is the best in the country; a system that allows doctors to look at X-rays on a computer anywhere in the hospital rather than a porter having to go and get the films; and Vital PAC, hand-held devices for nurses into which they can input observations, reducing the need for paperwork, displaying the trend over time and advising when observations need to be repeated. But I did see areas where improvements need to be made - for example, the staff that take calls from patients about their outpatient appointments can't currently access appointment lists for some parts of the hospital.
On Thursday, I spent the morning in an operating theatre observing several operations (not for the squeamish!) and the afternoon with Community Services, in particular the wonderful Children’s Hospital at Home team who, as the name suggests, provide care for children - often with life-threatening or life-limiting conditions - at home. Mayday took over responsibility for community services like this on 1st August to form Croydon Health Services and there is a real opportunity to integrate them even more closely with the acute services provided at the hospital to improve patient care. For example, in the past there were two seperate physiotherapy teams, one at the hospital and one in the community and when you were discharged from hospital you were passed from one to the other. Staff at the hospital may have been unsure what level of support would be available in the community so would keep patients in hospital that bit longer. In the future, the same physiotherapist should be able to care for you in hospital and after you are discharged, which is better for patients and should mean you get discharged a bit quicker.
And on Friday I spent the morning looking at outpatient services - about which I have already commented above - and the afternoon back with Nick Hulme.
A few general observations. Lots of constituents contact me about Mayday, some full of praise for the care they or a relative or friend received, others less happy. It was great to see that staff at all levels are aware of this mixed feedback and are working hard to ensure the Trust consistently delivers high quality care. The Trust recently published five Patient Promises, setting out what patients should expect. Most of the complaints I receive are about how patients are cared for rather than medical outcomes - for example whether anyone checked that an elderly patient was eating their meals - so I was really pleased to see that one of the promises is that patients should feel cared for by helpful and welcoming staff, who respect them as an individual. To help make sure that is the case, the hospital has introduced hourly rounding - nurses checking with their patients at least once an hour whether they need anything, anonymous 'Just a minute' feedback cards and a number of matrons, several of whom I got to meet and who are clearly making a real difference.
Second, the quality of the estate is variable. Some of the wards and clinics are state of the art but others, particularly some of the outpatient clinics, are in need of investment.
And third, the hospital is running at pretty much full capacity. On the days I was there, virutally every bed was occupied. Clearly it wouldn't be a good use of resources if lots of beds were empty but running at or near 100% occupancy isn't easy and it was inspiring to see the commitment of staff at all levels to providing a good service to the people of Croydon.
Finally, despite the fact that the Coalition Government is protecting the NHS from the savings that are having to be made in other parts of the public sector, the rising costs of drugs and our ageing and increasingly diverse population means that the Trust still has to take some pretty tough decisions to balance the books. In that context, it is worth noting that 14 per cent of patients do not attend their appointment, a shocking waste of resources. I am sure the Trust could do more to remind people and make it easier for them to get through to the right person to say they are not attending, but I think we should also look at whether people who waste precious NHS resources in this way should face some kind of penalty.
A very big thank you to Nick for arranging the week, to everyone who showed me round and to those staff and patients who allowed me to observe procedures. Next up, a week in a primary school, hopefully at the end of September.