Dr Peter Miller, Chief Executive of the Leicestershire Partnership (NHS) Trust submits a report that outlines a summary of the Care Quality Commission’s (CQC) latest key findings and details the Trust’s processes for delivering assurance against the CQC inspection action plan.
The update report and the inspection report with other supporting information are included as follows:
Update report (Appendix B1)
CQC inspection action plan (Appendix B2)
· CQC inspection report published in January 2018 (Appendix B3)
· Report of the CQC considered at the meeting of the Leicester City Council Health and Wellbeing Scrutiny Commission 7 March 2018 (Appendix B4)
· Draft minute extract of the meeting of the meeting of the Leicester City Council Health and Wellbeing Scrutiny Commission held 7 March 2018 (Appendix B5)
· Minute extract of the meeting of the Leicestershire County Council Health Overview and Scrutiny Committee held 28 February in relation to the consideration of the Child and Adolescent Mental Health Services (CAMHS). (Appendix B6)
Dr. Anne Scott, Acting Chief Nurse, East Leicestershire and Rutland Clinical Commissioning Group, submits the following papers as supporting information in respect of the above item of business.
a) East Leicestershire and Rutland Clinical Commissioning Group - briefing paper (Appendix B7)
b) East Leicestershire and Rutland Clinical Commissioning Group - power-point presentation: Commissioner monitoring and supporting quality and safety improvements (Appendix B8)
The Chair introduced the item and explained that a report of the Leicestershire Partnership NHS Trust (LPT) on the Care Quality Commission (CQC) Inspection 2017 had been considered by Leicester City Council’s Health and Wellbeing Scrutiny Commission on 7 March 2018. That report was attached at appendix B4 of the agenda. At the meeting, Members had requested further information on the inspection and also for the Clinical Commissioning Group (CCG) to provide an update from their perspective on the inspection and the LPTs response. The Chair added that she was pleased that areas inspected had moved from an ‘inadequate’ rating to ‘requiring improvement’.
Dr Peter Miller, Chief Executive of the Leicestershire Partnership (NHS) Trust presented a report that outlined a summary of the CQC’s latest key findings as well as details of the Trust’s processes for delivering assurance against the CQC inspection action plan. Members heard that Dr Miller was pleased with the improvement in the five services that had been inspected. While he wanted the services to be ‘Good’, the CQC’s findings demonstrated that the trust was on a positive trajectory.
Members were asked to note that the CQC inspection had taken place at a specific point in time and it did not reflect the pressures that the Trust were under; including pressures in Children and Adolescents’ Mental Health Service (CAMHS) and Adult Mental Health Services.
Dr Anne Scott, Acting Chief Nurse, East Leicestershire and Rutland Clinical Commissioning Group presented a briefing paper, as previously circulated, which provided an update on the commissioners’ processes for monitoring the progress against the action plan.
During the ensuing discussion, a number of questions were raised. Those questions and their responses included the following:
· Dr Miller was asked if the outcome of the inspection would have been different if there had been a full complement of staff. The theme in the inspection report was that the Trust was under-resourced. Dr Miller responded that staffing and the workforce was the biggest risk on their risk register but there were monthly safer staffing reports and he was confident that there was adequate staffing at all times on all of the wards to maintain safe levels; however there were at times significant numbers of bank and agency staff to maintain those levels. Dr Miller did state though that bank staff are often existing staff members and that they knew the service well. Across the Trust there should be about 1600 band 5 and 6 qualified nurses but there were currently about 220 vacancies. There should be 150 registered nurses on the Bradgate Unit, but there were regularly vacancies of 40-50 nurses so the challenges were to deliver consistency of care. Bank staff were subject to the Trust’s training and support which resulted in greater compliance to the Trust’s policies. Agency staff may be new to the ward and there was less likelihood of compliance. Dr Miller did therefore believe that a full complement of staff would have led to a better inspection outcome.
· Concerns about fridge temperatures and lack of monitoring were raised by Members. Dr Miller explained that there were procedures in place to monitor fridge temperatures and it was extremely frustrating that the inspection had identified that fridge temperatures were not being monitored correctly. There had been improvements and there was an automatic system to monitor fridge temperatures on some wards; this needed to be rolled out across all wards. Dr Miller added that this was something he was determined to get right. The Chair expressed concerns that the failure to monitor fridge temperatures had been a recurring problem. Dr Scott responded that while the CCG recognised that there was still work to be done, the CCG had been reassured that it was an isolated incident.
