Agenda item

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

(To receive a report from United Lincolnshire Hospitals NHS Trust (ULHT), which provides the Committee with an update on the Quality and Safety Improvement Programme.  Michelle Rhodes, Director of Nursing ULHT will be in attendance for this item)


Consideration was given to a report from United Lincolnshire Hospitals NHS Trust, which provided the Committee with an update on progress made with the Quality & Safety Improvement Programme.


The Chairman welcomed to the meeting Dr Neill Hepburn, Medical Director, United Lincolnshire Hospitals NHS Trust and Michelle Rhodes, Director of Nursing, United Lincolnshire Hospitals NHS Trust.


The Committee was advised that following the Care Quality Commission (CQC) inspections made during 2018, the Trust had developed and submitted an improvement plan to the CQC at the end of July 2018 containing 12 work programmes.  It was noted that the Trust's process for delivering and monitoring progress against the Quality and Safety Improvement Plan remained the same as 2017/18.  It was noted further that the Director of Nursing was the Senior Responsible Officer for Quality with individual Executive Directors being held responsible for each of the work programmes.  The Committee was advised that the Improvement Plan was scrutinised on a weekly basis and then presented to the Quality Safety Improvement Board every two weeks; and to the Quality Governance Committee monthly.


Attached to the report were the following Appendices:-


·         Appendix A – Highlight report: Improving Quality & Safety (May 2019);

·         Appendix B – Quality Safety Progress Overview Report (May 2019);

·         Appendix C – Quality and Safety Improvement Plan; and

·         Appendix D – Details relating to Divisional Leads and Trust Board members July 2019.


The Committee noted that since the February inspection in 2018, measurable progress had been made in response to the CQC's immediate concerns. Details of the progress made against the work programmes were shown in Appendix B to the report.  Page 20 of the report highlighted some identified challenges relating to Safety Culture; the Deteriorating Patient and the Emergency Department at Pilgrim Hospital.


It was highlighted that a further core visit had taken place during June 2019, when five pathways had been inspected at the Pilgrim and Lincoln Hospital sites.  The Committee was advised that feedback had been received for the Lincoln County Hospital site in relation to: Urgent and Emergency Care, Maternity, and Children and Young People Services; and for Pilgrim Hospital Boston for Urgent and Emergency Care, Maternity and Children and Young People Services.  (Copies of the Care Quality Commission letters concerning the inspection of the Lincoln County Hospital and Pilgrim Hospital sites had been circulated to members of the Committee as part of the Supplementary Chairman's Announcements, as referred to in Minute 14 above).


The Committee was advised that the Trust was having a well led CQC inspection of core services in the week beginning 15 July 2019; and that the Trust was hoping that it would be moved out of special measures.  It was noted that once the report was released (anticipated in September) the Trust would share the findings with the Committee.


During discussion, the Committee raised the following issues:-


·         Some concern was expressed to the CQC findings of bullying of staff taking place at the Lincoln County Hospital site.  The Committee was advised that the Trust had also been very concerned that bullying was taking place.  The Committee was advised further that the Trust did not tolerate bullying or harassment.  It was reported that a meeting had already been held with one team; and that a piece of work would be carried out with the other identified area.  The Committee noted that the Trust was doing a lot of work around values and behaviours; and that when the Trust was employing new members of staff, they ensured that the individuals had the required values.  The Committee noted further that sometimes bullying could be the result of a member of staff not coping very well; the Trust was therefore looking at coaching, training and support to help prevent further incidents occurring.  It was highlighted that the situation would be closely monitored over the next 12 months;

·         One member referred to the impact of cultural issues at the Pilgrim Hospital, Boston site, as well as low staff morale and lower rates of staff appraisals.  Representatives present advised that the appraisal rates were 95% for medical staff; and 80% for nursing staff. The Committee was also advised that the Trust had published a clear strategy for each site.  It was noted that the main issue for the Trust was making sure that services provided were sustainable.  It was recognised that it had taken time to develop the Trust's vision, and that it would take further time to implement the vision; and the Trust was frustrated at the time it had taken.  Members of the Committee who had any specific concerns were invited to speak to a Trust representative outside of the meeting;

·         Appraisals – Confirmation was given that the completion of outstanding appraisals was being actively pursued, to make sure that all staff had a development plan in place.  A request was made for the Committee to have a copy of the Trust's Whistle Blowing policy; and details of the rate of staff appraisals;

·         The effect of the new tax rules introduced in 2016 relating to consultants.  The Committee was advised that this issue was being considered at a national level.  The Committee noted that some trusts had introduced a separate policy to allow consultants to opt out of the Pension Scheme following appropriate advice. Confirmation was given that the Trust would be looking forward to the Department of Health and Social Care developing a solution;

