Presentation from the London North West University Healthcare NHS Trust.
The Sub-Committee received a report from London North West University Healthcare NHS Trust’s Chief Nurse, which provided an update on the Care Quality Commission (CQC) inspection in April 2021 of Maternity and A&E services provided by London North West University Healthcare NHS Trust (LNWHT) at Northwick Park Hospital. The following key points were raised:
· A CQC visit had taken place at Northwick Park Hospital in April 2021, where two departments were visited: Maternity Services and the emergency department.
· The overall rating for the Trust remained to be “required improvement” however inspectors had noted significant improvements within the emergency department.
· The CQC rated Maternity services as inadequate and had found areas of serious concern. A full improvement plan for maternity services had been developed in response to the issues found. This plan consisted of three themes which were: workforce, culture and leadership; women-centred care and safe, effective care.
· Improvements had been made to their systems and processes at Northwick Park Hospital, in addition a new leadership team had been introduced which had made a positive difference.
· Freedom to speak up champions were introduced which had given staff who might otherwise had been afraid to report concerns. In addition, a zero tolerance of bullying stance had been taken.
· The maternity improvement plan was reviewed on a weekly basis, the internal maternity improvement group would meet on a monthly basis ensuring the plan would be delivered. The ICS had operated a fortnightly check and challenge meeting within the Maternity ward which had since moved to a monthly meeting.
· A priority remained for appointments in key leadership posts to be made. In addition, an organisational development plan had been implemented in order to support and nurture teams. However, vacancy rates remained a challenge and were highlighted to be a long-term issue.
· Progress had been made and there was a focus for long-term strategic plans to be implemented for success to be ensured.
· General feedback from the CQC had been received and included improvements in staff attitudes, behaviours and morale were to be seen. Significant improvements in documentation were also noted and that it was recognised that changes made were required to be embedded into their structure.
The Chair thanked officers and NHS representatives for their updates and asked a number of questions, which were responded to as follows:
· A Member noted that it was good for some progress to be seen but aware that more work was needed. It asked how working cultures differed between departments within the same hospital and what mechanisms were in place to allow for shared learning. The interim CEO at London North West University Healthcare NHS Trust explained that they had identified a need for excellent clinical leadership where there would engagement, staff would be supported and that diversity and inclusion were embraced would have a positive impact on work place culture. It was noted that the new structure in the maternity unit had met these values.
The London North West University Healthcare NHS Trust’s Chief Nurse added that a key challenge for improved learning within the maternity ward had been that the ward was geographically isolated compared to other units within Northwick Park Hospital. A buddy system for maternity ward based matrons to shadow other matrons had been implemented and secondments to other hospitals had been planned in order for learning to take place at different settings.
· A Member asked how the Trust had compared to other Trusts in terms of vacancy and sickness rates within the maternity services. The London North West University Healthcare NHS Trust’s Chief Nurse explained that Northwick Park Hospital had high vacancy rates at band 6. However, high vacancy rates were noted to be a London wide issue. They added that turnover had been high but had seen an improvement.
· A Member asked, with the shortage of midwives, had these duties been delegated to other staff. The London North West University Healthcare NHS Trust’s Chief Nurse explained that maternity support workers though not qualified midwives had received additional training that was appropriate to support patients. In addition, services had been consolidated in order for safety issues to be managed.
· A Member noted that targets set that could be measured regularly would be of benefit when considering accountability. The interim CEO at London North West University Healthcare NHS Trust explained that a series of metrics had been put into place that were agreed with the service and clinicians, these metrics were reviewed monthly at the internal maternal improvement group meetings, so that progress could be ensured. In addition, objectives had been set for the leadership team and metrics were discussed fortnightly amongst the directorship.
· The Chair asked if there were areas of the maternity service that required more attention compared to other parts of the service, to which the London North West University Healthcare NHS Trust’s Chief Nurse explained the triage service and the labour ward had been of focus due to their high risk nature. In addition they noted that community services were in need of modernisation with technology raised as an area in need of improvement.
· The Chair asked how the needs of local residents had been considered with Northwick Park Hospital. The London North West University Healthcare NHS Trust’s Chief Nurse highlighted that there had been a need for the language and translation services to be better utilised so that accessibility could be improved.
The Chair thanked the Sub-Committee for their questions and thanked the NHS Staff for their presentation and answers and wished the NHS staff all the best for the future.
RESOLVED: That the report be noted.