Agenda item

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

The Chairman welcomed to the meeting Mark Brassington, Chief Operating Officer, United Lincolnshire Hospitals NHS Trust and Victoria Bagshaw, Director of Nursing, United Lincolnshire Hospitals NHS Trust.

The Committee was advised that the Care Quality Commission (CQC) had inspected the Trust during June 2019; and that a separate 'well-led' assessment had taken place during July 2019.  The Committee noted that the final inspection report had been published in October 2019.

It was reported that not all services and sites had been inspected. The services that had been inspected included:-

·         Urgent and emergency care at Lincoln and Pilgrim hospitals;

·         Medical care at Lincoln and Pilgrim hospitals;

·         Critical care at Lincoln and Pilgrim hospitals;

·         Maternity services at Lincoln and Pilgrim hospitals; and

·         Children and young people's services at Lincoln and Pilgrim hospitals.

Details of the 2019 Care Quality Commission ratings were shown on pages 28 and 29 of the report.  It was noted that the Trust remained with an overall rating of 'requires improvement'.  It was highlighted that the CQC report detailed a mix of positive improvements and current challenges for the Trust, many of which had been identified within the Trust prior to the inspection and formed part of the on-going Quality and Safety Improvement Plan.

It was reported that the individual ratings for each hospital was that Lincoln County Hospital and Pilgrim Hospital, Boston 'required improvement'. Grantham and District Hospital and County Hospital, Louth, which had not been inspected continued to be rated as 'good'.

The Committee noted that the Trust was in the process of developing an Integrated Improvement Plan and was reviewing the process and structure through which the plan was owned, delivered and assured.

The Committee noted further that the CQC had identified examples of outstanding practice and exemplary care across services, and that this was particularly recognised at Pilgrim Hospital, Boston, where the overall rating had moved from 'Inadequate' to 'Requires Improvement'.

Details of identified challenges for the Trust were shown on pages 30 and 31 of the report and Appendix A provided the United Lincolnshire Hospitals NHS Trust Response to CQC Must Do's and Should Do's for the Committee to consider.

In conclusion, the Committee was advised that the Trust was finalising an Integrated Improvement Plan following the inspection, which was a new structure through which the Trust described, delivered and monitored improvements.  The Committee noted that once the plan had been agreed, the document would be shared more widely.

It was also highlighted that the Trust had a programme of work to support the development of leaders and to further embed the new Trust Operating Model.  It was highlighted further that to improve the staffing position, the Trust was currently undertaking an extensive domestic and international recruitment programme for both medical and nursing posts, as well as working with universities to support further recruitment into nursing posts and supporting the development of the Lincoln Medical School.  The Committee was advised that since the inspection in July 2019, measurable progress had already been made to respond to the CQC's immediate concerns.

During discussion, the Committee raised the following issues:-

·        The opening of Grantham and District A & E 24/7.  The Committee was advised that no decision had been reached with regard to Grantham and District A & E as it was part of the Lincolnshire Acute Services Review and that there had been engagement on its future as part of the 'Healthy Conversation' in 2019;

·        Public availability of the Section 31 Enforcement Notice and Section 29A Warning Notice.  The Committee was advised that the content of the Section 31 Notice was shown within the CQC's report and was an enforceable Notice.  The Section 29A Notice was a warning.  Clarification was given that the CQC did not release copies of the Section 29A and 31 notices into the public domain;

·        Service changes at Pilgrim Hospital, Boston.  Representatives of the Trust advised that they were not aware of any imminent service changes;

·        Hand hygiene practices – The Committee was advised that this was an on-going issue.  The Committee noted that compliance did vary and that it was not just a problem in Lincolnshire;

·        Concern was expressed to the time taken to develop an action plan.  The Committee had previously been advised earlier in the discussion, that a new Integrated Improvement Plan was still being developed.  Reassurance was given that the new plan for the first time would bring together delivery, quality, performance and finances all into one document;

·        The three conditions applied following the 2019 inspection (as shown on page 31 of the report).  A question was asked as to how much impact staffing issues were having on the Trust being able to move forward.  The Committee noted that at Pilgrim Hospital, Boston maintaining staffing levels represented a significant challenge; and that half the nursing positions were being filled by agency staff.   On a more positive note, the Committee was advised that for the first time for six year's there were no gaps within the Trust for consultant-grade medical staff.  It was noted that the newly recruited staff would all be in place by the end of April. It was highlighted that the new members of staff would still need to undergo further training to help them transition into the NHS and the Trust.  Confirmation was also given that A & E staffing remained in a similar position; it was noted that there were proposals to expand the current establishment which would be concluded at the end of January 2020; 

·        The outcome of a recent CQC inspection.  The Committee was advised that inspectors had returned to Lincoln County Hospital; and Pilgrim Hospital, Boston Emergency Departments as part of winter assurance, not part of the normal inspection regime.  The headlines had been that Lincoln County ED was improving; and Pilgrim Hospital, Boston ED was under pressure.  The Committee noted that Pilgrim Hospital, Boston ED was not large enough to deal with the current level of demand and that funding had been allocated for building work, and this was expected to be completed in 2023.  The Committee noted further that the Trust was lobbying government for funding to extend Lincoln County Hospital's emergency department;

·        Sepsis – The Committee was advised that improvements had been made and the Trust was now in the top quartile nationally for detecting and treating sepsis;

·         The effect of the CQC report on staff morale – The Committee was advised that staff morale had been affected.  Talks were on-going with staff to obtain their views and to ensure that they were involved in the process and any changes.  The Committee noted that the Integrated Improvement Plan would highlight the challenges ahead, which would have a positive effect on staff.  It was highlighted that HR were doing additional work around specific health and wellbeing issues;

·        The CQC four hour A & E standard. The Committee was advised that the Trust was still waiting for planning guidance on any replacement to the four hour standard, which would then inform the Trust's direction of travel;

·        Timescale for the programme of works and the Integrated Improvement Plan being finalised.  It was reported that evidence had shown that this type of plan was successful.  The Committee was advised that once the plan had been developed and had received approval from the Trust Board, it would then be shared with the Committee;

·        A request was also made for more information regarding the refugee doctor project;

·        The involvement of NHSE/I in improvement planning since the Trust had entered special measures in 2016.  The Committee noted that the Trust had received national intensive support and regional support, which had provided the Trust with expertise and access to funding; and

·        Public reassurance to the 'inadequate' rating.  Reassurance was given that most areas were safe with systems and processes in place; and in the specific areas of concern highlighted; these concerns had now been addressed. 

The Chairman on behalf of the Committee extended thanks the representatives present and commended staff for their continued hard work in the areas where improvements had been made.

RESOLVED

1.    That a further update on the Care Quality Commission Inspection be received by the Committee in three months' time.

2.    That a copy of the finalised programme of works, the Integrated Improvement Plan and the RAG ratings be provided to the Committee.

3.    That information relating to the refugee doctor project be made available to members of the Committee.