Agenda item

(To receive a report from United Lincolnshire Hospitals NHS Trust, which invites the Committee to consider the information presented on the inspection report by the Care Quality Commission on United Lincolnshire Hospitals NHS Trust, and the Trust’s actions in response to the inspection report.  Andrew Morgan, Chief Executive and Karen Dunderdale, Deputy Chief Executive and Director of Nursing, at United Lincolnshire Hospitals NHS Trust will be in attendance for this item)   

Consideration was given to a report from United Lincolnshire Hospitals NHS Trust (ULHT), which invited the Committee to consider the information presented on the inspection report by the Care Quality Commission (CQC), and the Trust’s actions in response to the inspection report.

The Chairman invited the following representatives from United Lincolnshire Hospitals NHS Trust: Andrew Morgan, Chief Executive and Karen Dunderdale, Deputy Chief Executive and Director of Nursing, to remotely, present the item to the Committee.

In guiding the Committee through the report, mention was made to the unannounced core-service inspection and the announced ‘well-led’ inspection during the months of October and November 2021; the findings of the CQC report published on 8 February 2022, these were shown in Appendix A to the report; and Appendix B provided the Committee with details of the key findings of the report for their consideration.

It was reported that overall, the CQC had recognised the widespread improvements made by the Trust in the quality and safety of services since the last inspection in 2019.  Positive comments were also received about the Trust having a strong cohesive team with collective leadership at Board level.  The Committee was advised that the overall Trust CQC rating remained as being ‘Requires Improvement’.  It was highlighted that the overall rating of ULHT was not able to be changed, as the CQC had not inspected all services on all sites.

Comparison information with the previous 2019 ratings were set out on pages 27 to 30 of the report for the Committee’s consideration.

In conclusion, the Committee noted that the ULHT Board of Directors had considered the CQC report at their meeting on 1 March 2022, at which they had acknowledged the widespread improvements made and recognised that further improvements were required.  They had also endorsed the preparation of an action plan to be submitted to the CQC, as required, by 10 March 2022.

During consideration of the item, the Committee raised some of the following comments:

·       Some concern was expressed that Lincoln County Hospital still required improvement;

·       The good rating for Grantham and District Hospital and the excellent service provided by staff at the hospital.  The Committee noted that Grantham Hospital remained a key part of the Trust’s services; and confirmation was given that not all services could not be provided at all sites, as the Trust needed to ensure that services operated within safety standards and remained sustainable;

·       The need for the Committee to have access to the latest action plan;

·       The 2017 special measures.  The Committee was advised that the Trust was put into special measures because of quality, safety, and financial issues by NHS England (NHSE).  It was noted that the CQC had written to the NHSE concerning the recovery programme status, and it was hoped that the Trust would soon be exiting special measures and the recovery programme.  The Trust offered to share the action plan with the Committee at its May meeting;

·       Medicine Storage.  It was reported that significant work had been undertaken to ensure that medicines were stored safely and correctly and at the right temperature and that staff were aware of the procedures in place;

·       Staffing shortages.  The Committee was advised that ULHT was now in a better position than it was two years previously.  The Committee noted that the Trust had been successful in recruiting health care support workers and that more recently, the Trust had received some good applicants for consultant positions.  It was noted that widespread improvements had raised the reputation and profile of ULHT; as people now wanted to come to Lincolnshire to work for its location, the high standard educational provision for children but also for the attraction of ULHT being at the cutting edge of new development, for example the introduction of robotic surgery;

·       Bottom of Page 40 - areas for improvement relating to urgent and emergency care with regard to child protection information sharing.  The Committee was advised that this particular comment related to how the hospital system/GP system picked up the flags for looked after children as it had been identified that the approach taken was not consistent.  It was reported that work had taken place with the local authority to ensure that this had now been rectified;

·       Whether the Trust had made progress regarding the comment on the bottom of page 43 of the report relating to the organisational culture not always encouraging openness and honesty at all levels.   The Committee was advised that the Trust was not yet in the position where it wanted to be with regard to this matter, and that work was in progress to change procedures and processes to make things easier for staff.  One scheme mentioned was the recruitment of a “Speak up Guardian” whereby staff could speak to an independent person concerning their issues;

·       Bullying and harassment.  The Committee was advised that there had been incidents of bullying. The Committee was advised further that bullying was not tolerated by the Trust.  It was reported that mechanisms had been put in place to help mitigate any situations;

·       Reassurance was sought as to whether the Trust was meeting is legal requirement (as highlighted on pages 40 and 41 of the report pack).  Reassurance was given that since 2019, the Trust had made significant improvements; and that there had been sufficient evidence offered to the CQC to support the progress made;

·       Whether staff morale had improved.  The Committee was advised that the staff survey conducted in October 2021 still highlighted areas of concern.  It was noted that a further staff survey was due to take place shortly;

·       What measures were being put in place to improve the flow of patients into Lincoln County Hospital’s urgent and emergency department.  It was noted that this was an issue nationally, as well as locally.  Measures were in place to encourage A& E to be used appropriately and where possible patients should initially be signposted to 111, GPs etc.  It was also highlighted that there were also wider issues in the health and care system and the Trust was working with partners to help mitigate the situation; and

·       When would the Trust be moving away from paper records on to a digital way of working.  The Committee was advised that this was an area that needed improvement, and at the moment, further investment would be required to make that happen.

RESOLVED

1.     That support be recorded for the efforts of United Lincolnshire Hospitals NHS Trust, in making a range of improvements across a number of services, as reported by the Care Quality Care Commission.

2.     That a further update on improvements in line with the action plan be received by the Committee at its 18 May 2022 meeting.

3.     That a recovery update be received by the Committee at its 18 May 2022 meeting.