Agenda item

(The purpose of this report is to provide the Health Scrutiny Committee for Lincolnshire with assurance that Lincolnshire Partnership NHS Foundation Trust (LPFT) is making progress with implementation of the action plan arising from the Care Quality Commission (CQC) Comprehensive Inspection, which took place between 30 November and 4 December 2015)

Consideration was given to a report from Dr John Brewin (Chief Executive – Lincolnshire Partnership NHS Foundation Trust) which sought to provide assurance to the Committee that Lincolnshire Partnership NHS Foundation Trust was making progress with the implementation of the action plan arising from the Care Quality Commission (CQC) Comprehensive Inspection which took place between 30 November and 4 December 2015.

Dr John Brewin (Chief Executive – Lincolnshire Partnership NHS Foundation Trust), Ian Jerams (Director of Operations – Lincolnshire Partnership NHS Foundation Trust) and Anne-Maria Olphert (Director of Nursing and Quality – Lincolnshire Partnership NHS Foundation Trust) were in attendance for this item.

The report provided background to the inspection by the Care Quality Commission (CQC) which looked at eleven service areas of Lincolnshire Partnership NHS Foundation Trust following which, on 23 April 2016, a detailed report was published giving the findings.

Overall the organisation had been rated as "Requires Improvement" with a "Good" rating for caring in all services inspected and an "Outstanding" rating for community based Child and Adolescent Mental Health Services (CAMHS).  The rating for "safe" was "Inadequate" due to concerns raised about potential risk associated with Mixed Sex Accommodation and Points of Ligature.

It was reported that the vast majority of the findings were consistent with the Trust's own assessment of its areas for improvement, as presented to the CQC on the first day of the inspection.  The Trust deemed that the concerns raised in relation to the "safe" key line of enquiry conflicted with the interpretation by the Trust regarding anti-ligature and same sex accommodation guidance.  As such, the Trust had responded proactively to the assessment of the CQC in respect of these areas of risk and had also challenged the same sex accommodation assessment for the Ash Villa Child and Adolescent Mental Health inpatient unit to which a response was awaited.

Following the publication of the report, the Trust was required to submit an action plan covering the five CQC domains and to address the issues raised.  This action plan was submitted to the CQC in early June 2016 in line with the deadline given.  This was a key plan and could be found on the Trust's website at www.lpft.nhs.uk/get-involved/meeting-dates-and-minutes/board-of-directors-meetings/30-june-2016-bod-meeting-papers

The action plan was developed immediately following the inspection to address the initial feedback during the visit itself.  This included the breaches in Mixed Sex Accommodation and Point of Ligature.  A safety fence had been erected at the Ash Villa Unit to create a safe outside area due to the trees providing possible ligature points.

The action plan was updated further following the publication of the CQC report and included a list of the immediate actions identified.  The action plan included approximately 100 actions and noted against each an accountable person along with the evidence of progress made and key milestones for each.  This action plan formed part of the overall Quality Improvement Plan.  Internal monitoring of the plan was led by the Director of Operations who liaised on a regular basis with Clinical Division leaders and through the internal Operations Governance meetings.  Factual evidence of progress was done through the Compliance Team and the Chief Executive had a further oversight of progress via regular updates to the Executive Team.

The following work was also being undertaken to strengthen the action plan further following feedback received from the Quality Summit and NHS Improvement:-

·       Incorporation of the CQC Well Led key line of enquiry into the action plan (complete);

·       Completion of the Assurance and Evidence columns (will be complete end of July 2016);

·       Description of the monitoring process (complete); and

·       Consideration, by the Board of Directors, of the Well Led Domain.

Risks to delivery were described and monitored as part of the Trust Board Assurance Framework on a monthly basis and would be included in the Clinical Divisional Risk Registers and escalated to the Operational Risk Register accordingly.

Assurance on progress was overseen by the Health Scrutiny Committee for Lincolnshire, NHS Improvement, NHS England and South West Lincolnshire Clinical Commissioning Group through regular contact and quarterly meetings. 

The Committee was assured that this was not just a bureaucratic exercise for the Trust and had been given due attention and action.

