Agenda item

This report seeks to update the Committee on progress at Kent and Medway NHS and Social Care Partnership Trust. Prior to the Committee there was a request for more information on waiting lists associated with Complex Emotional Difficulties and Hoarding, this is included in this report.

Discussion:

Members considered a report on progress at the Kent and Medway NHS and Social Care Partnership Trust (KMPT).

Members were advised that Dr Jackie Craissati, the Chair of KMPT, had also been appointed as Chair of the Dartford and Gravesham NHS Trust.

The following issues were discussed:

Delayed discharge/Bed pressures – regarding the fact that days lost to those Clinically Ready for Discharge were at the highest level since August 2022 (13.3%), Members were advised there were several causes but there was some seasonal variation. A new beds strategy had been launched with the aim of moving patients through system as quickly as possible. Data was monitored daily.

In terms of what was being done to reduce the number of patients readmitted in a shorter time than expected, the readmission rate was benchmarked against other providers and the rate in 2021/22 had been lower than the national rate.

Out of area placements – a Member commented that a report in 2016 had recommended there should be no out of area placements. Whether KMPT adhered to that recommendation was questioned. The Director of Partnerships and Transformation at KMPT advised that the aim was to get all inappropriate placements down to zero over the next three years. The lack of specialist facilities in Kent and Medway was being addressed in the beds strategy. The beds strategy also aimed to reduce specialist out of area placements to a minimum. In 2022/23 there had been seven out of area placements from Medway.

Regarding how many out of area placements were a result of clinical reasons and what percentage should be treated in Medway if that was possible, Members were advised that out of area placements were monitored daily and there was an escalation policy if needed.

Compliance with personal supportplans – noting that compliance was at 43%, what was being done to improve this was queried. The Director of Partnerships and Transformation responded this was monitored monthly and counter measures were requested. Staffing issues had been one of the main causes.

Acute Inpatient Wards – the Care Quality Commission (CQC) inspections had found issues with restricted practices at all their hospitals. What staff training was in place was queried, so this was kept to a minimum. The Director of Partnerships and Transformation commented that a number of issues had been dealt with within 28 days of receiving the notification from the CQC. Work was underway on the estates issues and other initiatives to make improvements.

Vacancies – noting that the vacancy rate was 20% with high staff turnover, whether this was spread across the Trust, or whether there was one specific area, was questioned. In response, Members were advised the Trust was still managing to provide care and was looking at how use the workforce in different ways. Some long-term vacancies were being reviewed.

In terms of the impacts of vacancies on waiting lists, it was critical the whole workforce was used as efficiently as possible. A question was asked what services would look like if there were full staffing levels. Members were advised that modelling on this was quite complex.

Staffing issues – questions were asked about retaining trainees, progressing the results from the staff survey and the extent to which agency staff were used to fill vacancies. Members were advised that the staff survey results were similar to other providers. In terms of what was being done to eliminate all red outcomes in the survey, the Director of Partnerships and Transformation acknowledged there were still a lot of areas which needed improvement. The aim was to develop a coaching culture, so staff felt empowered to make improvements for patients. A request was made for more details on which positions had vacancies.

Ruby Ward – Why Ruby Ward was still being closed was questioned when there was a shortage of dementia beds. Members were advised the ward was relocating to the Maidstone site and would be a new, state of the art unit. It was hoped that this would be completed by the end of the year and online in the first quarter of 2024. In response, the point was made that this still meant a service moving out of Medway and a firmer commitment on when the ward would open was requested. An undertaking was given to provide an update.

Unsafe clinical practice – a Member commented that the fact only 59% of staff would feel confident that the Trust would address concerns about unsafe clinical practice was unacceptably low.

Physical violence - in terms of what happened when this occurred, Members were advised that if a staff member was the perpetrator there were clear HR policies to follow. The aim was to reduce violence and aggression overall in wards by 15% over the next 3 years.

Prevention – how KMPT and others helped prevent mental health was queried. Members were advised the Trust worked with the voluntary sector and there were a number of initiatives.

Restraining of patients - a Member asked how rates at the Trust compared to the national position. The Director of Partnerships and Transformation commented that restraining rates were monitored monthly. A comparison with the national position would be obtained and shared with Members.

Waiting lists for complex needs – in response to comments expressing concerns at long waiting times, Members were advised the aim was to reduce waiting lists significantly for complex emotional difficulties.

Whistleblowing – Members were assured that the Trust was confident in the whistleblowing procedures. Whistleblowing was reviewed by the Board every six months. In light of the recent Letby murder case, staff had been reminded how to raise concerns and an external organisation had been commissioned to help with this. A Member commented that the staff survey showed staff were still scared to speak up. The Director of Partnerships and Transformation commented the Trust wanted a culture that was open and inclusive.

Strategic ambitions - Members were advised there was an operational plan that underpinned the Trust’s strategic plan. Further information could be provided to Members.

International nurses – an assurance was requested that every effort was made to recruit locally to not take away skills from other countries and whether this would affect the projected budget break even position was questioned. Members were informed that the Trust used the NHS England programme of international nurses to avoid depletion. The Trust was confident it would break even. A Member commented that paying staff the correct level of remuneration would solve a lot of problems.

Dementia backlog – Members were advised that the Trust was on target to eliminate the dementia backlog by the end of September and was working with GPs to improve the diagnosis rate.

Mental Health Together Service - in response to whether this was a new service, Members were advised this was a new way of working which looked at the patient as a whole, when well and not well. An update could be provided in the next report.

Racial abuse – a concern was expresses that the report did not reference this when the CQC reports showed many BAME staff were racially bullied or harassed.  The Director of Partnerships and Transformation commented that any behaviour of this sort was unacceptable.

In conclusion, Members remained concerned about the level of service provided and did not feel reassured about progress in tackling waiting lists or the results of the staff survey. It was suggested that the Trust come to all future meetings for the foreseeable future in order to offer assurances that improvements were taking place.

Decision:

The Committee agreed to note thereport and requested that the Trust provided updates at all future meetings, on a thematic basis.