Agenda item

Report of the London North West University Healthcare NHS Trust and Care Quality Commission Inspection Report.

The Sub-Committee received a report of the London North West University Healthcare NHS Trust in response the Inspection Report of the Care Quality Commission (CQC).  In addition, the Trust also tabled a document setting out the context, ratings, responses to warning notices, steps proposed and its Transformation Programme to help make improvements in the way care was provided.  The Sub-Committee accepted the additional document as the slides provided context to the documents circulated with the agenda.

Representatives of the Trust introduced the report and informed Members that the CQC had undertaken an announced inspection of London North West University Healthcare NHS Trust for three days from 5 to 7 June 2018.  Scheduled inspections took place across four sites:  Northwick Park, Ealing, Community Inpatients-Willesden and Clayponds and Community Dental.

The CQC had also undertaken a ‘Well-Led’ specific inspection of the entire service from the 3to 6 July 2018 through tours and scheduled interviews with senior managers, service leads and the Executive team.  An unannounced inspection took place between 8 to18 July 2018.

Members noted that, as part of the inspection, the CQC spoke to patients, visitors, carers and staff (in the hospitals, in focus groups and formal interviews) to gain a view of London North West University Healthcare NHS Trust’ 8 core services; Surgery, Critical care, Maternity/Gynaecology, Services for Children and Young People, Medical care, Urgent & Emergency Care, Community and Community Dental Services.

A representative of the Trust stated that it was disappointed with the report of the CQC and identified the opportunities provided to put measures in place.  The majority of the areas had had improved significantly since the last CQC Inspection in 2015.  He drew attention to the overall ratings and outlined issues at Ealing Hospital’s Emergency Department and Medical Services, and Critical Care at Northwick Park.  He outlined the measures that had been put in place, details of which were included in the tabled document.

The representative identified the steps that the Trust would be taking forward to address the recommendations of the CQC and the following measures were planned:

-               a Quality Summit would be held at Ealing Hospital on 6 November 2018.  He alluded on the proposed programme and informed Members that key stakeholders had been invited to the Summit;

-               work would continue with various sectors of the hospitals to develop and implement action plans, identify further improvements, design suitable solutions and carry out governance reviews;

-               move forward with the Transformation Programme to embed quality improvement methodology across all services.  The Transformation Programme would look at the following areas:

(a)          innovation and improvement: developing staff to lead on improvements which would include training to help develop long-term solutions to local issues as well as championing a culture of quality improvement across the Trust;

(b)          work on core safety issues to offer safe and a high quality of care;

(c)          a seamless care service for patients across acute and community services assisted by new technology;

(d)          ensure that the Trust was fit for the future and worked efficiently.

Members asked the following questions:

-               were there any surprises in the CQC’s report or were the judgement as expected;

-               over the years, the Maternity Service had continued to concern the Sub-Committee and the CQC report had not alleviated these concerns.  What measures would be put in place to address the CQC’s concerns and were these different from previous action plans;

-               would the Council and Councillors have an opportunity to input into the future direction of the Trust at the Quality Summit;

-               post natal care was considered to be poor, especially for new mothers.

In response, representatives of the Trust stated that:

-               they were disappointed with the report of the CQC, particularly in relation to the ratings for Ealing Hospital.  They had been surprised that basic issues had been identified;

-               that the issues identified in relation to the Maternity Service were different and related to safety and security.  Clinical performance at Northwick Park Hospital was good but that technical issues had been identified which had since been resolved;

-               that some of the ratings in a number of areas had been classified as ‘Good’ and the Trust was proud of its achievements and that it was pleased that the rating ‘Inadequate’ in relation to safety at Ealing Hospital was not linked to its clinical services;

-               the issues around the culture within the Trust were being addressed as part of its training programme and the CQC had acknowledged that the staff at the Trust were better a reporting incidents.  It was important that staff were able to speak openly on issues.  In relation to the Maternity Service, it was expected that an obstetrician would be trained to deliver training to other staff;

-               significant changes had been put in place for post natal care but surveys had sown that more work was required.  The results from the surveys would feed into the improvement plans and it was essential that correct staffing levels with appropriate skills were available.  The Trust was also resolving issues at local level – local resolution.  It was essential that the Trust worked with its Commissioners.  The Maternity Voices Forum met on a monthly basis and regular meetings were held between midwives and users to allow issues to be captured early.

An adviser to the Sub-Committee pointed out that it was important to note that the CQC had not been critical of clinical care within the Maternity Service and it good to note that the outcomes were positive.  The majority of users had had good experiences and further training would help.  The collaborative work with the national regulator NHSI (Improvement) had shown that handovers had been seamless.  It was important that staff were involved and empowered to make improvements in services.  The high rate of miscarriages related to the deprivation and early interventions were required to improve the care.

Another representative of the Trust reported that the midwives were accessible in clinical areas and that they worked cohesively.  A cultural shift in the way that staff worked was underway and the support of NHSI provided an opportunity to learn and share different ways of working.  She was of the view that, overall, the services provided was good but the Trust was not complacent.  The consolidation of the Maternity Service at Northwick Park Hospital had been successful and had helped to provide a greater resource base.

A Member asked how the key aspects of the action plan would be prioritised and whether these were achievable.  She also enquired about the timelines set.  A representative of the Trust stated that the Quality Summit would help answer these questions and that the outcomes would be shared with stakeholders.  Some actions would require longer time frames and that the Trust would work with the CCG and NHSI to finalise timelines.

The same Member reported that her constituents had complained about the lack of responses from the Trust in relation to complaints about post natal care.  Representatives of the Trust reported that it was important that the complaints system was used by users but that the Trust was working hard to ensure that responses were sent out in a timely fashion.  He asked if the Member could ask her constituents who had complained about the lack of responses to send the complaints to him personally.  They acknowledged that the Trust needed to explore different ways in which it could reach out to its services users.

Another Member asked if the Trust’s satellite sites such as the outreach clinic at Hammersmith Hospital had been part of the inspection by the CQC.  He was informed that the inspection of such sites would form part of the assessment of that hospital.

Members were informed that they should contact the Chief Nurse of their desire to attend the Quality Summit as places were limited.

Members complimented the Trust for the improvements made in Urgent Care which they felt was delivering a better service.  They added that their constituents had also complimented on the improvements made to the Maternity Service.

RESOLVED:  That the report of the Care Quality Commission (CQC) on the inspection of the London North West University Healthcare NHS Trust be noted, including the actions and next steps being taken by the Trust to address CQC’s recommendations.