Sharron Hotson, Director of Clinical Quality submits a report and power-point presentation that provides the Committee with an overview of the outcome of the Care Quality Commission’s (CQC) inspection of the University Hospitals of Leicester (UHL) NHS Trust in November and December 2017 and their well-led review in January 2018.
The report, presentation and supporting information are attached as follows:
Report of the UHL’s CQC inspection (Appendix D1)
UHL Power-point Presentation (Appendix D2)
· CQC inspection report of the UHL (Appendix D3)
Sharron Hotson, Director of Clinical Quality, University Hospitals of Leicester (NHS) Trust (UHL) submitted a report that provided the committee with an overview of the outcome of the Care Quality Commission’s (CQC) inspection of the UHL that took place in November and December 2017 and their Well Led review which took place in January 2018.
The Chair noted that within the inspection report, there was praise in some areas including the care of patients with sepsis. Some areas required improvement and Improvement Notices had been served in relation to insulin management.
Sharron Hotson presented the report and explained that the inspection report had been published in March and the action plan had been very recently submitted to the Quality Outcome Committee. There was also a separate action plan which related to insulin management and was subject to weekly monitoring and monthly reporting to the Board. Ms Hotson commented that it would take time to embed the new practices for insulin management; as every patient on every ward was affected.
Ms Hotson referred Members to the ratings table contained within the report and explained that some of the ratings related to a previous inspection. Those ratings could not be changed until the CQC re-inspected those areas. Members heard that there were no inadequate ratings from the most recent inspection.
A Member expressed concern that targets for some areas of staff training and appraisals were not being met. The value of the staff was emphasised and Ms Hotson was asked what the UHL were doing to address those concerns. Ms Hotson responded that there had been a problem with delivering training with the pressures during the winter months but Members were also asked to note that the data had not portrayed the correct information. The system had now been improved and targets were being monitored.
It was noted that St Mary’s Birth Centre had received a ‘good’ rating on all aspects and in response to a question, Ms Hotson confirmed that the centre was one that Sustainability Transformation Plan was proposing to close.
A Member asked about the ‘Red to Green’ process for the discharge of patients. Ms Hotson explained that this was a tool that was used to ensure there was a timely discharge. If there were delays, there was need to understand what those delays were and what action could be taken. The Red to Green had added transparency to the process. Ms Hotson was asked whether some discharges took place too soon resulting in the patient being readmitted. Members heard that discussions about discharging the patient and the situation at home often occurred prior to operations taking place but it could be very difficult to manage expectations. The Chair stated that there needed to be a culture shift; Members at the Leicester City Council Health and Wellbeing Scrutiny Commission meeting had heard that patients, through patient choice, opted to remain in hospital longer rather than going into a community hospital.
A Member referred to leadership and questioned whether improvements in leadership would result in an overall improved rating. Ms Hotson explained that just two ratings of ‘requiring improvement resulted in an overall rating at that level. There was a confidence in leadership at Trust level but this needed to be across the board at every level so it was a challenge to get that right. A concern was raised that the inspection report referred to inefficient performance management and Ms Hotson responded that the action plan included work around capacity and the capabilities of the clinical management team, who were the next level down from the Executive Team.
A Member questioned whether all the appraisals were being entered onto an electronic system and it was confirmed that there was an electronic system for recording appraisals, details of which were sent to managers. Questions would then be asked if appraisals were not taking place as it was very important for staff to have individual time with their manager.
The Chair concluded the discussion and made the following points:
1) The report had recognised some outstanding areas of work including the St Mary’s extended post- natal care which was particularly beneficial to women with complex needs and physical disabilities. The Chair suggested that this could be considered at a future meeting alongside discussions around the STP.
2) The Chair was very pleased with the work that had taken place with the Emergency Department and sepsis team and that the experience gained was being used in relation to insulin management.
3) The new purpose built Emergency Department was excellent and had increased capacity to manage pressure surges, such as admissions from the East Midlands Ambulance Service.
The committee agreed that it would like to receive future CQC inspection reports relating to the UHL and Councillor Waller asked that the future reports be brought to the committee at a time when the action plan was also ready.
that further CQC inspection reports of the University Hospitals of Leicester (NHS) Trust, along with the resulting action plans, be brought to future meetings of the committee.