Agenda item

(To receive a report from United Lincolnshire Hospitals NHS Trust (ULHT), which invites the Committee to consider the Lincolnshire Elective Recovery Plan 2022/23 and the response of ULHT to the inspection report by the Care Quality Commission.  Simon Evans, Chief Operating Officer ULHT and Sarah Brinkworth, Planned Programme Lead, Lincolnshire Clinical Commissioning Group 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 Lincolnshire Elective Recovery Plan 2022/23 and the response of ULHT to the inspection report by the Care Quality Commission (CQC).

The Chairman invited the following representatives from United Lincolnshire Hospitals NHS Trust: Simon Evans Chief Operating Officer, Karen Dunderdale, Director of Nursing and Sarah Brinkworth, Planned Programme Lead, Lincolnshire Clinical Commissioning to present the item to the Committee.

The following appendices were attached to the report for the Committee to consider:

·       Appendix A – provided a copy of the Lincolnshire Elective Recovery Plan 2022/23;

·       Appendix B – provided a copy of the Response to the Care Quality Commission Report;

·       Appendix C – provided a list of CQC ‘Must do’s’ & ‘Should do’s’; and

·       Appendix D –provided a copy of the CQC Improvement Action Plan.

In guiding the Committee through the report, reference was made to: the response to the Care Quality Commission Inspection report, the CQC’s required actions following the inspection which were detailed at Appendix C; the five ‘Must-do’ actions that the Trust had to take action on in order to comply with its legal obligations, these were shown on pages 29 to 30 of the report; the Trust’s CQC Improvement Action Plan, a copy of which was shown at Appendix D to the report; and Lincolnshire’s Elective Recovery Plan for 2022/23, which was detailed on pages 34 to 30 of the report.

It was highlighted that the Trust Board would receive regular progress updates and that progress would be monitored using the Trust’s established Blue, Red, Amber and Green (BRAG) ratings and that any identified risks would be escalated to the Trust’s performance review meetings and reporting through Executive and Trust Leadership team meetings.  It was highlighted that a revised approach to obtaining assurance linked to the CQC had recently been approved and would be implemented for all elements of the Trust’s monitoring and management of actions in response to the 2022 inspection report.  Details of the approved process were shown on page 32 of the report pack.

During discussion, the Committee raised some of the following comments:

·       Recruitment measures - The Committee was advised that since the Trust had left special measures, there had been an increase in the number of candidates applying for specialist positions in Lincolnshire, and that the Trust was marketing Lincolnshire, building on that positive news and to the fact that Lincolnshire was already managing to reduce its waiting lists.  It was highlighted that the Trust was also working with the University of Lincoln in respect of rotational posts and allied care worker positions, as well as looking into new emerging roles.  The Committee noted that the Trust had been successful in recruiting 220 health care support workers, some of whom were new to the care profession.  The Committee was advised that the number of student nurse placements had increased, and the benefit of these places would be seen in three years’ time.  The Trust also had apprenticeships and had introduced the role of Nursing Associate.  The Committee was advised that further information could be provided in this regard.  It was also confirmed that the Trust was not currently seeing a high level number of vacancies pertaining to non-clinical staff.  One member enquired as to what the current picture was regarding recruitment in the areas highlighted by the CQC report.  It was reported that there were very few nursing gaps regarding children and young people, and that two paediatricians had been recently recruited.  The Committee was advised that the Trust was currently in the process of recruiting student midwifes and that the Trust was in a good position in this regard. However, in relation to urgent and emergency care there were significant nursing shortages, and the Trust was relying on bank and agency staff to fill those vacancies.  There was recognition that this situation had to be reversed as the Trust moved forward as there needed to be a more sustainable workforce;

·       Financial risks.  The Committee was advised that the national funding mechanism this year had reinforced that funding would be allocated to trusts where there had been a sizable reduction in waiting lists, and that there was an expectation for trust’s being as efficient as they could be, in line with the national scheme ‘Getting it Right First Time.’  It was felt that these two factors would help the Trust in balancing its books for the current year;

·       More information was requested as to how the Trust was dealing with the backlog and the impact this was having on waiting lists in Lincolnshire.  The Committee was reassured that further information could be provided to a future meeting.  The Committee was however advised that a huge amount of work was being done to alleviate the backlog and reference was made to some of the following: the provision of extra operating theatres at Grantham Hospital; extra scanners across Lincolnshire; recruiting additional staff; better use of IT resources i.e., remote consultations; developing services with primary care; and the provision of new equipment to help change procedures, such as robotic services;

·       Ambulance delays, caused by the lack of available in-patient beds.  The Committee noted that this was a national issue, as well as a local one, and that work was being done with care partners to help alleviate the situation; 

·       Confirmation was given that the arrangements put into place relating to the children and young people provision at Pilgrim Hospital Boston were temporary.  It was highlighted that the arrangements had worked very well, and credit was extended to all staff working in this area;

·       Mandatory training for staff.  The Committee was advised that mandatory training had to be undertaken and completed as it was part of the contract with staff.  The Committee was advised further that the Trust was not aware of any cases where staff had not been engaged in the training;

·       Patient Choice regarding the type of treatment/surgery selected.  Confirmation was given that there was patient choice;

·       Whether the provision of Nursing Associate posts represented deskilling.  The Committee noted that services were now provided in a less traditional way and that the post gave the opportunity to upskill to provide support, and then those at the next level were able to upskill into a more specific area.  The role enabled the Trust to have an enhancement of practices.  Reassurance was given that there was a robust skills framework which was aligned to the role, to make sure that competency levels were attained.  The provision of nursing associate roles enabled support to be given to the registered nursing workforce;

·       Clinical pathway to Community Diagnostic Centres (CDCs).  The Committee was advised that currently referrals were being made by GP’s, it was also highlighted that some patients in hospital requiring repeat tests would also be able access a CDC.  Confirmation was also given that patients would be given the option of accessing a CDC of their choice;

·       Use of remote care.  The Committee noted that with digital innovation and the lessons learnt from Covid-19, more digital monitoring could now be done in some circumstances, without the patient needing to come into hospital;

·       Progress on the BRAG ratings detailed on page 47 of the report.  The Committee was advised that these were all on target, except for the ones affected by the impact of the recent fire at Lincoln County Hospital; and

·       How often was the CQC action plan going to be monitored by the ULHT Board.  It was reported that the Board Sub-Committees would review the plan monthly and that the Board would then oversee the CQC action plan on a quarterly basis. 

The Chairman on behalf of the Committee extended his thanks to the presenters.

RESOLVED

1.      That the information presented on the Lincolnshire Elective Recovery Plan and the Action Plan from United Lincolnshire Hospitals NHS Trust be noted.

2.     That a further update be received on the progress of the CQC Action Plan in six months’ time.