Agenda item

(To receive a report from Jan Sobieraj (Chief Executive, United Lincolnshire Hospitals NHS Trust), which advises the Committee of the progress made since the Care Quality Commission (CQC) published its findings on 11 April 2017 following its inspection of United Lincolnshire Hospitals NHS Trust (ULHT) in October 2016.  Jan Sobieraj and Michelle Rhodes (Director of Nursing) will be in attendance for this item)

The Committee gave consideration to a report from Jan Sobieraj, Chief Executive, United Lincolnshire Hospitals NHS Trust, which advised on the progress made since the Care Quality Commission (CQC) had published their findings on 11 April 2017; following a partial inspection at Lincoln County Hospital, Pilgrim Hospital Boston and Grantham Hospital in October 2016; and an unannounced inspection in December 2016 at Pilgrim Hospital Boston.

Details of the CQC ratings for each site were detailed in Appendix A to the report.

The key concerns highlighted by the CQC had related to:-

·         governance, which included serious incident management;

·         medicines management;

·         failure to meet national access standards for A & E; cancer and referral for treatment;

·         identifying vulnerable adults and responding to their care needs;

·         staff morale and managerial supervision; and

·         board level oversight.

It was noted that the Trust had been asked to respond to a number of concerns in a prompt manner.  It was noted further that substantial progress had been made against these issues; and as a result the issues had been incorporated into the Trust's forward plan.  Details of the issues raised and progress made against each issue was contained within the report presented.

Trust representatives expressed their disappointment to the outcomes of the CQC report; but also recognised that the Trust could do better.  It was highlighted that staff shortages within the Trust had resulted in some issues taking longer to resolve.  Despite operational issues, the Trust was making good progress and reassurance was given that if CQC inspectors conducted an inspection now, they would be looking at a different organisation.  Working with partners, the Trust would continue to make progress to improve quality and safety.

During discussion, members of the Committee raised the following points:-

·         Some members felt that the Trust should promote its good working achievements more.  Particular reference was made to 'Surgery', which had achieved good CQC ratings in each category.  Good news stories reflected on Lincolnshire as a whole; and better promotion might help with recruitment going forward.  One member stressed that there was a need to communicate in Plain English to the residents of Lincolnshire.

It was also highlighted that the Trust needed to keep residents aware of what was going on to improve the Trust's CQC ratings; and that this should be conveyed in Plain English also, this would then ensure community buy in.  It was highlighted further that awareness of the CQC's rating evaluation method needed to be defined and communicated better.  Clarification was given that the CQC's 'N/A' in this context meant 'Not Available';

·         The non-inclusion of Delayed Transfers of Care (DTOC).  It was reported that the CQC inspection did not focus on DTOCs; in any event, overall DTOCs were not an issue at the moment.  The percentage was at 4.1%, but had been as low as 3.6%;

·         An explanation of the CQC rating pertaining to 'Maternity and Gynaecology' in relation to Pilgrim Hospital Boston, when the Sustainability & Transformation Plan (STP) had included a reference to consideration of the discontinuation of such services on safety grounds, yet the CQC report had given Maternity and Gynaecology a good rating in the 'Safe' domain.  The Director of Nursing United Lincolnshire Hospitals NHS Trust explained that this was due to a shortage of paediatric nurses at Pilgrim Hospital Boston, but that Pilgrim Hospital Boston had systems and processes in place to mitigate the situation, i.e. being able to close beds and cots down better than the Lincoln County Hospital site.  The Director of Nursing advised that the Trust currently needed 375 nursing staff.  Details of the Trust vacancies had been reported to the Trust Board in the previous month; and the Trust was happy to share this information with members of the Committee.  Confirmation was given that there was not a shortage of midwifes, it was a lack of paediatric nurses that was the issue.  The Committee noted that the Trust worked closely with the University to help fill some of the vacancies.  The Committee noted further that work was being carried out with regard to a 'talent academy' and that there were open days with schools encouraging young people to come into the health profession.

It was noted further that the Trust would be looking at the team around the patient, which would involve all disciplines providing care;

·         One member expressed disappointed that the Trust was back in special measures; and felt for the Trust to improve it needed to be well led and operate in safe manner; a question was asked as to whether the management team would be able to succeed in this task; and when was it hoped the turnaround would be achieved.  The Chief Executive explained that for the first time since his arrival in December 2015, he was now heading a team of substantive (rather than interim) Directors, who would be supporting him to reduce the overspend; improve the quality and safety of patient care; and improve support to staff.  The Committee noted that a structural shift was planned to provide better care in the community; and the need for the STP to work effectively.  With regard to when the Trust would be out of special measures, this was up to the CQC; and at the moment the Trust was unsure when this would be.  An estimated timescale quoted was 2018 and beyond;

·         Some concern was expressed as to whether the hospital was safe; due to the number of CQC ratings provided being 'Inadequate' or 'Requires Improvement'.  It was highlighted that it was the level of detail behind the CQC rating; some were specific to a particular ward.  These specifics were now being tracked. An example given was that as a piece of equipment was found to be out of date at Lincoln County Hospital, this had then resulted in a score of 'Inadequate' the Committee was advised that the Trust was working with others outside of Lincolnshire; an example of Morecambe Bay was cited as they had achieved 'Outstanding Status' and the Trust was looking at their working practices, with a mind to introducing similar practices in Lincolnshire;

·         Progress of the STP - It was noted that wider considerations for Lincolnshire were dependent on the STP.  It was reported that health and social care staff were working closer together to reduce the need for patients to be admitted to hospital; and that a shift was being made to Neighbourhood Teams with more care being provided in the community.  Reference was also made to the supported housing trials.  The Trust had expressed support for the use of technology which would assist someone being looked after in their own home;

·         Culture and Development – The Committee noted that work was in progress to improve staff culture and development; confirmation was given that any member of staff wishing to raise a concern was able to do it through the Freedom to Speak up Guardian (this was a neutral person outside of the management team).  The Trust was also monitoring awareness and usage of this route;

·         Some reference was made to fact that the Pilgrim Hospital Boston was struggling in relation to its 'Medical Care'.  The Committee was advised that Boston Hospital Boston had the largest number of vacancies and most of them were in medicine.  It was noted that since the CQC inspection there had been a lot of changes in these areas; and

·         Walk-in-Centre Consultation – The Committee noted that the Trust was working together with Lincolnshire West Clinical Commissioning Group concerning the detail of what was involved, particularly with regard to A & E provision at Lincoln County Hospital.  The Trust was still to make its response.

In conclusion, the Committee enquired as to how areas of improvement would be reviewed.  The Trust agreed to send a copy of the full plan to all members of the Committee.  The Committee agreed that an update report should be received twice a year where appropriate.

The Chairman extended thanks to the Chief Executive and the Director of Nursing for their report and attendance.

RESOLVED

1.    That the findings of the Care Quality Commission in relation to United Lincolnshire Hospitals NHS Trust be noted.

2.    That the Committee's assurance be recorded in relation to United Lincolnshire Hospitals NHS Trust and its progress since the inspection in October 2016, and its future plans for improving quality and safety.

3.    That updates on the progress from United Lincolnshire Hospitals NHS Trust be presented to the Health Scrutiny Committee for Lincolnshire twice a year where appropriate.