Agenda item

The report focuses on the Improvement Plan developed by MFT in response to the findings of the Care Quality Commission (CQC) inspection of the Trust undertaken in November 2016. This follows the brief update that was provided to the Committee at the March 2017 meeting, where the Committee was informed that the hospital would be receiving a rating of ‘requires improvement’, compared to the previous rating of inadequate and would, as a result of this improvement, be exiting special measures.

Discussion

The report was introduced by the Medway NHS Foundation Trust Director of Nursing. The Director of Communications was also in attendance.

A presentation was given to the Committee, the key points of which were as follows:

·         The Care Quality Commission report published in March 2017 followed an inspection undertaken in November 2016. MFT had been rated as ‘requires improvement’ compared to the previous rating of ‘inadequate’.

·         The Trust was implementing its Recovery Plan in phases. The Plan was addressing the 46 must do and 25 should do actions identified by the previous inspection.

·         13 services had previously been rated as red. This had been reduced to one in the latest inspection. One service had been rated as outstanding in the caring domain.

·         Incident reporting was now in line with national averages having previously been one of the worst.

·         The staff survey showed improved staff engagement and satisfaction with the best response rate for five years.

·         The Recovery Plan was monitored through a quality improvement group. 5 actions had been completed, 1 was on track and 4 were expected to return to their planned delivery dates. 6 actions currently had a red status. In some cases this was due to there not yet being sufficient evidence to close the action.

·         Hospital Standardised Mortality Rate had reduced from 120 in January 2014 to 99.

·         Phase 3 of an improvement programme, ‘Better, Best, Brilliant’ had been launched. The programme was now in its best phase with there being a focus on patient flows and operations in order to achieve brilliant.

·         Patient experience and satisfaction was improving with the number of different doctors being seen by each patient being reduced through more effective management.

·         The level of clinical vacancies was high with the hospital working hard to address this. Reliance on agency staff had been reduced and there was good staff retention amongst those recruited from overseas.

·         The Trust’s planned deficit of £37.8 million was less than in the previous year. The Financial Recovery plan aimed to reduce this by £12.6 million.

Questions and points raised by the Committee were responded to as follows:

Recruitment – It was acknowledged that there was still more work to be done to improve recruitment, although the Trust was starting to see the number of new starters outnumber leavers. There was an increased number of applicants for advertised vacancies. Close working took place with Canterbury Christchurch and Greenwich universities to target potential job applicants. Safe staffing levels were being maintained through use of daily reviews and escalation protocols. Half of the workforce had responded to the latest staff survey. A variety of other staff engagement methods were being used. Line managers were committed to obtaining day-to-day feedback. The Executive team went on walkabouts to talk to frontline staff and staff and senior manager drop in sessions were also utilised.

Staff Appraisals – A Committee Member voiced concern that staff appraisal completions were relatively low. The staff appraisal system was being reviewed with some departments already having good compliance. The aim was to increase appraisal compliance to above 95% from 75%. The staff survey showed that staff tended to value having clear objectives and regular contact with managers more than appraisal completions.

Children’s Services – Children’s provision was delivering good performance overall. It was not particularly challenging to recruit paediatric nurses but neo-natal recruitment was more difficult.  There were 2 must do actions related to children’s services in the CQC report. One of these was in relation to child patients being segregated from adults. As there was no national standard for this, changes had been made and the action closed following discussion with the CQC. The second must do action related to increasing place specialist cover to ensure that cover was not depleted when the specialist was on leave. Another place specialist had been appointed to address this.

GP Provision – In response to Member concerns about GP provision in Medway being spread too thinly, the NHS Medway CCG Accountable Officer advised that GPs were being encouraged to work in groups serving populations of 30,000 to 50,000. This would enable other medical professionals to support the GPs and to see some of their patients, thereby increasing GP capacity. This was particularly important as one third of Medway GPs were approaching retirement age. The increased use of digital technology was being encouraged, including use of telephone GP consultations. Medway Council and Medway CCG were working together to support the streamlining of services.

IT System Compatibility – A Member said that it was important for other health providers to be able to access the hospital’s IT systems in order to access patient information. The Committee was informed that an IT digital workstream was included in the recovery programme and there was also a digital stream in the Kent and Medway Sustainability and Transformation Plan. However, access to other systems would not improve in the short term.

Guys and St Thomas’ Buddying and Patient Transport –  The Guys and St Thomas’ buddying scheme had formally ended earlier in 2017. Medway Foundation Trust had benefited from this shared learning. The arrangement covered processes and culture rather than clinical services. It was not the intention to move patients but there were some services where this needed to happen. Where Medway patients were treated at Guys and St Thomas’, patient transport was provided for inpatients but was not provided for the majority of outpatients.

Presentation Contents  – A Member highlighted possible inaccuracies in some of the statistics included in the presentation, questioned why evidence was not being gathered more quickly to demonstrate improvement and also asked which improvement areas were considered to be most important. The Member found this difficult to determine from the presentation. The Committee was informed that a quality assurance checking process was undertaken and that actions would only be closed when there was clear evidence of progress. Issues shown as bigger text in the presentation tended to be those that had been mentioned the most frequently in the CQC report. Key workstreams were being prioritised although all areas of improvement were being progressed.

The Director of Public Health highlighted data that showed that the obesity and smoking prevalence figures for Medway were lower than those included in the presentation, although it was acknowledged that this difference could be due to the Trust having used figures that also included Swale. The figures also masked the significant health inequalities between wards in Medway. It was agreed that clarification of the figures would be provided following the meeting.

Safeguarding – The Director of Children and Adults Services advised that Deprivation of Liberty Safeguarding (DOLS) training had been provided at Medway Hospital with the Council and Trust working together. A Medway Adult Safeguarding Executive group had been established with the hospital being represented on the group. It was working to improve both safeguarding report rates and incident reviews.

Finances – In response to a Member question about the impact on services of the planned deficit reduction, the MFT representatives advised that a monthly meeting took place with the CQC to review the Improvement Plan. All potential improvements with cost implications went through a Quality Impact assessment. These all had to be signed off by the Chief Nurse and the Medical Director. Cost reductions so far had looked to reduce wastage and duplication. It was intended that there would be no detrimental impact on quality as a result of cost reductions.

Decision

The Committee commented on the progress report produced by Medway NHS Foundation Trust and agreed that a further update should be brought to the Committee in December 2017.