Angela Wood, Chief Nurse to present.
Angela Wood, Chief Nurse, provided an update regarding the findings and the ongoing actions to improve the Care Quality Commission (CQC) rating for the Trust, in particular for the Urgent and Emergency Care Centre (UECC).
Four requirement notices were given to the Trust following CQC inspections in 2018, plus 74 actions, (a combination of 47 Must Do and 27 Should Do actions), some of which were organisation-wide such as governance, training and medicines management. A comprehensive action plan was developed and monitored in the Trust with significant progress made to address the concerns raised by the CQC. Examples of activity and improvements were outlined across all five domains – Safe, Effective, Responsive, Caring and Well-led. Two actions had slipped and the Trust was in dialogue about these with the CQC – training around mental health capacity and medical audits around care in the UECC. The remainder of the actions would be completed by 31 October 2019, followed by monitoring/audit for a period of sustained improvement.
The CQC had subsequently returned in an unannounced inspection in August 2019 to the UECC and the Trust was awaiting the draft report for commen on factual accuracy. A re-rating of the core service would ensue and the Trust hoped to achieve improved ratings in the domains previously rated as inadequate.
The CQC would probably return again in early 2020 as some core services had not been inspected for a while. A request for a Provider Information Return would flag up that the CQC were expected imminently, usually within six weeks. Regular meetings were taking place with the CQC, including inviting them to visit core services and to a quality assurance meeting. The CQC had also visited a Serious Incident Panel and complimented the Trust on the rigour with which that was conducted. Preparation for the next inspection was under way through assessments and peer reviews and after 12 months in post the Chief Nurse was able to see the progress made in terms of engagement and quality of care.
Members raised the following issues.
· Was a system in place to reward positive role models and staff behaviours? - This had been touched upon at the last meeting and discussed subsequently. Star cards are sent as thanks for staff going over and above what they should be doing or demonstrating really good values. The Proud awards on 15th November, 2019 would be voted for by staff and there was also a patients’ category. One area to look at capturing would be if a person received multiple star cards.
· The positive report was welcomed as good news with the hope of it being formally confirmed in due course and clarification was sought on several acronyms within the briefing.
· With the reorganisation within the Trust to what extent did the CQC pick up on the teething problems? – Some recognition was given to this such as the vastness of the areas, bringing things together and cultural issues to work on. Team building and organisational development were worked on, including strong leadership and support for escalating issues, but it was also about delivery to the required standards as well.
· Recently on social media messages were posted asking people not to go to the UECC due to a shortage of beds. What was the current position? - Nationally, increased numbers had been attending A&E and the usual summer lull did not occur in 2019. The hospital was looking to improve patient flows through the hospital to have beds available, for example improvements in the discharge process through the work of the Integrated Discharge Team. Some of the issues related to the sheer volume of people attending and whether they should be at the UECC or seen elsewhere. Work was taking place with GPs and RCCG around the pathways and increased care at home and support to avoid hospital admissions.
· In relation to mandatory training work with certain staff was mentioned, so what more was needed to ensure compliance? - Significantly increased compliance had resulted, but further work was taking place with some of the medical colleagues but it could be difficult to release staff from the sharp end in the UECC so the Trust was looking at alternative methods of delivery.
· Staffing - had there been a reduction in use of agency staff and were measures being introduced to try and retain the Trust’s own good staff? - Significant staffing issues had been present in the paediatric UECC before but no agency staff had been used since early 2019. The hospital’s own staff and bank staff had been used for extra shifts. The Trust had now exceeded the CQC requirements for paediatric nursing staffing. In general UECC some agency staff were used due to unfilled vacancies, more for medical staff than nurses and a review had just been undertaken of nursing staff and vacancies would be backfilled with bank/agency staff to ensure an appropriate skill mix. Recruitment would be taking place in November and a number of staff were also on maternity leave.
Monthly culture checks, what were they for and what were they
- They covered working together and appropriate escalation of issues. Various pieces of work were under way as outlined in the paper, including the drop-in clinics for people to share ideas or concerns. Organisational development within HR was looking to introduce monthly barometer checks to gauge how people were feeling.
· From a patient perspective, how different would things look and feel now in the UECC compared with at the beginning of this journey? - The UECC was busy but would feel like a calmer and safer environment to be in and with staff now more engaged. Information came through more quickly and better communication was happening. With a high throughput of patients delays were inevitable but triage times were monitored and staff were ensuring people were streamed appropriately from the front door. Ambulances were also bringing people in to rapid assessment areas.
1) That the progress being made with the 2018 and 2019 inspection process be noted.
2) That a further monitoring report be provided for HSC once the outcome of the CQC re-inspection was known.