Agenda item

The attached paper from the Medway NHS Foundation Trust updates Members on recent inspections by the Care Quality Commission.

Discussion:

Members considered a report from the Medway NHS Foundation Trust updating Members on recent inspections by the Care Quality Commission.

During the course of the discussion Councillor Van Dyke disclosed that she was a public governor of the Trust but did not consider this presented a conflict of interest.

The following issues were discussed:

·       Improvement plan and recovering elective services – in terms of how this was progressing and the impact of Covid, the Chief Executive of the Trust advised that Covid had had a devastating impact on services. At the peak of the backlog around 1,000 people were waiting 52 weeks for treatment. This figure had now reduced to about 200 and it was a priority to clear this backlog by the end of the financial year. The pandemic had meant many cancer services having to be paused but the Trust was now complying with its 2 week wait target. There was a focus on the recovery of cancer and elective care services and the backlog of very serious incidents had been cleared.

The point was made that any improvements were from a low base and the more streamlined action plans were welcomed. A comment was also made that the report offered some reassurances and it was acknowledged that ratings moving from inadequate following the most recent CQC inspection was a significant achievement.

·       Working with external mental health providers to improve waiting times for crisis beds and travel arrangements – in relation to this action, the point was made that there was a need for an overall mental health strategy and KMPT could help with this. In response the Chief Executive commented that the Trust received good support from KMPT operationally and there were good escalation procedures. There were delays in respect of patients in crisis admitted to the ED in getting to a bed, but these tended to be younger. A paediatric area in the hospital had been refurbished to make the environment better and safer. The Trust was working with KMPT to improve matters but there was no easy solution.

·       Review of oversight of clinical incidents and embed an effective system to learn from such incidents – disappointment was expressed with regard to the conclusion that a learning culture was not embedded in the Trust, and that there was a lack of effective governance around serious incidents and a lack of appetite for organisational learning. The Chief Executive advised that the backlog of serious incidents had been cleared and there was a target to clear lower-level incidents by the end of November.

·       Ensuring that where medical care service risks are identified, mitigation is put in place in a timely manner – regarding this target, the point was made that lines of accountability were clear but were not always affective and there had been a lack of oversight from leadership team.  The Chief Executive commented that he was confident lines of accountability were now clearer.

·       Ensuring the Emergency Department always has enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care – reference was made to the CQC finding that safe staffing levels for the whole day required 39 registered staff but 31 staff were available. Whether this situation had improved was questioned. The Chief Executive was pleased to report full recruitment in respect of nurses in the ED. Sickness levels were around 4% so there were days when a full roster of staff was not deployed, but the gap was not as great as before.

·       Emergency Department (ED) performance – the extent to which this was affected by the performance of other departments and outside the hospital was questioned. The Chief Executive responded that ED performance was very challenging. The ED department was now performing better than before but demand had increased significantly. The reasons for this were not clear but a factor could be problems some people faced in getting face to face appointments in primary care. There was no easy solution to this and a collaborative approach was needed. In response to a query how the lack of face-to-face GP appointments was impacting on the Trust and how this compared to other hospital Trusts in the southeast, the Chief Executive commented that there was a low baseline in Medway with a fragile primary care system in Medway and lower numbers of GPS and more locums compared to other areas. 500 patients a day were attending the ED and Meddoc and part of this was probably due to patient frustration and wanting to see someone face to face. Possibly 10-20% of that figure could be dealt with elsewhere but there was no data on how many attended due to frustrations in getting a face-to-face primary care appointment. The Integrated Care Partnership was working collaboratively on how the different parts of the health system in Medway could support each other. This included working with SECAmb on how to triage differently given 120 ambulances a day were arriving at the hospital and 20% of these were then being diverted elsewhere. The capacity of the ED and urgent care service was being increased to increase capacity for the more serious patients.

·       Bullying of housekeeping staff  - why the programme for cultural change set up in response to these concerns had been closed was queried. The Chief Executive commented that the Trust was working on how to improve the culture and was training and supporting managers to speak up more freely. While the action had been closed in respect of the CQC inspection as there was evidence to support this, the Chief Executive acknowledged this was a long-term project to improve the culture of this area. Whether this process of closing actions sent the wrong message was questioned.

·       Council of Governors meetings – why some governing body meetings were being held in a Masonic Hall was questioned given this venue could potentially exclude some people from attending. The Chief Executive commented this venue was only used once and would not be used again and members of the public had the option to observe the meetings remotely.

·       Staff morale - in terms of current levels of morale, the Chief Executive commented staff had worked extremely hard during the pandemic and on recovery. Surveys and briefings showed increased levels of optimism, but morale would be a big issue over winter. Public support for the NHS had declined and staff were experiencing more frustration and sometimes violence from the public.

Decision:

The Committee thanked Dr Findlay for his attendance, expressed their appreciation of the work of all staff at the Trust and noted the report.