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)    CQC Update for Portsmouth Hospitals Trust

b)    CQC Update from Southern Health Foundation Trust

c)    CQC Inspection Report from Frimley Health NHS Foundation Trust

d)    CQC Inspection Report from University Hospital Southampton Foundation Trust

a)    CQC Update for Portsmouth Hospitals Trust

Representatives from Portsmouth Hospitals Trust presented a report providing an update on the action taken by the Trust in response to the areas the Care Quality Commission had identified as “Requiring Improvement”.  Members heard:

·         The Trust was taking a different approach to move to a culture of continuous improvement and engagement not simply due to CQC ratings, but from their own aspirations to provide excellent care.

·         A shared assurance and improvement programme with commissioners alongside heat map activity with CCGs and Healthwatch to agree collaboratively on concerns and address issues raised with an agreed plan for working together to investigate, respond, and measure improvements.

·         A quarterly programme of quality reviews and conducting mock investigations similar to the CQC with other partners in health and social care system to track and evaluate improvements on the ground with an agile and responsive programme of quality reviews.

·         Ward accreditation programmes and early visits to provide encouragement towards bronze, silver, and gold awards based on CQC metrics and locally raised issues.

·         An integrated joined-up improvement plan with activities will be key, rather than having various plans in response to feedback from CQC, local teams, and aspirations

Regarding ambulance delays, Members heard:

• Despite a capacity plan for winter pressures with added investment and resources, winter was challenging with a steady increase in daily attendance including older and more vulnerable patients.
• Significant improvements have been made to aim for a 93% occupation rate to weather the winter effectively.
• There was a deterioration in ambulance handover delays and requires a significant amount of work to improve.
• The older building layout not designed for nearly 400 attendants daily creates added challenges to deliver consistent flow with higher than 92% occupancy.
• 95% is the average occupancy and measure of hospital capacity with robust middle grade staffing overnight and support.
• The objective is to move towards upper quartile of national performance for ambulance delays which is ambitious but necessary to maintain.
• The necessary actions include continued commitment with consolidations and evidence-based improvements for the occupancy project, as well as proactive bed moving to decompress the emergency department at times of maximum crowding.
• The Trust have received 58 million for an emergency/urgent care rebuild and transformation programme over the coming years to fit current and new challenges
• Whole system response and data from past reviews revealed the 4 key drivers (population health and demand, emergency department processes, bed occupancy, and out of hospital service).
• A 92% occupancy goal to provide consistent flow, avoid ambulance holdups.
• Users need to know how to access emergency care and facilities with necessary support for people who are ready to go home.
• The immediate next steps include: discharge targets, reduce number of medically fit patients, increase paramedic access to alternative care, and implement agreed out of hospital schemes.
• Local health and social care partners (including the county), as well as NHS England and NHS improvement collaborations are underway.

In response to questions, Members heard:

• Every patient is triaged by a nurse or doctor upon arrival but due to delays, this can take place in the ambulance, thereby holding it back from going on to another location.
• 30-35 beds free would reduce occupancy to 92% by getting medically able patients out of beds for more system capacity and better delivery performance.
• Healthier patients need to receive the right care in a different setting.
• The goal is to reach people earlier in their admission pathway and integrated intermediate care workstream to address and ensure that older, frail and vulnerable patients do not have prolonged waits and are able to go home earlier.
• The clinical judgement of the paramedics remains unaffected by occupancy rates and they are trained to determine who needs treatment in hospital.
• As a safety and risk issue, patients must be offloaded safely allowing ambulances to get to the next call immediately.
• SCAS is excellent and 56% of patients do not require hospital care, heading home after treatment and the safety of the patients remaining the priority.
• In addressing a growing population, the modelling done has considered 5-10 years ahead and as a health-economy been anticipatory of future needs.
• Traditional ways of delivering care will be inadequate and strategic provision of care nearer to people with access and flexibility without an A&E default with specific plans in place for people with long-term conditions.
• The majority of care is still delivered through the hospital and this is an opportunity to address the challenges and navigate an intelligent way forward with renewed commitment to safely delivering the best care possible.
• Anticipatory prescriptions in a timely manner and within capacity ahead of patient discharge is a key component of current occupancy project. 
• Patients are also triaged and directed to the GP service based in A&E 7 days a week, 10 hours a day and the service has been in place for about a year.
• Urgent treatment centres and primary care hubs are useful but logistically challenging to staff and run with adequate resources and transportation needs.
• Delays in assessments or moving patients around affects the occupancy level, flow, and wait times.
• A recent analysis of 60k patients will exceptionally useful in exploring anticipatory discharge prescriptions, positive flow, and appropriate or efficient use of the beds.
• Discharge lounges help but proven to be risky and less efficient, while delivering prescriptions is very expensive.
• With changes in population and increased demands, system plans and organizational changes with system partners is necessary to meet needs.
• The most significant success of the winter was the limited rescheduling of planned operations which continues to improve.
• Currently waiting for CQC information request to trigger an inspection in the next 12-18 months and the Trust would be disappointed if the rating didn’t change.
• Plans not yet agreed, refined, and ratified but expected to be over the next few weeks and work is already underway. 

