Agenda item

To consider a report of the Director of Transformation and Governance on issues brought to the attention of the Committee which impact upon the planning, provision and/or operation of health services within Hampshire, or the Hampshire population.

a.    Hampshire Hospitals Foundation Trust - CQC Inspection Update 

b.    Portsmouth Hospitals NHS Trust– Update following CQC focused inspection of Emergency Department in February 2019

a.    Hampshire Hospitals Foundation Trust - CQC Inspection Update

The Chief Nurse and Program Lead for Quality from Hampshire Hospitals NHS Foundation Trust reported back on progress and provided an update on action taken by the trust in response to the areas the Care Quality Commission (CQC) had identified as requiring improvement, following the inspection of the trust’s services in 2018 (see report, Item 6a in the Minute Book) and new 2019 inspections against the 29a warning notice.  Members heard that the:

• CQC Winter Pressures team saw a “sea change” in culture, improved flow, and positive verbal feedback.
• New paediatric assessment units and rapid assessment treatment bays now in use at both sites.
• Continued improvements in patient safety checklists, compliance, and timely assessments.
• Updates to policies, schedules, departmental responsibilities, equipment maintenance, risk management processes, mandatory training, and accessible information.
• Mental Health Act implementation, training and recruitment of mental health staff.
• Progress to 159 actions completed but some issues due to delays and ensuring continuance of care.
• New inspection against warning notice on a particularly pressurized winter’s day with record number of patients.
• Significant improvement noted in terms of issues resolved or in the process of being resolved but final report not yet prepared.
• 3 new divisional chief nurses to assist with areas of vulnerability.
• Improvements to annual reviews and day to day procedures.
• Equipment maintenance now at 80% compliance and cleaning issues being addressed.
• Retention of staff is high, staff training implemented with support from Solent, as well as a peer review program.
• 72% progress towards completion of outstanding actions (although short of 80% target)

In response to questions, Members heard:

• Support is needed to train emergency staff on the Mental Health Act and a new joint appointment made for a mental health nurse and educator.
• New rooms in both ER waiting areas for patients needing mental health care.
• In terms of addressing staff morale for such a large organization, whilst it was been a challenge, morale is now improving as there are monthly meetings to discuss concerns, feedback, areas of improvement, and how staff are feeling.
• Peer reviews have been very helpful with ward visits in terms of setting clear expectations whist reviewing internal teams and identifying improvement areas.
• Feedback from Members was being taken back in terms of ensuring patients feel cared for and the need for wait times to be shorter, which are both monitored through a check list used by staff.
• The critical role of effective appraisals in health care and the need to address and improve cultural and leadership issues of the organization to promote better understanding of expectations, engaging staff, capturing meaningful feedback, and tracking improvements against measurable metrics.
• Ensuring the completion of mandatory training, strengthened cleaning protocols, improved theater capacity, adequate equipment, as well as equipment maintenance, labeling, and monitoring as they are central to diagnosis and treatment of patients.
• Engaging users and carers to gather further feedback regarding improvements in treatment and care.
• Effective management and leadership plan in place to help staff successfully navigate a high-pressure environment with professional development and support.
• Current hiring challenges in the medical field and steps taken to attract qualified staff.
• Encouraging intercommunication and shared learning, tools, resources, best practices, and strategies between hospitals.

RESOLVED

That the Committee:

a. Note the update on action taken by the Trust in response to the 2019 CQC inspection findings.

b. Request a further progress update for the November 2019 meeting.

b.    Portsmouth Hospitals NHS Trust– Update following CQC focused inspection of Emergency Department in February 2019

Members heard from Director of Governance & Risk regarding the report and summary of the CQC inspection.  The 25 February inspection was presented in the context that there were 1300 more patients in 2019 than the previous year was indicative of the significant pressure, sicker patients, and increased footfall through the department.

A number of improvements were noted as being implemented in April and May. There has been increased efforts with commitment, transparency, and collaboration.  Whilst there were distressing “Must Do” items in the report, plans have been put into place to tackle specific issues building on the framework already in place.

A sprints approach has been taken to address improvements in people flow through the department, as well as looking at physical layout and redevelopment. Embedding the Trust’s values in staff and working together for patients with compassion and promoting those messages is key.  Staff has also engaged in “Sit and See” and watching from an objective perspective to better understand the implications for the department. Daily equipment checks have had a practical solution with a dedicated nurse to follow up.  The requirements are now leading the way to the Trust’s ambitions and aspirations.

In response to questions, Members heard:

• In order to spread leadership focus across the operation, a new development program was implemented for all clinical and non-clinical leaders over 9 months.
• Emergency teams also had feedback from other trusts with learning exchange and the NHS improvement regulatory body with support and mentorship with organizational development team.
• Attracting staff (nurses and junior doctors) to the emergency team to staff the department to the desired level.
• The trust is working to understand the demands, times, attendance patterns, locations, and needs from different areas to work with CCGs to better understand the disproportionate statistics for certain postcodes to address local issues.
• Further recruitment and training, embracing values, Sit and See observations, increased audits, and a cultural shift all facilitate better patient care.
• Physical redevelopment will be critical but also systems, culture, and improving pathways from patients' homes to urgent care in the widest sense of the pathway – not just bricks and mortars – and changing the whole approach to care, including finding care in other settings.
• Collaborating across departments even under pressure to maintain effective care, cleanliness, and dignity for all patients is key.
• Quality reviews, peer reviews, working together, and challenging each other to improve care, believing that “The care you walk past is the care you endorse”.
• The emergency department is highlighted because it was the focus of the inspection, but comprehensive review will also follow to address changes in standards, regulations, demands, designs, health and social care settings.
• Working with colleagues to diffuse staff pressure and better the urgent care pathway to assess and treat users in a timely way in the right setting.

RESOLVED

That the Committee:

a.         Noted the update on action taken by the Trust in response to the February 2019 CQC inspection findings.

b.         Request a further progress update for the July or November 2019 meetings.