Agenda item
Barts Health Trust - Feedback on inspection and development of improvement plan
Minutes:
Karen Breen, Lucie Butler and Simon Harrod from Barts Health Trust were in attendance to present their report. They reported that following the poor rating of the services provided by Barts Health NHS Trust as inadequate, the inspection of the trust’s three main hospitals in London the Trust was placed under Special Measures.
The presentation provided an overview of the CQC inspection of Barts Health, with a specific focus on the Royal London Hospital. It summarises the areas of good practice and areas that required improvement, and also looked at the improvement plan that Barts Health had developed to address immediate concerns and CQC compliance actions.
The CQC had identified 65 areas where the Trust must make improvements. The areas of concern included the following:
· There was an issue with safety and quality of services. Across the trust there it was found that there was too little attention paid to safety, with failures in incident reporting and auditing. Bed occupancy was so high that patients were not always cared for on appropriate wards, and the high occupancy was affecting the flow of patients through the hospitals.
· Some patients faced delays of more than 18 weeks from referral to treatment and some patients had their surgery cancelled on several occasions. There were unacceptably long waiting times and often, operations were cancelled.
· Leadership issues found at Whipps Cross were replicated at the other hospitals. There was a lack of engagement with the staff, low morale, high levels of stress and confusion among the workforce about who was in charge. Inspectors had also identified a culture of bullying and harassment.
· There were failures in dealing with and learning from complaints.
· The Trust’s directors didn’t seem to have confidence in their own data – a basic requirement in assessing their performance.
· Staffing levels in some areas were significantly below recommended levels and did not provide consistently safe care.
· Although many individual services required improvement, examples of good services were found at both Royal London Hospital and Newham University Hospital. There was a very committed workforce who although felt undervalued by the Trust leadership, they were valued by their patients and colleagues, and their local managers.
· The inspectors concluded that the trust lacked strategy and vision.
The Royal London hospital however was rated Good for Critical Care with patients positive about the treatment received.
It was noted that the Improvement Plan was not just a response to the CQC; it also included the actions that staff felt were necessary to provide the local communities with safe, effective, compassionate and high quality care.
The initial focus had been on addressing the CQC compliance actions and immediate concerns. Whilst continuing to support on-going actions, improvement approaches, there was also a focus on developing detailed milestone plans, resourcing plans and improvement routes to ensure objectives were met and achieved a safe, effective, compassionate and high quality care.
Officers from the hospital reported on the progress of the CQC compliance actions and immediate concerns. They were noted as follows:
· a significant and comprehensive change to emergency care and patient flow
· A review in leadership and organisational development, to ensure that services were well led and the management and governance of the hospital assured the delivery of high quality person-centred care,
which supported learning and innovation and promoted an open and fair culture. The objective was to create a fair, open culture, improve staff morale and clarify reporting lines.be clear about who does what, so they know who to go to.
· A review of the workforce: recruiting, retaining, developing and deploying the right numbers of permanent staff required to provide high quality care 24 hours a day, seven days a week. The objective was to
ensure that there were appropriate levels and skills mix of staffing to
meet the needs of all our patients and to improve the induction of bank and agency staff, so that they understood the Trust’s policies and procedure.
· A review of outpatients and medical records to ensure the effective management of outpatients clinics so they run smoothly, patients were seen in a timely manner and cancellations and rescheduling of appointments were minimal.
· That the fundamental standard of care, which everybody had a right to expect when they received was ensured i.e. a safe and effective care system where statutory and mandatory training for staff was complied with and monitored, ensuring that patients needs were met, particularly engaging appropriately with people with long term illnesses and patients at the end of their lives and a better management of patient care plans.
· Compassionate care had been taken as the baseline for any improvement and included listening and being responsive to patients, early contact with complainants with the establishment of a single telephone line for both internal and external calls.
· The establishment of an information system/dashboard accessible to both staff and patients.
· Learning from incidents by having weekly reviews and tracking outcomes in respect of recommendations resulting from those incidents.
· Greater use of technology to improve the appointments system in the outpatients department.
