IN THE Hotseat this week was Chief Executive of the Great Western Hospital NHS Foundation Trust, Nerissa Vaughan.
We grilled Nerissa with your questions and here’s what she had to say.

Q. Why does it seem that people who are admitted to the Great Western Hospital come out with a worse illness than they went in with?
Clearly I don’t think that’s the case. We treat thousands of patients every year and I get as many compliments as I do complaints. We do sometimes get it wrong and when we do, we take it very seriously and we follow that through to make sure we put everything right. Sometimes it is more complex than little issues and it will require changes across services. But most of the complaints are about communication rather than clinical care. Our staff do a fantastic job of improving outcomes - we’re seeing more and more patients because they are doing such a good job and people are living longer.

I think the care we’re delivering is second to none. 1.5 million people were cared for by the Trust last year and that will range from somebody turning up with minor ailments to those with proper complex symptoms. The complaint figures year on year are going down and this year we have seen a significant decrease in the number of complaints we’ve received, and that means we are bucking the national trend. I’m delighted we are getting that bit right. One of the things we have started doing is the Friends and Family Test - we get feedback from 2,000 people a month and the majority of these will be positive and these will be fed back to the nurses on the wards. Only a small number will be significant complaints.

Q. When are you going to cut back on the grossly overpaid admin and managerial posts and employ more medically experienced staff?
We’ve got pretty low management costs We run a service within which the expenditure is nearly £3m a year. We’ve got 5,500 staff and management posts make up a small number, it’s miniscule when you compare it to the private sector. Seventy per cent of our workforce is nursing staff, we’ve got to put it into context. We’re a bit organisation, we do need some management, but the focus really is about clinical care. Even those managers are managing clinical pathways. It’s very much about developing services with clinical staff. We’ve been investing in nurses in the past year, and we’ve got 130 new nurses and we’re still recruiting. We’ve also had a 14 per cent increase in the number of consultant staff at the hospital.

Q. How many doctors and how many nurses employed at the GWH received their medical training overseas, and how many official complaints received about medical staff at the hospital relate to those who did not receive their training in the UK?
Anybody that goes into healthcare will have gone through recognised training, even if they do come from overseas, we check that their registration is equivalent to ours. There should be absolutely no difference between those trained overseas and those in this country. We’ve seen a 15 per cent fall in complaints over the last year and that is not an insignificant achievement.

With every consultant interviewed at the hospital, there will be someone from their royal college present, so if we are interviewing a physician for example, somebody from the Royal College of Physicians will be on the panel. Their role is to check that the qualifications, even though they may be European or further afield, are equivalent to our qualifications in the UK. Two years ago a revalidation process was introduced for GPs - they go through an appraisal system every year and they have to go through revalidation every five years to ensure they are fit to practice.

Q. Where do you stand in fast tracking a purpose built radiotherapy unit in Swindon? Everything seems to have gone quiet whilst patients are having to travel to Oxford for treatment. What is happening, when is something going to happen and why the delay?
I’m really keen on this. One of the things immediately obvious to me when I came to Swindon was there were gaps in some of the services which I would have expected to see in an area like this, and radiotherapy was a clear example. I was pretty horrified that patients were having to travel up to Oxford every day. We’ve really been fast tracking the process for radiotherapy and we are doing working with Oxford to ensure we’ve got a service locally.

It does take time because of the level of investment and the equipment needed. The business case approval process is what is slowing things down. The funding has been approved, the business case has been approved it’s due to go to the full business case in the summer. Because Oxford isn’t a foundation trust it has to go through trust development authority to see if it is financially viable. I don’t think it is a bad thing that it has to go through this approval process, there’s a lot of public money being spent to do this and the process has been fairly quick given the complexity of it. It’s moved on a lot this year and we’ll see a lot more movement around Christmas time. We’re aiming for 2017. We think a public appeal will launch early 2015.

Q. Why is the food so consistently poor? Would you eat it?
I do eat it yes, I often have the sandwiches, and I sit in the restaurant when I have time. I think there’s definitely things we can do to improve the food, it’s the very nature of delivering food to a huge number of people at certain points of the day when the hospital is busy. I think the food is a bit expensive but I don’t think the restaurant is all that bad, I think it’s pretty good quality. There’s obviously things we can do to improve the choice for patients, so they’ve got a number of different options. The transportation of the food on to the wards and the presentation of it can sometimes suffer, I don’t mean that in a derogatory way, but getting it from A to B and making sure temperatures are maintained.

