Agenda item

This report is to inform the Committee of the details of the latest Care Quality Commission (CQC) inspection of Medway Maritime Hospital.

Discussion:

The Chairman welcomed the representatives from Medway NHS Foundation Trust to the meeting and emphasised that the Committee would not be going through the entire report.  However, a number of questions had been shared with the Trust prior to the meeting and he hoped they would be addressed as part of the introduction.  He welcomed the positive comments in the Care Quality Commission (CQC) Inspection report particularly in relation to maternity and gynaecological services and services for children and young people.

The Chief Executive of Medway NHS Foundation Trust (MFT) explained the background to the latest inspection of the hospital and stated that there was a long list of ‘must dos’ and a list of ‘should dos’ to be worked through but she was confident that the Trust had a strong communication plan and was assured that the good practice achieved in some areas of the hospital could be replicated elsewhere.

She set out some of the changes which had taken place within the Trust, including the strengthening of the Clinical Leadership Team, which were helping progress to be made, she did, however, stress that the Trust needed the support of partners with their plans.  The most important thing was for Medway Hospital to provide safe care and she was pleased that the CQC inspection had found staff to be caring.

The Chair of MFT responded to a number of questions forwarded to the Trust and stated that three additional Non-Executive Directors had been appointed to the Trust and she felt confident that the board now had the right skills mix and background to be able to successfully challenge the executive.

In relation to the questions about staff morale she stated that she was confident things would improve now there was more stability at the hospital and the Council of governors and Healthwatch Medway were engaging actively with staff which would enable staff to share any concerns.

At the invitation of the Chairman, the member of the Committee who attended the CQC Quality Summit on 8 January 2016 fed back on his experience of the event and made the following observations:

·         The event was well attended and the Care Quality Commission helpfully set the scene by explaining that Medway Maritime Hospital was built to cope with 45,000 attendances but was actually receiving 99,000 people in a year.  He stated that 1200 pieces of evidence had been gathered about the hospital and the importance of getting things right was emphasised bearing in mind the length of time the hospital had been classified as inadequate.

·         It was stated that the Chief Executive of the hospital had been very frank about the amount of work needed to bring about real improvements at the hospital. His view was that there was a real sense of camaraderie from the Clinical Directors and Board about getting the right systems and culture in place.  There was a zero tolerance in place about bullying at the hospital and drop in clinics had been set up to allow staff to talk freely about any problems in this regard;

The representative from the Pensioners’ Forum referred to the involvement the Forum had had with the hospital and expressed concern at the staff shortages at the hospital.  She also stated that a number of pensioners were expressing anxiety about the possibility of being admitted to the hospital in view of the negative publicity.  She queried whether perhaps volunteers or more junior staff could be involved in assisting people with vital access to water, and addressing any infection control and hygiene issues. 

In response to the above question, and further questions posed by the Committee, the Chief Executive, MFT made the following comments:

·         In February the Trust would be launching their vision and values and this should have a positive effect on the recruitment of new staff

·         100 new nurses had been recruited to the Trust by direct involvement of nurses from the Trust visiting Greece and Spain.  These nurses had been targeted to come from areas with similar training styles to those used in Medway and had to prove fluency in English.  They would arrive in stages and she would be looking to try to find suitable accommodation in the area for them.  She referred to work with the university around this point.  They would be subject to the same sort of reviews in post as other nurses.  The response to the open day had been unprecedented with a fourfold increase in attendance

·         There was an understanding in the Trust that new technology needed to be introduced to give the staff the relevant tools to do their jobs

·         An in-house nursing bank was being set up to reduce the over-reliance on agency staff at the hospital

·         The buddying with Guys and St Thomas’ Hospital was really helping the Trust to move forward

·         The hospital had 300 volunteers who help there and she saw this as a great strength

·         The £13.4m given to the hospital for improvements to the emergency department was a loan.  The improvements to the minors area had been completed but the majors and resuscitation areas had yet to be started

·         The cost of the buddying by Guys and St Thomas’ Hospital was funded by the Department of Health

·         Any outsourcing would need to be considered carefully to ensure that it only goes ahead if the task could not be completed economically and efficiently in-house

·         Before the release of the latest CQC report there was a meeting of 400 staff to brief them on the contents

·         Until the new Director of Clinical Operations is in post the Deputy Director of Nursing is providing a focal point for staff to report to in the surgical department

·         In future it was intended to streamline the entry into A&E to ensure that the system is fit for purpose and does not require patients having to see a sequence of people, or take a ticket, before being assessed

·         In a three year period there had been 178 recommendations purely in relation the emergency department.  It was clear that the area needed a complete redesign of the pathway

·         In relation to staff feeling undervalued it was stated that with a new clinical leadership in place and new vision and values this should give a clearer direction for staff and improve morale

·         Disappointment was expressed about the figures on page 46 of the agenda which indicated that 33% of black and minority ethnic staff had reported experiencing harassment, bullying or abuse from staff.  It was emphasised that bullying has no place in the Trust.  A further staff survey had been undertaken recently and it was agreed that the findings could be shared with the Committee as a briefing note.

·         It was agreed that briefing notes would also be produced setting out plans for new technology and about capital programmes

The representative from Healthwatch Medway explained how they had been very much involved in giving feedback to the hospital but stated that he would welcome being even more engaged in the improvement journey.  He stated that, following the appearance of the Healthwatch Medway Chair on BBC South East there had been a surge of positive feedback about the hospital.  Counter to that, however, he stated that there had been some negative feedback around agency staff in particular.  He queried what more the community could do.

In response, the Chair of MFT explained that more needed to be done around what the community could do to support the hospital but she welcomed the approach from Healthwatch Medway in this regard.

Discussion then took place about the role of the Board in approving schemes and finances, and it was emphasised that support would be given where it could be clearly seen that quality would be improved as a result of the changes but value for money was also important.  A Quality Impact Assessment would be completed when any new plans/changes were developed so that the Board could see the likely impact of those changes.

Decision:

The Committee:

(a)  Invited the Chief Executive of MFT to share with the Committee, at the next meeting, the action plan to address the issues in the Care Quality Commission inspection report, and any further progress made;

(b)  Agreed that the Chair, Vice-Chair and spokespersons of the Committee should consider, outside of the meeting, how best to obtain feedback and patient experience in relation to a specific area of hospital care, such as the frailty pathway and/or mortality, with a view to discussing all relevant issues with the Committee at a later date.  (The hospital, Pensioners Forum, Healthwatch Medway, service users, their carers and the voluntary sector would be invited to contribute to that debate once it is programmed);

(c)  Requested a joint report to the next meeting from MFT and the Deputy Director (Children and Adults) on an update on discharge planning;

(d)  Requested briefing notes from MFT on the following topics raised during the meeting:

·         Results of the staff survey

·         Capital programmes

·         Plans for new technology at the hospital