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

·       When asked why the standard health and safety assessments undertaken by the Trust had not picked up the concerns, it was explained that the Trust was aware of the guidance for same sex accommodation but was confident that they were compliant.  The CQC had not noted these concerns during previous visits.  Nevertheless the Trust was in disagreement with the CQC on the judgement of this issue as the interpretation of the guidance by the two organisations was clearly different.  As a result, and with support from commissioners, a challenge to the CQC had been submitted;

·       The Trust did undertake regular health and safety ligature assessments but, admittedly, one or two had been missed however the process for these assessments had been amended to ensure further robustness;

·       In relation to Ash Villa, the ligatures highlighted were in the garden area and, as a children's facility, patients would not be in that area without supervision.  However, all play facilities had been removed as a result of the report until a response to the challenge had been received;

·       Each of the 97 actions had sub-actions therefore it was reported that 400-500 actions were required and these were currently being worked through successfully;

·       Following feedback received at the last meeting of the Committee, it was reported that the bedding at Ash Villa had been reassessed and would be changed although would remain in line with stringent infection control guidelines.  Young people in the facility had been consulted, via a focus group, on what type of bedding they wanted and that feedback had also been taken on board. The Committee was thanked for their input;

·       During a 12 month study, it had been found that of 105 ligature incidents, only six were to a fixed point.  Of those six, only two were not to a collapsible fixed point.  It was reported that the highest proportion of suicide attempts was by ligature;

·       The cost to make the required changes, following the publication of the report, was in the region of £500k.  The most expensive being the changes to bathrooms and to make the outer area of Ash Villa secure;

·       In the event that the CQC did not accept the challenge, an estates business case was being prepared giving consideration on how to separate the areas in anticipation of the required changes;

At 12.30pm, Councillor Mrs S M Wray left the meeting and did not return.

·       It would be difficult to turn each room at Ash Villa in to an ensuite facility without considerable expense.  NHS England, as commissioners of this service, fully supported the challenge to the CQC for this decision;

·       It was confirmed that no patients or families had raised any concerns regarding the same sex accommodation or the arrangements for use of facilities during the night;

·       The Quality Network for Inpatient CAMHS (QNIC) (Royal College of Psychiatrists) had inspected the facility one week prior to the CQC and had given an "Outstanding" rating with no concerns raised.  This report had also been referred to in the challenge submitted;

·       It was thought that the amendments could be met within six months as this was not only physical changes but cultural changes.  A programme for staff had been developed to incorporate the visions and values and was also included within the Trust's induction programme, 1:1s and appraisals;

·       The Trust had developed a detailed plan which had overall actions required with evidence attached as and when completed.  This was thought to be the most robust way of monitoring the requirements and was linked to the report from the CQC.

The Committee requested that this item be added to the work programme for the meeting on Wednesday 26 October 2016 but that more detailed and concise information be included.  This was to assure the Committee of the progress made and to give a better understanding of the process.

The Committee was invited to visit Ash Villa in Sleaford and it was agreed to ask the Health Scrutiny Officer to liaise with the Director of Nursing & Quality – Lincolnshire Partnership NHS Foundation Trust.

The Chairman took the opportunity to reiterate the comments made during the Chairman's Announcements and thanked Dr Brewin for facilitating the mental health training session provided to the Committee on 15 June 2016. 

RESOLVED

1.    That the report and comments be noted;

2.    That the assurance given to the Committee on the process by which the plan was monitored be accepted;

3.    That a further update, including detailed and concise information on progress, be considered by the Committee on 26 October 2016

NOTE:       At 12.55pm, the Committee adjourned for lunch and reconvened at 2.00pm.  On return, the following Members and Officers were in attendance:-

County Councillors

Councillors Mrs C A Talbot (Chairman), R L Foulkes, R C Kirk, Mrs J M Renshaw and S L W Palmer

District Councillors

Councillors C J T H Brewis (Vice-Chairman) (South Holland District Council), J Kirk (City of Lincoln Council), Mrs P F Watson (East Lindsey District Council) and Mrs R Kaberry-Brown (South Kesteven District Council)

Officers in attendance

Liz Ball (Executive Nurse – South Lincolnshire CCG), Andrea Brown (Democratic Services Officer), Dr Kakoli Choudhury (Consultant in Public Health), Ian Hall (Senior Delivery and Development Manager – NHS Improvement), Jim Heys (Locality Director – Midlands and East (Central Midlands) NHS England) and Tracy Johnson (Senior Scrutiny Officer)

Apologies for Absence/Replacement Members (Councillors who attended the morning session)

Councillors Miss E L Ransome, Mrs S Ransome, Mrs S M Wray, T Boston (North Kesteven District Council), Mrs L A Rollings (West Lindsey District Council) and Healthwatch Lincolnshire representative, Dr B Wookey.  The Executive Support Councillor for NHS Liaison and Community Engagement, Councillor B W Keimach, also submitted apologies.