We are definitely doing quite a bit of work with Carillion to improve the quality and the Chief Nurse is leading on that. It’s a big issue for her. There’s a lot of evidence that people get better quicker when they have good food and nutrition. We serve 400,00 in patient meals a year, and there’s not a huge amount of funding for these meals, the NHS doesn’t have a huge amount for food. We also do regular food testing checks every few days which I have taken part in.

Q. How difficult is it to run such a large organisation?
It has its challenges but to be honest I think Swindon is a very good hospital. I didn’t inherit something that was a major problem. We’ve had our challenges over the last two to three years but that’s largely because we are treating so many more patients. We’ve seen a huge increase in the number of patients coming to the Trust, and that is putting pressure on the service. So for me, really the challenge is that we’re delivering safe care when we are seeing such an increase in patients. We are sort of a victim of our own success as we help people and make them better, they are actually living longer and are therefore coming in to the hospital more frequently.

It’s a fantastic Trust, it’s somewhere I’m pleased to come to work, it’s challenging. The only stresses I find are when we get it wrong. When we get things wrong, that for me is what makes me stressed. It’s a responsibility definitely. I feel responsible and you’re never, ever away from it, even when I’m not there, I’m still thinking about it. It’s the nature of what I do. There’s more upsides than downsides if anything, it’s more frustrating sometimes if we can’t get things done quick enough because of the complexities of what we’re dealing with. The upside is when patients tell me the fantastic work the staff have done. I get that a lot. Sometimes I see wards struggling, like Jupiter ward for example, which had a number of things going wrong, to now see the fantastic progress that has been made there and see staff that really care about the service they deliver is just brilliant. When we get it right, we get it really right. Every day there’s interaction between human beings, one treating and one on the receiving end in often stressful situation. That is always going to have its challenges.

Q. The Swindon Renal Unit has been open since 2003 and yet more and more renal patients are still having to travel to Oxford three times a week, despite a twilight shift and a new ward starting in the near future. How can this be in the best interests of the patient and why after all these years has the situation not improved for the patient?
Dialysis is a growing requirement. It’s not just local to Swindon. That’s because more people are going into renal failure. More people are surviving having dialysis longer than before with improvements with the way they are treated. Over the last year, we have been working with Oxford like we have been with the radiotherapy, to increase the size of the unit. One area we could look into is home dialysis. I’ve worked on units where that’s been possible, and that will need to be part of the discussions we have with Oxford. It is something we are working on.

Q. Do you think staffing levels are dangerously low to the extent that it is jeopardising human life?
No. I think the challenge for us in staffing levels has been about not just making sure funding is in place, because we’ve had a lot of investment. The problem has actually been recruiting sufficient nurses, which is why we’ve been working overseas. We did have a moderate concern in the CQC inspection last October/November about staffing levels, and since then these nurses have arrived and they’re now working in the hospital. I think we’re in better shape than we were 12 months ago. There’s always more we can do and we are doing more in recruitment. This week we’re out in Spain to recruit additional nurses. There is a national shortage of nurses and we are doing imaginative things like working with universities, trying to get people back into nursing, but there aren’t enough nationally to meet the needs. I don’t think we are at dangerous levels.

Q. What is the current situation with car parking at the GWH and are there any plans in place for future expansion?
The hospital is over crowded because we’re treating more patients. The car park was designed for a lot less patients than we now treat. It was built 12 years ago, the demand for parking was much lower then. It’s increased year on year. In September we got planning approval to improve the number of spaces for staff which we have done. We’ve changed the Brunel Treatment Centre car park at the back, we’ve added patient and visitor spaces and we’ve got more disabled spaces, so we’ve done quite a lot to manage the demand in car parking.

For us to just put a multi storey car park in, it would be incredibly expensive and that would be money which could be used to treat patients. It’s a problem in a lot of places, I went to Oxford the other week and I couldn’t park. It’s a major challenge.

Q. How many patients missed their appointments in the last year and at what cost to the hospital? How can we, the patients and staff help to prevent missed appointments?
Last year we had 730,000 outpatient appointments and we had 40,000 DNA’s (did not attend), at a cost of approximately £5 million. Some of those will be people who have chosen not to turn up without letting us know, but there will be some where our own process needs to be improved. We know there is a process to get right, but the majority of these people are simply patients who just didn’t turn up. If you have an appointment and you can’t make it, and there’s perfectly good reasons why many people cannot attend, please let us know and then we can reallocate the appointment to somebody else.