Agenda item

Report of the London North West University Healthcare NHS Trust

The Forum noted that, at its meeting in October 2018, the Sub-Committee had received a report of the London North West University Healthcare NHS Trust setting out the response to the Inspection Report of the Care Quality Commission (CQC).

The report before Members at tonight’s meeting (4 January 2019) provided an update on the following:

-               the recent unannounced CQC visit on 10 January 2019;

-               an update on the completion of the ‘MUST DO’ Action Plan;

-               an overview of the developed Composite Improvement Plan;

-               a progress update on the Actions from the Quality Summit;

-               a proposal of the CQC Preparation Plan.

A representative of the Trust introduced the report and stated that, since the Inspection, a CQC Review Group had been set up to consider the Action Plan, which was attached to the report.  Good progress had been made and the CQC had made an unannounced visit in January 2019 and their further report was awaited.

Another representative informed Members of the progress made following the CQC Inspection Report and the next steps for the Trust.  She added that the Trust had made good progress towards the recommendations of the CQC.  A strong governance framework had been established to ensure that the progress made was sustainable.  The visit by the CQC in January 2019 related to the ‘Warning Notices’ issued following the Inspection in 2018, which had mostly been technical in nature and had not compromised safety of patients.  All the issues raised at both the Ealing Hospital and Northwick Park Hospital sites had been addressed.  She re-iterated that a further report of the CQC was awaited.

The Sub-Committee was informed that since the receipt of the Inspection Report, the Trust had engaged with frontline staff and comprehensive measures had been put in place in relation to Maternity Services.  The pledges following the Quality Summit were also being addressed.

Members asked the following questions:

·                     Action Plan - which actions in the Plan had been completed? What was outstanding?  How had the staff been involved in the implementation and had they taken ownership?  Which actions in the Plan were proving particularly challenging to implement and why?

A representative of the Trust reported that engagement with staff had been positive.  For example, in Maternity Services, a staff newsletter had been introduced to ensure that staff were kept informed of developments.  Measures had been put in place to ensure that the progress made was sustainable.  All Trusts faced difficulties in recruiting nursing staff and the Trust was working with NHS Improvement in this regard.  Recruitment and retention measures were also being looked at, including that the Trust needed to be seen as an ‘employer of choice’.  International recruitment was being explored.

Another representative stated that the majority of the recommendations in the Inspection Report related to compliance with training and stock management.  He stated that additional staff training had been put in train, particularly in relation to the Bleep System(s) in Maternity Services.  It was essential to embed practice and audits were undertaken to ensure that the measures put in place were working.  He explained that dedicated time slots for testing had been introduced and staff had been informed on how to escalate issues.  Follow up audits were also conducted by other departments.

·                     Action Plan – what policies had been put in place for the management of medicines, including those where the date had expired?

A representative of the Trust stated that robust mechanisms had been put in place and the Trust was now compliant with its policies for the management and stock control for drugs at ward level. The CQC, as part of their unannounced visit in January 2019, had put this to test at Ealing Hospital and their report was awaited. It was noted that no patients had been harmed as a result of this issue. The Trust was not complacent on this matter and would ensure that it remained fully compliant with the requirements.

Another representative added that Omnicell products to dispense medications had been purchased to help ensure patient safety.  The products helped to ensure that medications were kept at the correct temperatures.  The products allowed for stock control and dosage compliance.  Checks against allergies were also made.

In response to a further question on how these products were being financed, the same representative stated that the costs were being met from existing budgets.  He explained that whilst the Trust had received additional funding, the money was being used to fund, for example, the post of an Improvement Director and the appointment had been made from within the Trust for a fixed term of 1-year.

·                     How had the feedback from service users and patient groups helped shape the action plan for improvements?

A representative of the Trust informed the Forum that various meetings/organisations, such as the Patient Experience Committee, Healthwatch, patient stories and complaints had helped capture key messages for the Trust to work on.

·                     There would be a re-inspection in the first quarter of 2019/20 (i.e. summer).  What can the Council do to help facilitate a successful inspection?

Representatives of the Trust stated that their attendance at meetings of the Council helped to provide feedback, including Member feedback from their constituents.  Additionally, the following would help:

-               ensuring that there was sufficient access to placements when the Trust was in the process of discharging patients.  There continued to be some challenges around provision in care homes and the Council could help with their improvements;

-               CQC would look at areas in which the Trust was languishing.  An improved health/social care system together with collaborative working would help;

-               improved service delivery, supporting each other, positivity, transparency and integrated working between the Trust and the Council was also essential.

·                     Budget - Who managed the audit?  Were both internal and external audits carried out?

In response, a representative of the Trust stated that, for all action plans, audit was conducted within teams and by external teams.  Internal audit would examine pathways (such as in the A&E), CQC would follow-up by carrying out further inspections, NHS Improvement carried out reviews and the CCG would monitor on a monthly basis against the Plans and provide checks and balances.  There were different tiers of scrutiny.

·                     Risk Register – Was there an issue due to insufficient staff?

A representative from the Trust explained that new entries included Paediatric Anaesthetic cover at Ealing and Junior Doctors’ compliance with mandatory training.  Steps were being taken to ensure that all staff were trained and compliant. 

·                     Had winter pressures unduly impacted upon the Trust’s ability to deliver the CQC action plan?

The Sub-Committee was informed that, since Christmas, the pressures on the emergency pathway had been extraordinary.  Other areas of the Trust, such as the cardiology team, had to provide additional support to A&E Service. Such demands inevitably caused pressures on the Trust.

Staff had fully engaged with the Action Plan.  Some areas were challenging but, overall, engagement with staff had been positive and they remained engaged.

The Chair thanked representatives of the Trust for attending the meeting and answering their questions.

RESOLVED:  That the report be noted.