Agenda item

(To receive a report from United Lincolnshire Hospitals NHS Trust, which provides the Committee with an update on progress with the response to the Care Quality Commission inspection.  Senior Managers from United Lincolnshire Hospitals NHS Trust, will be in attendance for this item)

The Chairman welcomed to the meeting the following presenters from United Lincolnshire Hospitals NHS Trust:-

·         Kevin Turner, Deputy Chief Executive;

·         Dr Neill Hepburn, Medical Director; and

·         Michelle Rhodes, Director of Nursing.

The Director of Nursing provided an update on United Lincolnshire Hospitals NHS Trust progress in response to the Care Quality Commission inspection.

The Committee was advised that the Trust had a Quality and Safety Improvement Plan (QSIP) in place which included twelve work programmes, with individual Executive Directors being responsible for each of the work programmes.  It was noted that the QSIP was scrutinised on a weekly basis and was presented to the Quality Safety Improvement Board bi-weekly; and to the Quality Governance Committee (QGC) monthly, with escalations of issues being referred to the Trust Board via the QGC.

Detailed at Appendix A to the report was a Glossary of Terms; and Appendix B provided the Committee with an overview of progress made up to the end of January 2019.

It was reported that since the inspection in February 2018 measurable progress had been made in response to the CQC's immediate concerns, and that all twelve programmes were on track to deliver what had been agreed.

The Committee was advised that there were still some risks attached to the programmes and that everything was being done to mitigate those risks.  The Committee noted that some significant work had been done relating to Children and Young People.  The Committee was advised further that a senior nurse had been on secondment from Leicestershire to identify any gaps relating to provisions for children.  It was reported that from the analysis of the data captured, a plan would be created which the Trust would be happy to share with the Committee (in approximately two months' time). 

It was reported that all the posts had been filled within the Children and Young People Directorate; and that the new structure would take forward the work programme.

The Trust was pleased to advise the Committee that its hospital mortality rates had reduced significantly.

It was highlighted to the Committee that governance was still not as strong as it could be; and that governance procedures had been developing over the last year.  The Committee was advised that when the new structure came in to force from start of April 2019, more governance arrangements would then come into place.

It was reported that the biggest clinical risk was the lack of staff at Pilgrim Hospital, Boston.  The Committee was advised that on 25 February 2019 an unannounced visit had been made by the CQC to the Emergency Department at Pilgrim Hospital, Boston.  The Committee was advised that the inspection report was not available yet, and that when it was it would be shared with the Committee.  The Committee noted that the CQC had seen improvements, which confirmed what the Trust was experiencing.

It was highlighted that the main issue at the Emergency Department at Pilgrim Hospital, Boston was overcrowding, this was an issue the Trust was encountering on a daily basis, and one the Trust at the moment was unable to resolve.  The Committee was advised that the Trust would keep the Committee informed of progress and the outcome of the CQC inspection.

During discussion, the Committee raised the following issues:-

·         How the hospital mortality rates in the United Kingdom compared with the rest of the world.  The Committee was advised that the methodology for the two most common hospital mortality rates related to the United Kingdom.  For both the SHMI (Summary Hospital-level Mortality Indicator) and the HSMR (Hospital Standardised Mortality Ratio), confirmation was given that the indicators were re-based every year at 100, therefore every year the Trust needed to improve;

·         One member expressed appreciation of the work done so far by the Trust and the continued improvements;

·         The representative from Healthwatch advised that patients were still expressing concerns about the waiting times at A & E at Pilgrim Hospital, Boston; that patients were experiencing problems with appointments being cancelled and then being given several appointments on the same day; and also it was highlighted that Healthwatch had received a few comments on the level of care received as patients.  The Trust was disappointed that some negative comments had been received and agreed to seek more information from Healthwatch outside the meeting.  The Committee was advised that changes to appointments might be as a result of having to maximise the numbers of patients in a clinic, for example having to change an appointment time by 15/20 minutes.  Trust representatives agreed to look into the issue.  The Committee was advised that longer waiting times in A & E were replicated throughout England and were not just in Lincolnshire.  It was reported that other initiatives were being developed to reduce the pressures on A & E, such as using GPs, pharmacies and the use of primary care streaming at the front of A & E departments.  It was highlighted that whatever systems were put in place, the Trust always ensured that their priority was to ensure that patients were kept safe;

·         A question was asked whether there were any plans to use capital funding to extend the facilities at Pilgrim Hospital.  The Committee was advised that plans had been submitted as part of a county-wide NHS Capital Bid, which had not secured any funding;

·         One member enquired as to what Intentional Rounding was?  The Committee was advised that Intentional Rounding referred to nurses checking patients on their rounds every hour; this was a way of making sure the patient was well; and that there had not been any deterioration.  It was noted that a Safety Huddle was when doctors, nurses etc., got together to share intelligence on patients in their care.  The Committee noted that the introduction of both pilots had made significant differences on the wards; and in A & E Pilgrim Hospital, Boston.  It was noted further that the processes would be embedded across the Trust;

·         One member enquired what effect A & E pressures were having on patients.  The Committee was advised that governance had been strengthened; and systems were in place where there were identified hotspots.  Doctors and nurses now had better knowledge about working with children in A & E.  The Committee were reminded that the full plan presented to the Committee previously detailed all the measures that were being put in place to improve the patient experience;

·         The need for more preventative measures;

·         The need to ensure that good news stories were celebrated and communicated better to the general public;

·         Attendance at conferences to share best practice.  Confirmation was given that staff were supported to attend conferences to develop best practice.  The Committee was advised that best practice was shared across Trusts, for example with North Cumbria (an outstanding trust), which had resulted in learning on both sides.  It was also highlighted that best practice was shared when staff attended conferences;

·         The need to get the message out better regarding alternative provisions to attending A & E.  Reference was also made to better publicity of the Advice App.  It was also highlighted that there needed to be a generational health care shift; and

·         A suggestion was made for the inclusion of the Grantham A & E into the system to help alleviate the peaks at Lincoln and Boston.

In conclusion, the Chairman on behalf of the Committee extended thanks to the three presenters for the considerable amount of work that had been done and for to the improvements that had been made so far.  Thanks were also extended to NHS Staff for the brilliant job they were preforming performing.

RESOLVED

1.    That the update and progress made in response to the CQC inspection report be noted.

2.    That a further update on the United Lincolnshire Hospitals NHS Trust – Care Quality Commission Inspection be received by the Committee in three months' time, along with a copy of the updated RAG report.