Agenda item

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

The Chairman welcomed to the meeting:-

·         Jan Sobieraj, Chief Executive, United Lincolnshire Hospitals NHS Trust;

·         Dr Neill Hepburn, Medical Director, United Lincolnshire Hospitals NHS Trust; and

·         Michelle Rhodes, Director of Nursing, United Lincolnshire Hospitals NHS Trust.

In guiding the Committee through the report, representatives from ULHT provided the Committee with an update on the progress made with the response to the Care Quality Commission (CQC) inspection.  It was noted that details for each of the work programmes were shown in Appendix A.  It was noted further that the Trust was making positive progress against the work programme with some areas making some significant improvements; these specific areas included were Safety Culture; Governance and The Deteriorating Patient.

It was noted further that the CQC inspection report had identified a number of 'must do's' and 'should do's' all of which had been mapped to individual work programmes.  The Committee noted that good progress was being made on all of these.

It was highlighted that some challenges had been identified, details of which were contained on page 23 of the report presented.

The Committee was advised that due to the fragility of the service, the performance of Pilgrim Hospital Emergency Department would continue to be monitored daily by ULHT's Executive Directors and Senior Leadership Team.

The Committee were taken through each of the Quality and Safety Improvement Plan – Work Programmes as detailed in Appendix A to the report.  The Committee noted that Appendix B provided key milestones reported at the weekly Quality and Safety Implementation Group, fortnightly at the Quality and Safety Improvement Board and monthly to the 2021 Programme Board, and the Quality Governance Assurance Committee and Trust Board.

During discussion, the Committee raised the following issues:-

·         The positives gained from learning and sharing information and dialogue with other health trusts;

·         The problems encountered from having a long term shortage of specialist staff.  It was reported that it was difficult embedding learning and culture, when staff were only present for short periods of time.  The Committee noted that there was a vigorous assessment process in place when an incident occurred.  It was noted further that induction and follow up processes were being embedded to reduce or prevent mistakes;

·         How staff were trained to check for the 'basic things'.  It was reported that when nurses were trained 'basic things' formed an integral part of the training, for example making sure that the correct patient was being treated through "positive patient identification".  Further clarification was sought concerning a "never event".  The Committee was advised that there were lots of near misses; and reassurance was given that lessons were learnt from near misses.  It was noted that staff were encouraged to come forward early in a situation, so that the matter could be dealt with promptly.  It was highlighted that this was being embedded as part of the learning culture;

·         Resource concerns – It was highlighted that out of all the programmes, Pilgrim Hospital, Boston ED was the biggest risk, due to the number of temporary staff.  It was highlighted further that £100,000 had been spent on agency nurses from just one agency.  The Committee noted that the Trust was trying to integrate the temporary staff into the team, by getting the same agency nurses when possible, this then made for safer working, ensuring the staff were inducted, and were able to access further training.  It was highlighted that temporary staff were costly, and that as a result the deficit figure was increasing.  The Committee noted that staff recruitment was a national issue.  It was noted that the Trust was in the process of up-skilling existing staff, to reach the required skill mix; and that more was being done to get the required skill mix across the whole of the hospital;

·         Page 25 – QS04 – Pilgrim ED – One member highlighted that it was good to see that the department wished to consistently achieved 95% plus 4hr target, however, it was felt that this was optimistic target, based on the identified challenges highlighted in paragraph 1.3 of the report.  The Committee was advised that action was being taken and that over the last two years, a senior management leadership programme had helped the Trust attain a level of management skills; that the introduction of the staff charter had provided clear expectations; and that contracts now clearly defined personal responsibilities.  The Committee was advised that all staff were encouraged to advise management of issues that were not working, or needed looking at further.  The Committee noted further that the Trust was also bringing people in from other well performing ED Departments to share their knowledge and expertise.  So far, this exercise had proven to be very helpful.  Clarification was given that the QS04 on page 25 was the target the Trust was aiming to achieve;

·         Ambulance waiting times – The Committee was advised that waiting times had improved over the summer, but there was more that could be done;

·         Staff recruitment – The Committee was advised that some additional staff had been recruited with the necessary skill set;

·         Some members welcomed the inclusion of the Improvement Plan;

·         Page 58 – Emergency Department at Pilgrim Hospital – Some concern was expressed that the milestone columns within the document had not contained any deadline dates.  It was felt that as a public document, dates should have been included.  The Committee was advised that the document was just a progress report which provided information of what was being done;

·         A question was raised concerning the cancellation of leave for some staff working on the Stroke Ward at Pilgrim Hospital, Boston.  The Committee was advised that this was not an issue any of the Trust representatives had knowledge of, and that this matter would be looked into outside of the meeting;

·         A question was asked whether the Trust was aware how extensive the next CQC inspection would be in the spring of 2019.  The Committee was advised that there was an assumption that there was the likelihood that it would be core services plus a review;

·         How the CQC rating had affected recruitment and retention of staff; and how maintaining staff morale was being addressed.  The Committee was advised that the Trust being in special measures had affected staff recruitment and staff morale; and that the situation was not likely to improve until the outcomes of the Lincolnshire Sustainability Transformation Plan had been agreed.  It was also noted that staff were working very hard to help the Pilgrim Hospital ratings;

·         Some members thanked Trust representatives for the progress being made, for their honesty in answering questions raised and for the confident way services were being improved. One area highlighted as needing more work was communicating better with the general public.  One member extended thanks to staff at Pilgrim Hospital, Boston for the level of care they had received.  The Committee was advised that from comments received from friends and families of patients, there was support that the level of care provided was getting better; and

·         One member enquired whether staff had access to the Datex IT system.  Confirmation was given that staff had access to Datex; and that any members of staff having problems, a Datex Team was available to help with any issues.

The Chairman, on behalf of the Committee extended thanks to the representatives for the on-going work of the Trust.

RESOLVED

1.    That the Care Quality Commission's findings as detailed in the report be noted and that a further update be received on the ULHT's progress in response to the CQC inspection at the 20 March 2019 meeting.

2.    That the progress made by Lincolnshire Hospitals NHS Trust in improving quality and safety since the inspections in February and April 2018 and the update to the Committee in September 2018 be noted.