· Members asked why staff preferred to be part of the Trust’s bank staff as opposed to having fixed hours contracts. The meeting heard that some people preferred the flexibility; they might have caring responsibilities or may not want to work at nights or weekends. The Trust tried to ensure that bank staff were as much a part of the organisation as the substantive work force.
· A Member questioned whether the culture within the Trust was such that staff were confident about approaching management with concerns. Dr Miller commented that there was a significant number of staff who felt they could raise issues with management but he acknowledged that staff surveys suggested staff in some areas might be reluctant to do so.
· Dr Miller was asked about training provision in areas such as communication and stressed the importance of people skills. Dr Miller responded that communication skills were a core part of training and there was also mandatory training in about 15 different subject areas.
· In response to a question, the meeting heard that there were women psychiatrists and the Trust tried to respect requests for referral to them where possible.
· A question was raised around the process for GPs and Locums to feed in their concerns and report complaints. Concerns were expressed that there may be barriers in particular for Locums to do so. Dr Scott said that the CCG received complaints from GPs and Locums, though not necessarily in relation to the LPT. She did not believe it was difficult for Locums to report a concern or submit a complaint as such concerns were submitted by email. After some discussion, Dr Scott said that she would feed the concern back to the Patient Safety Team and the Chair asked for this to be fed into a future scrutiny report, possibly on staffing issues.
· In response to a question relating to compliments, Dr Miller responded that they received more compliments than complaints and the Trust tried to feed them back to the individuals concerned. Both compliments and complaints were reported to the Board.
· A member referred to the action plan and asked Dr Miller how confident the Trust was that the plan would result in prompt improvements to achieve an overall rating of ‘good’. Dr Miller responded that there had been improvements but some challenges remained, such as the estates, in particular the Bradgate Unit, and staffing. These were likely to remain an issue when the CQC returned in November.
· In respect of the Bradgate Unit, a capital bid was being compiled to fund either a re-build or a revamp. This would give patients privacy and dignity and make the provision CQC compliant. It would take some considerable time to put together the bid but it was anticipated that a strategic outline case would be ready in July 2018.
· Dr Scott was asked whether the CCG had the appropriate skilled and trained staff to carry out effective performance management and audits on contracts. Dr Scott confirmed that the team who managed contract monitoring were senior staff who were skilled and trained in that specialism.
· In response to a question, Dr Miller said that issues around cleanliness had been found on one ward. Cleaning was carried out by contractors provided by the UHL and the LPT had increased their scrutiny in relation to their performance. He was confident that there were sufficient resources to ensure that cleaning was carried out to the expected standard, but he had concerns as to whether there were sufficient resources in relation to maintenance and repair.
· Dr Miller was asked whether there were targets for the discharge of those patients receiving treatment from the mental health service. Members heard that while no individual patients had a target, they were looking forward to try to discharge patients as soon as possible to alleviate pressure on beds.
The Chair drew the discussion to a close with the following comments:
· It was pleasing to note that all the ‘inadequate’ ratings had been removed, some improvements were being made and it was important to remember that until fairly recently, the ‘requires improvement’ rating equated to satisfactory.
· Staff in the LPT were praised and the Chair requested that the thanks of the committee be passed onto them as they were essential in any improvement journey.
· The problems with the estate were noted; the committee would like to see the plans for the re-building of the Bradgate Unit at a future meeting.
· It had been helpful to see the action plan in more detail but assurances were sought as to the monitoring of issues once they were removed from the plan.
· The CCG were thanked for attending the meeting and the Chair felt assured that they and the Quality Assurance Committee were monitoring progress.
· There were concerns however relating to the 19 ‘must do’ actions and whether they would relate to an improved future inspection.
· The Chair expressed concern that the committee had not been fully assured that actions around medicine management, fridge temperatures, cleanliness and blind spots in waiting rooms had been completed and could be taken off the action plan.
· It was acknowledged that the LPT were currently going through the Transformation Programme and it was anticipated that this would result in some further improvements. The Chair asked that any outcomes from that strategic piece of work should be shared with the individual authorities after which a decision could be made as to whether to consider that further as a joint committee.
The Chair moved that the Committee supported the action plan but wanted to see prompt improvements in the fundamental issues such as cleanliness, medicine management, fridge temperatures and blind spots in waiting rooms. This was agreed by the members of the committee, with the exception of Councillor Sangster who abstained.
The Chair also requested that an update on the action plan be brought to the Committee in one year’s time.
1) that the Committee support the action plan but want to see prompt improvements in the fundamental issues as detailed above; and
2) that a further update be brought back to the committee in one year’s time.