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.

·       Portsmouth Hospitals NHS Trust: Care Quality Commission Re-Inspection – Monitoring of Quality Improvement Plan

Councillor Tonia Craig left at this point in the meeting.

Portsmouth Hospitals NHS Trust; Care Quality Commission Re-Inspection – Monitoring of Quality Improvement Plan

The Chief Executive of Portsmouth Hospitals NHS Trust and his representatives attended alongside a representative from Hampshire CCG Partnership in order to speak to the Quality Improvement Plan and related issues (see report, Item 7 in the Minute Book).

Members heard that a number of papers had been sent to the Committee including progress against the quality improvement plan, which was a detailed overview of all the actions being undertaken by the Trust.  This overview provided an indication of those actions that are on track and those where delivery required further action.  This spreadsheet was the same document made available to the internal Trust review group considering progress made against recommendations.  Also included within the papers were the outcomes and Trust statement on the Care Quality Commission (CQC) investigation into radiology services.

In response to questions, Members heard:

·      That the Trust received an unannounced inspection of its urgent care services in February which focused on the Trust’s response to winter pressures.  The Trust had been one of a number of Trusts inspected due to its status as a ‘high risk’ system. 

·      The CQC’s urgent care inspection report highlighted some areas of positive progress but was also clear on areas for definite improvement.  All the recommendations from this report had been picked up through both the quality improvement plan and the wider system improvement plan.  The Chief Executive was confident that those recommendations requiring urgent action had been implemented, and that the comprehensive inspection that had been undertaken in April and May would see improvements.

·      It had been three years since the Trust had last been subject to a comprehensive CQC inspection; the reports published since had focused on areas of the Trust’s activity but had not provided overall ratings.  The inspections were considering all elements of the Trust’s business, with the exception of gynaecology.  The inspection elements had finished in the last week, with the most recent visit focusing on whether the Trust was a well-led organisation.  It was expected that an initial draft report would be available towards the end of June.

·      The CCG had been involved in the oversight process, with a significant role in ongoing quality committees, and the Director of Quality and her team actively involved in assisting the Trust.  Meetings and the sharing of information took place both weekly and monthly, in order to ensure that actions are being completed.   The CCG continued their view that improvement was being evidenced in the Trust, and the new Board were committed to leading the Trust through its improvement journey.

·      At the last meeting where Portsmouth Hospital Trust appeared before the Committee, the issue of the urgent care department and acute medical unit’s estate was raised and discussion was held on whether works could be undertaken to improve the flow and layout of this area of the hospital.  This estate issue remained difficult to resolve, as capital funding for works was a national issue and all NHS bodies requiring finance to support building works were required to enter a bidding process, competing against other bids.  The Trust had detailed what an amended urgent care estate model would look like, including what changes would be required and how much this would be likely to cost.  A local project team had been appointed to work on this, and it was hoped that an outline business case would be ready by the end of June for submission.

·      The other two major issues previously raised in relation to urgent care were staffing, policies and processes.  Since this time, the Trust had made significant investment in staffing, increasing the amount of consultant and doctor support, and ensuring that staffing rotas matched the busiest times in the urgent care department.  The Trust also felt that positive improvements had been made in implementing policies around patient flow, but it was recognised that there was still more to do in relation to this, some of which had been highlighted in the most recent CQC inspection report.

·      The Trust were content with the progress made around GP triage and treatment in urgent care, with approximately 50 to 60 patients a day being diverted from urgent care.

·      There also remained significant issues around finding the most appropriate place for patients once they no longer required acute medical care.  Significant progress had been made around these delayed transfers, with the past nine weeks seeing the lowest escalation levels across the system in the past five years.  Work was ongoing across the geography with Newton Europe to identify what other actions could be undertaken to continue to improve this position.

·      A year ago, the Trust were positioned 136^th out of 137 acute hospital trusts for its urgent care performance.  Currently, the Trust were performing 76^th out of 137, a significant improvement.  The current year-to-date figures showed an average 88% performance against the four hours arrival to treatment target, against a national average of 89% against a national 95% target.  A year ago, this was sitting at approximately 72%.  The Trust still had further improvements to make, but the trajectory was the right one.

·      The MRSA rate had seen a slight increase over the previous year, with cases seen showing increased complexity and severity.  The Trust were putting actions in place to mitigate the risk of acquiring MRSA in the hospital, but there was an increasing rate of MRSA being acquired in the community.  Six cases had been seen in the previous year; each case was reviewed by a panel and investigated in conjunction with the CCG to identify learning.

·      There had been discussions previously about accountability at Board level, and the need for every individual to take responsibility for the Trust’s improvement journey.  The Chief Executive remained very clear about the need for the Board to both hold each other to account, and for this to happen from Board to Ward.

·      The issue of accountability was also topical, with NHS Improvement’s new Chair making comments on the need for firmer fit and proper person tests, and for the procedures around poor performance and misconduct by leaders to be reconsidered and toughened.   The Chief Executive of the Trust noted that the fit and proper person test had been applied to everyone on the Board.

·      The changes required to improve the governance of the radiology service had been implemented as soon as the Trust were alerted to them, with all images now reviewed by appropriate clinical staff.  The report commissioned by the Trust had recognised that the improved governance processes were now stronger.

RESOLVED

That Members:

a.  Note the progress against the quality improvement plan of the Trust, and the response to the radiology inspection findings.

b.  Request that a further update is heard at the November Committee meeting or following the publication of the Care Quality Commission’s comprehensive inspection, whichever is soonest.

c.  Request that an update be received at this time on the progress of the capital programme funding for estate works to the QA Hospital site’s urgent care and acute medicine units.

Councillors Alan Dowden and David Harrison left at this point in the meeting.