Agenda item

(To receive a report from Dr John Brewin (Chief Executive – Lincolnshire Partnership NHS Foundation Trust) which presents the Committee with the report of the Care Quality Commission (CQC), following its inspection of Lincolnshire Partnership NHS Foundation Trust (LPFT) between 30 November and 4 December 2015.  Dr John Brewin (Chief Executive – Lincolnshire Partnership NHS Foundation Trust) and Ian Jerams (Director of Operations – Lincolnshire Partnership NHS Foundation Trust) will be in attendance for this item)

A report by Dr John Brewin (Chief Executive – Lincolnshire Partnership NHS Foundation Trust) was considered which presented the report of the Care Quality Commission (CQC), following its inspection of Lincolnshire Partnership NHS Foundation Trust (LPFT) between 30 November and 4 December 2015.

Dr John Brewin (Chief Executive – Lincolnshire Partnership NHS Foundation Trust) and Ian Jerams (Director of Operations – Lincolnshire Partnership NHS Foundation Trust) were in attendance for this item of business.

The Committee were taken through the report where the main findings in the CQC's report were highlighted.  It was reported that there were eleven further detailed reports covering particular service areas, each with their own finding.  The overall finding for the Trust was that it 'requires improvement'.  The initial response of LPFT to the CQC report was in the form of a powerpoint presentation:-

·       Introduction;

·       LPFT Challenges – 30 November 2015;

·       Our response;

·       Same-sex Accommodation (deemed to be unsafe);

·       Ward environments;

·       Supervision;

·       Access;

·       Summary; and

·       Questions

The Trust believed that the overall rating of the CQC was reasonable and acknowledged that improvements were required.  However, the Trust was disappointed with the 'inadequate rating' for safety.  The areas highlighted as inadequate for safety were further expanded upon:-

Same Sex Accommodation – the children and adolescent mental health inpatient unit had been rated as 'inadequate' for safety.  The twelve bed unit had both males and females, who had to share a corridor, for example to use lavatories at night.    Although there was a member of staff stationed on the corridor during the night, the CQC thought that this mitigation was insufficient.  This finding had been explored in detail by the Quality Summit and a challenge to that decision was being considered, which was supported by NHS England.  Possible options to address this finding included the construction of a separate corridor, separating males and females, or designating the unit single sex (the majority of patients were female, but this would result in male patients being sent out of county).  The latter option could lead to the need to construct a separate unit for male patients.  At the present time, the Committee was advised that practice had not changed and a member of staff was stationed in the corridor during the night.

Ward Environments – the 'inadequate' rating in this area was in relation to fixed ligature points which patients could use to hang themselves.  It was acknowledged that these ligatures points had been removed during the week of the inspection.

It was stressed that no attempts had been made at strangulation or hanging in any facility nor had any concerns from parents and families been raised regarding the shared corridor in the children and adolescent mental health inpatient unit.

Members were given the opportunity to ask questions, during which the following points were noted:-

·       The use of plastic covers on all duvets and pillows was highlighted as being uncomfortable for patients.  It was explained that LPFT was constrained by hospital guidelines and must comply with national standards around hygiene, hence the need for plastic covers.  Although it was suggested that blankets and sheets could be used instead of duvets, the Committee was advised that these could be used as a tool for strangulation/hanging;           

·       It was stressed that a rigorous audit programme of all units and external spaces looking at potential ligature points had taken place, but the CQC report had found some examples where ligature points had not been addressed. The current programme identified fixed ligature points were as safe as possible.  In relation to external ligature points, for example in garden areas, further information was to be included within individual care plans to identify if a patients had self-harm tendencies or the potential for suicide and to manage that situation individually.  The CQC was not satisfied that this process was robust;

·       The CQC would consider the response to the report but it was advised that they would only change a rating when they returned to re-inspect the units;

·       The Committee was concerned about the section in the report relating to staffing and the potentially unsafe staffing levels.  The Committee was assured that a report was presented to the board monthly which indicated that the minimum staffing levels were being met.  Staff recruitment and retention continued to be an issue which was across the wider NHS.  Work was ongoing, however, to attract young professionals into Lincolnshire, despite the challenges;

·       Two staff surveys had been undertaken, both of which had received disappointing outcomes.  Consideration was being given to recruitment and retention of existing staff and maximising opportunities and support to the existing Health Care Assistants.  The lack of availability of university bursaries for next year was also making an impact on this type of recruitment;

·       Accurate reporting of delayed transfers of care was essential.  The number of delays was currently increasing and it was explained that a number of patients admitted to LPFT were homeless.  Therefore, work with District Councils was required to support these patients into appropriate housing once they were fit for discharge;

·       It was agreed that the LPFT improvement plan, referred to in the report, would be circulated to the Committee. It was stressed that this was still in development stage, but that a plan would be presented to the Public Board of LPFT on 19 May 2016;

·       Page 19 of the CQC report referred to particular concern of the team based in Skegness.  It was reported that the team were now in a better position and scheduled to move into new premises which would further improve their working environment.

The Committee acknowledged that the CQC report had been published on 21 April 2016 and in particular congratulated the Trust on the 'outstanding' rating for community children and adolescent services.  The Committee concluded that at this stage it would require further information on the response of the Trust to the CQC's report and its proposed actions. 

RESOLVED

1. That the Care Quality Commission's report on Lincolnshire Partnership NHS Foundation Trust and the Trust's initial response to report be noted; and

2.That an item be added to the Committee's Work Programme for consideration on 20 July 2016, which would set out the formal response of Lincolnshire Partnership NHS Foundation Trust to the Care Quality Commission's  report.