Agenda item

United Lincolnshire Hospitals NHS Trust - Update on Care Quality Commission Inspection

(To receive a report from United Lincolnshire Hospitals NHS Trust which provides the Committee with an update of the Care Quality Commission (CQC) inspection at United Lincolnshire Hospital NHS Trust (ULHT))


The Committee gave consideration to a report from the United Lincolnshire Hospitals NHS Trust, which provided the Committee with an update on the Care Quality Commission (CQC) Inspection at United Lincolnshire Hospitals NHS Trust.


The Chairman welcomed Jan Sobieraj, Chief Executive, United Lincolnshire Hospitals NHS Trust and Michelle Rhodes, Director of Nursing, United Lincolnshire Hospitals NHS Trust.


Detailed at Appendix A to the report was a copy of the Quality and Safety Improvement Plan for the Committee's consideration.   It was highlighted that the Trust was receiving peer support from Northumbria Healthcare NHS Foundation Trust.


The Committee was advised that the CQC had inspected the United Lincolnshire Hospitals NHS Trust between Thursday 15 February and Thursday 8 March 2018.  This had then been followed by a separate 'well-led' assessment which had taken place between 10 April and 12 of April 2018.


It was noted that not all services had been inspected, but all sites had. The services inspected included:-


·         Urgent and emergency care

·         Medical care

·         Surgery

·         Outpatients at Lincoln and Pilgrim

·         Children and young people's services inspected at Pilgrim

·         Medical care and surgery at Grantham

·         Surgery at Louth


Overall, the Trust was found to have improved its overall rating from 'inadequate' to 'requires improvement'.  It was noted further that two of the four locations had been rated as 'good' overall, one as 'requires improvement' and one as 'inadequate'.


The Committee was advised that the Trust had developed and submitted an improvement plan to the CQC at the end of July 2018.


The report presented provided information on a number of areas that had been identified as requiring focus to improve.  It was highlighted that these were all challenges known to the Trust and that the CQC report acknowledged that the Trust had already commenced improvement works in these areas.  The three key areas identified were:


·         Delivering urgent and emergency care on the Pilgrim site specifically the Emergency Department;

·         Care of children and improving the responsiveness of services for children; and

·         Developing and delivering robust governance from Board to ward to be effective, robust and effective.


The Committee was advised that the Quality and Safety Improvement Plan would be scrutinised on a weekly basis and would be presented to the Quality Safety Improvement Board bi-weekly and the Quality Governance Committee monthly.  It was noted that upward escalation of issues would then be to the Board via the Quality Governance Committee.


During discussion, the Committee raised the following points:-


·         The Trust was commended for its aspirations, but disappointment was expressed as to the lack of evidence supplied in the report.  The Committee was reassured that there was evidence, which had to be signed off by the CQC.  The Committee was advised that this information would be available once it had gone through the governance process;

·         Some concern was expressed regarding safeguarding issues and to 14 to 16 year olds being placed on an Adult wards.  The Committee was advised that the number of people trained in safeguarding was down by a couple of percent.  However, a programme of work was ongoing to improve the training percentage; and confirmation was given that no issues had been raised regarding safeguarding practice. There was recognition that all staff needed to be trained to deal to with younger patients;

·         Some concern was also expressed regarding the need to reduce the amount of violence and abuse received by staff.  The Trust advised that it did not tolerate any abuse to its staff.  It was highlighted that patient violence was on the increase; and the Trust offered full support to its staff.  One member expressed concern regarding the morale of staff.  The Committee noted that a lot of positive feedback was received and that there was a 'thankyou' recognition scheme.  It was noted that 800 staff had been nominated in the previous year.  The Trust had also introduced the 'Daisy Scheme' which was an international scheme, which four hospitals in the UK had adopted, where patients were able to acknowledge the care provided.  The Trust also had a staff award scheme.  There was a recognition that the Trust needed to promote 'positive things' more;

·         A question was also asked as to how far behind waiting times were.  The Committee was advised that the length of waiting times had been increasing, but some of this was by Clinical Commissioning Groups; and the level of paid activity set by the contract;

·         The need to update patient medical records as recording information on paper was outdated.  There was recognition that this was an area that needed improvement.  The Committee noted that a capital bid had been made to address the issue of patient records.  Some concern was also expressed that outpatient services still needed improvement particular reference was made to quality and safety.  Reassurance was given that a plan was in place to tackle the issues raised; and

·         Some concern was expressed to the fact that the A & E at Pilgrim Hospital, Boston had slipped back as much as it had; and to the issue of staffing levels.  The Committee noted that some of the people that visited A & E could have been dealt with elsewhere in the system.  It was highlighted that plans were in place to explore other recruitment projects.  Confirmation was given that the Trust was managing to get staff to maintain the rotas.  It was highlighted that when the CQC had visited the A & E at Pilgrim Hospital, Boston, it had been when the 'beast from the east' had descended on Lincolnshire; and members of the CQC team had helped on the wards and A & E.  It was highlighted that the CQC had been impressed as to how staff had all pulled together a very busy time to provide a service.


The Committee acknowledged the improvements made by the Trust.




1.    That the Care Quality Commission's finding be noted.


2.    That the progress made by United Lincolnshire Hospitals NHS Trust since the inspection in February and April 2018; and its future plans for improving quality and safety be received, with evidence to support improvement being forwarded to members of the Committee once the Trust had given its approval.


3.    That going forward quarterly updates be received from United Lincolnshire Hospitals NHS Trust with regard to progress being made with the improvement plan; to include clear timescales and evidence.

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