·         Some concern was expressed to the Children and Young People's Services Governance systems not being very well established.  The Committee was advised that governance had improved across the two sites with the establishment of multi-disciplined governance meetings, which had clear objectives; and with regard to clinical governance the Committee was advised that more staff were being trained.  Confirmation was also given that certain guidelines were being updated;

·         One member expressed concern that consultant staffing was not in line with RCPCH standards.  The Committee was advised that Lincoln County Emergency Department did not see enough children to warrant having a separate children's emergency department.  It was noted that there had been some improvement at the Emergency Department at Pilgrim Hospital, Boston;

·         NHS Annual Staff Survey – One member enquired whether the annual staff survey had highlighted any bullying issues.  The Committee was advised that the Trust had seen an increase in staff response rates, as 43% of staff had completed the last survey.  It was noted that the results from the survey had been mixed; and that plans had been put in place to address the concerns raised;

·         There was a need to concentrate on early intervention and prevention more;

·         Page 23 – QS04 Pilgrim ED – A request was made for  more supporting evidence being submitted to the Committee in future reports, once actions/milestones had been completed.  The Committee was advised that the Pilgrim Hospital Emergency Department Improvement Plan was currently being revised and would be including Lincoln Emergency Department going forward.  There was recognition that there was more to be done, however, it was highlighted that there was now better leadership in place, which the CQC had recognised on their last visit;

·         Some disappointment was expressed to the management of the 'deteriorating patient' at the Lincoln County site, particular reference was made to the fact that some patients had not been screened for sepsis in a timely way in line with national guidance, and there had been delays in patients receiving antibiotics.  The Committee was advised that 88% of 'at-risk' adults had been screened within one hour; and that the national standard was over 90%.  The Committee noted that due to information technology issues, some instances of screening had not been recorded.  Reassurance was given that the rate for screening  would be at 90% for the next month;

·         Waiting times for ambulances – The Committee was advised that the position had improved at Pilgrim Hospital but not at Lincoln County.  The Committee was advised that an Improvement Plan was in place to help the system.  Confirmation was also given that 'Fit to Sit' was used at all sites when it was appropriate; and that ambulatory care was operating when the CQC visit took place;

·         One member from personal experience expressed thanks to the fantastic staff at Pilgrim Hospital, Boston for the brilliant service received;

·         Complaints between day and night shift staff – Confirmation was given that some complaints were received between the two shifts.  To help prevent some complaints, the Trust endeavoured to block book agency staff to ensure some continuity.  It was also noted that agency staff received an induction programme;

·         Response of the ULHT Board to the letters issued by the CQC.  The Committee was advised that letters had been considered by the Trust Board at their meeting held on 2 July 2019; and that the letters had been sent to the clinical divisions involved and action plans would be developed.  In some areas action had been taken immediately;

·         One member enquired when projects rated as 'amber/green' would move into the green category.  The Committee was advised that work was on-going now to move the projects to green and that evidence was being checked.  The Committee was advised that the next report would show that a lot more projects had now moved into the green category;

·         Page 30 – Safeguarding Project - A question was asked why this had been rated as green, when it was forecast to be 'amber/green'.  The Committee was advised that final pieces of work were being completed regarding 'conscious sedation'; and that learning disabilities policies within the diagnostic department were nearing completion;

·         Page 20 – Paragraph 1.3 – Identified challenges - One member requested the action plan including timescales for the achievement of the milestones.  The Committee was advised that the Safety Culture milestone had been completed; the 'deteriorating patient' milestone would take approximately six months to complete; and that the ED Pilgrim Hospital, Boston was work on-going.  A request was also made for a plan with timescales for the November meeting;

·         Correlation between the CQC's additional findings and those projects reported by ULHT.  The Committee was advised that the project overview report would be updated to reflect recent CQC findings, and where work had been completed, these milestones would be removed; and

·         Recruitment strategies – The Committee was advised that recruitment was conducted in accordance with the Trust's recruitment strategy and that going forward there was a focus on the values of the Trust and that all new members of staff were made fully aware of those values.  It was further highlighted that the top 200 managers/leaders at the Trust had to undertake a development programme.  The Committee was advised that workforce was a significant issue for the Trust; and that national and international recruitment was being considered.


The Chairman on behalf of the Committee extended thanks to the presenters for their open and honest report.  The Committee also thanked Michelle Rhodes for all her work with the Committee and extended their best wishes to her for the future.




1.    That the United Lincolnshire Hospitals NHS Trust – Update on the Care Quality Commission Inspection be received.


2.    That an update to include a response plan to the CQC findings be presented to the Committee meeting scheduled to be held on 13 November 2019.


3.    That information relating to the rate of appraisals conducted; and a copy of the Whistle Blowing policy be presented to 13 November 2019 meeting.

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