RESOLVED:

That the Committee:

a. Noted the findings of the most recent CQC inspection of Portsmouth Hospitals

Foundation Trust.

b. Noted the approach of the Trust to respond to the findings.

c. Requested a further progress update for the November 2019 meeting.

a)      CQC Update from Southern Health Foundation Trust

Item taken first, out of order, with Chairman’s permission to accommodate presenter.

The Chief Executive from Southern Health Foundation Trust presented a report providing an update on the action taken by the Trust in response to the areas the Care Quality Commission had identified as “Requiring Improvement”.  Members heard:

• Reasonably good progress has been made on several overdue actions whilst waiting to complete audit.
• Providing single sex accommodation has been a struggle at several facilities and some have been addressed fully and provide a dementia-friendly environment.
• The CQC will be considering these improvements carefully during re-inspections.
• An information request was received last week and the first step of the process with a full inspection to follow within 6 months of submission.
• Action plan spreadsheets including overdue actions will be reviewed by local panel every month for complete, validated status and evidence-based resolutions.
• Delivery of the action plan is now part of the governance and operational procedure for greater traction and improvements.

In response to questions, Members heard:

• There has been organizational pressure and demand for adult mental health beds.
• Proper gender separation in lounge areas, bathrooms lower risks and prevents dignity issues for vulnerable patients with nursing oversight.

Members noted that progress was being made but still had a long way to go to.

RESOLVED:

That the Committee:

a. Noted the findings of the most recent CQC inspection of Southern Health

Foundation Trust.

b. Noted the approach of the Trust to respond to the findings.

c. Requested a further progress update for the November 2019 meeting.

c)    CQC Inspection Report from Frimley Health NHS Foundation Trust

A representative from Frimley Health Foundation Trust presented a report providing an update on action taken by the Trust following their Care Quality Commission inspection of the Trust’s services with an overall rating of “Good”.  The detailed improvement plan put into place is to be shared with the Committee following the meeting.

Members heard:

• Frimley Health Foundation Trust was created in 2014 with the first inspection in November 2018 (clinical) and then December 2018 (leadership and resources).
• The CQC select services for inspection to take an in-depth look at a specific area.
• In March the Trust were pleased to receive an overall rating of “Good” while hospitals retained their individual ratings.
• The Trust is already putting improvements into place and not being complacent in providing the best care for patients.
• ‘Must-dos’ include maternity staffing (midwife to birth ratios) which do not meet the national benchmark, but the business case has been approved and funded.
• A detailed strategy for recruitment and retainment will be in place as well as a structured approach to managing safety and staffing issues.
• Mandatory training in line with roles and responsibilities is a must-do to meet the benchmark of 85% needing investment in training and online accessibility options.
• Even with Outstanding and Good care, staff are careful to support independence for patients both in and out of hospital.

In response to questions, Members heard that:

• The shortage of midwives did not have any serious implications and safety was maintained across maternity services.
• The catchment includes mothers with complex needs and progress is being made towards well-managed care.
• Creating an environment where midwives choose to work and are supported with a balanced workload is key.
• Members congratulated the Trust on their ratings and noted that it was the best matrix of ratings the committee had seen and that “Good” can always go to “Outstanding”. 

RESOLVED:

That the Committee:

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

b. Requested a further progress update for the March 2020 meeting.

d)    CQC Inspection Report from University Hospital Southampton Foundation Trust

A representative from University Hospital Southampton Foundation Trust presented a report providing an update on action taken by the Trust following their Care Quality Commission inspection of the Trust’s services with an overall rating of “Good”. 

Members heard:

• The CQC inspections included 4 key services across 4 sites.
• The Trust retained an overall “Good” rating and hospitals, their specific ratings.
• Good practices for safety have been put into use and issues are being addressed.
• An older estate location remains a challenge with an increase in demand and limited capacity.
• There have been positive findings with good and outstanding observations but also must do actions and ongoing audits.

An action plan would be submitted following the meeting per the Chairman’s request.

RESOLVED:

That the Committee:

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

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