Daily Insight: Virtual reality

Worcestershire’s virtual reality

Worcestershire Acute Hospital Trust was in the news again – this time for a whistleblower’s claim that A&E staff avoided four hour target breeches by placing patients in a “virtual” ward.

In the spirit of openness and transparency, Worcestershire shared with HSJ its original investigation in to the allegations.

An internal audit found that A&E patients were recorded on the trust’s system as being in the emergency decisions unit, when in fact they still remained in A&E.

Auditors also found examples where times entered in to the system did not match the time a patient was actually moved – resulting in the “four hour clock” being stopped too early and the trust avoiding a breach.

The trust is clear its investigations found no deliberate attempt to “game” the system but did admit there were some “poor processes and recording” issues.

According to the trust “virtual EDU”, which was being mentioned at senior managers meetings as early as 2013, was a term used to describe the discrepancies in the system rather than an active “policy initiative.”

This story is just one in a series of recent reports about Worcestershire, after the CQC gave the trust just six weeks to address patient safety issues.

The majority of issues highlighted by the CQC related to poor governance and process which would certainly speak to the trust’s audit findings.

The trust certainly has a long road to recovery, and the first stop it seems to have made is to appoint an NHS Improvement director as its acting chief executive for the next two months.

Richard Beeken, a regional director for NHS Improvement, will be the trust’s temporary chief, presumably to guide the trust through its CQC requirements until Michelle McKay joins permanently at the end of March.

A different world

There’s a lot of noise around A&E all the time these days, so it’s worth remembering that December’s results are especially bad.

Not only the worst performance since the target was introduced, but a disproportionate slide at type one units (proper A&E, not including walk-in centres and the like), compared to the increase in attendances.

Some trusts recorded steep declines in the face of steep increases in attendance, year on year (Hillingdon Hospitals, for example).

In December 2016 the three acute trusts in Cambridgeshire saw 50 more attendances than in December 2015 but all saw falls in performance of 19 percentage points or more – it’s not really clear what happened there.

A few saw an improved performance after a small increase in attendance (congratulations Hull and East Yorkshire).

All this takes place in the shadow of the A&E coding story in Worcestershire (see above), which had a terrible score for December. If results were distorted by counting patients in a “virtual” ward then the real position must be quite something.

Jeremy Hunt has already expressed concerns about the trust.

But the question is whether there are other trusts out there doing similar things.

Back in 2009, a chief executive had to resign over just eight 12 hour breaches. There had also been allegations of gaming.

We’re in quite a different world now: from October to December 2016 there were 1,257 12 hour breaches.