To consider a report from the Leicestershire Partnership NHS Trust that sets out their response to an inspection report from the Care Quality Commission (CQC).
The CQC Inspection was carried out between 19 December 2018 to 13 December 2018 and their inspection report, which is attached in Appendix A1, describes their judgement of the care provided by the Trust.
The Committee received a report from the Leicestershire Partnership NHS Trust (LPT) that summarised the outcome of the Care Quality Commission inspection of the Trust that took place between 19 November 2018 to 13 December 2018. The report also set out the Trust’s response to the inspection. The inspection report had been included in the agenda and showed that the overall rating for the Trust was that it required improvement.
Dr Peter Miller, Chief Executive Officer LPT, introduced the report and Members heard that while there were some examples of good practice, there were some key themes that required improvement and the CQC had issued the Trust with a Warning Notice. In response to this an action plan had been drawn up to include some immediate actions which needed to be completed by 27 May 2019. Members heard that the CQC had been critical of the pace of improvement following the previous inspection in October / November 2017 where the Trust had also received the same required improvement rating as it had in their two previous inspections prior to 2017. Members heard that two independent reviews had been carried out to find out why the LPT did not know about the lack of pace regarding the improvements.
Mrs Cathy Ellis, Chair of the Trust Board said that the Board had taken ownership of action plan and that they were all responsible for the outcome of the inspection. A meeting had been held with the CQC who were pleased with the action that the LPT had taken so far. Learning and Leadership from the services that had been rated as ‘good’ were being replicated in other services. Mrs Ellis expressed confidence that the Trust could deliver all the required actions.
The Chair said that Scrutiny had previously looked at the earlier LPT inspections and that in all of them, the overall rating was that the Trust required improvement. Some improvements had been made and these needed to be acknowledged and it was recognised that the CQC had judged that staff were good and caring, but there were strong concerns about the recurring key themes and issues throughout that time.
During the ensuing discussion, comments from Members and responses from officers included the following:
· Concerns were expressed that the inspection showed that there were still recurring themes that had not be addressed; including risks relating to ligature points and medicine management.
· There were concerns that smoking was not being managed in the Bradgate Unit. Members heard that while the NHS was a smoke free environment, managing this in the Bradgate Unit was challenging where some people were acutely ill. There was a clear commitment however to their ambition to be smoke free and there was now strong clinical leadership to help staff develop intervention measures. Advice to stop smoking, patches and vapours were all available and there were vapour areas in the garden.
· A Member commented that she was not reassured by the action plan. There were not just issues that needed to be addressed immediately but action was needed over the long term as well. Dr Miller agreed that improvements needed to be sustained.
· Members expressed strong concern that the well-led aspect of the Trust had been rated as ‘inadequate’ and criticisms were directed at senior management. A comment was made that there was no leadership to make the improvements and that there were too many areas of weakness and that was not good enough.
· A Member expressed strong concerns about the inspection findings particularly in view of the fact that many of the issues identified were not new and she questioned whether the Board’s plans filtered down to every level. The Member said that she had no confidence that the Board was addressing the problems identified.
· Dr Miller acknowledged that leadership was paramount; he said that the overall responsibility was his and he had announced that he would be taking early retirement. The Chair responded that this was a wider issue and not just the responsibility of one person.
· In respect of the Children and Adolescents Mental Health Service (CAMHS) it was noted that there had been a significant increase in demand for its services. A member commented that Rutland County Council had held a Task and Finish Group looking at young people’s mental health and had been told that some of the wrong people were being referred. She expressed concerns that there were no ‘wrong people’ and that a holistic approach was needed as to how young people with mental health issues could be supported. The Members asked at what point would CAMHS be able to say that there were no waiting times beyond the constitutional standard.
Dr Miller agreed that there should be a holistic approach and that children needed to be supported by different partners at an earlier stage. However, waiting times had decreased. The trust had an investment of £300k and more staff had been appointed.
Mr Micheal Smith, the HealthWatch Manager, Leicester and Leicestershire asked Members to note the positive experience of someone who had been able to access CAMHS very quickly.
The Chair added that there were issues for local authorities in relation to the prevention agenda for children’s mental health and she had asked at the City Council for details of those interventions. The Chair stated that the LPT were at the end of the model of delivery.
· A Member asked whether members of the Board were given the appropriate training to hold the leadership to account. Mrs Ellis explained that members were well qualified and received training including well led training.
· Mr Smith commented that patients had talked to HealthWatch about various problems they experienced in receiving treatment. Dr Miller responded that the LPT offered a wide variety of services which presented a challenge. However, 90% of people were happy with the service provided and feedback was generally good. Staff continuity of care though was impacted by the number of agency staff as currently there were approximately 200 nursing vacancies.
· In respect of the problems identified in the CQC report, Mr Smith commented that there were systemic issues in the LPT and those issues had been present prior to the current Chief Executive coming into the post.
· There was some discussion regarding the recruitment process for the new Chief Executive. A concern was raised that the Trust needed to appoint someone who had the experience of turning around a failing Trust. Mrs Ellis confirmed that they would be looking for someone who could turn the LPT around and there were potential candidates who would have experience of this.
· Dr Janet Underwood, HealthWatch Rutland, asked whether staff were demoralised and what was being done to support them. Dr Miller responded that staff were valued and their role in the quality of care given to staff was recognised and appreciated. Staff surveys were carried out and a significant improvement had been seen. In nine out of ten domains, the results of the surveys were above average. Dr Anne Scott, Interim Chief Nurse, LPT conceded that senior management had got it wrong and had not made improvements at the required rate, but stated that they did now have oversight and were determined to ensure improvements were accelerated.
The Chair drew the discussion to a close and commented that she believed that the Trust recognised that a radical transformation was needed, but at the same time the CQC report was a wake-up call for scrutiny and that scrutiny needed to be proactive rather than passive in its work. The Chair added that it showed that the lines of enquiry that Members had pursued in scrutiny had been justified. The Chair sought reassurance from the Board that they would be testing what was taking place on the ground.
The Chair recommended, and it was agreed, to invite the new Chief Executive Officer when in post, to the Joint Scrutiny Committee to talk about plans for improving the Leicestershire Partnership NHS Trust.
for the new Chief Executive Officer, when in post, to be invited to the Leicestershire, Leicester and Rutland Joint Health Scrutiny Committee to talk about plans for improving the Leicestershire Partnership (NHS) Trust.