· Although many individual services required improvement, examples of good services were found at both Royal London Hospital and Newham University Hospital. There was a very committed workforce who although felt undervalued by the Trust leadership, they were valued by their patients and colleagues, and their local managers.
Members expressed disappointment about the extent and level of concerns in all three hospitals, particularly in patients safety and leadership, given that Barts Health NHS Trust was the largest NHS trust in England, serving a population of well over two million people, and home to some world-renowned specialities. They asked a number of questions and made various comments including the following:
How the culture of bullying had been tackled?
Response
The outcome of a review of management and staff relations revealed that there was a poor management and interaction with staff, poor support to staff by management.
It was reported that the Managing Director and Site Medical Director were in now in post (from June 15 2015) and the Trust was operating a wide leadership model agreed and in place from 1 September 2015.
• Trust-wide Strategy had been established to ensure learning and
best practice shared.
• Royal London Hospital performance dashboards had been established to provide up to date information to ensure that clinical leaders were equipped with management information which was accessible.
• Values based recruitment training has been delivered for all new recruitment at Band 8A and above including medical consultants.
• Completed General Manager Development Programme was to be expanded in the new Leadership Operating Model.
• Renal culture change diagnostic and improvement programme was on-going.
• ‘Speak in Confidence’ was being used by staff to escalate concerns through to Executive for appropriate action.
• Small scale workshop on talent management and difficult conversations had been established.
• site based communications plan to all staff had commenced. Control
Members commented that there were incidents of patient bullying by staff and that there was no linkage between patients and staff. There was therefore the need for a stakeholder event to bring interested parties together.
Examples of poor treatment of people vulnerable with colour and elderly patients by staff. Members felt strongly that there should be a cultural change and that this issue be tackled.
Action: Karen Breen, Barts Health Trust
How complaints were being handled
·The site management teams had developed a site specific quality report to identify and target improvement issues and areas for the hospital.
• The hospital was in the process of refreshing and building on the existing monthly Complaints reports produced for site meetings, which would be communicated/shared with all staff for learning purposes.
• Weekly complaints challenge meetings chaired by Chief Nurse including target setting for complaint completion had been set up and weekly complaints tracker was shared with the Trust Executive.
• The complaints process had been review completed and there were new processes for the management of complaints.
The complaints review included two Complaints Summits with clinical leaders with an emphasis on complaints process, early local resolution and at the end of the process, closure with regards to learning.
• There was on going work to reduce the number of overdue complaints.
• Complaints training had been completed with some Ward Managers focusing on local resolution.
How the issue of resources was being dealt with?
· An analysis of high vacancy areas completed and top 9 areas of focus had been identified.
• The Senior team had undertaken visits to top 3 temporary staffing usage areas to support recovery.
• There was a pilot elevated bank rate for staff in emergency units in August and September 2015
• Fortnightly site based meetings with Bank Partners had started.
• Site based leadership recruitment strategies for top 9 areas to be developed in September 2015.
• One-stop-shop recruitment days to start in October 2015
• Focus sessions with nursing leaders had been set up on improving staff retention.
• Progress had been made on the publication of rotas 8 weeks in advance for all ward areas to ensure optimum staffing levels at all times.
How was data quality being improved?
The documentation standards had been reviewed with consultant medical staff to ensure they met required standards.
• All documentation that recording patients' care and treatment had been reviewed to ensure that it had been standardised.
• Director of Nursing with medical director and lead for AHP had review tools in use and access to records.
• Action was in place to ensure that senior staff audit records on at least on a monthly basis.
• Trust induction included supporting junior doctors in the use of power
chart for medical documentation
• There was a Trust-wide review of nursing documentation which was being piloted at Whipps Cross currently. In August, Senior Nurses at Royal London Hospital had been attending a bed side handover and challenging documentation standards.
• Early implementers of paper light recording now included critical care
and neurosciences.
Improvements in management and governance
A new structure had been developed incorporating a site Senior Responsible Officer (SRO) who would take responsibility for leading the implementation of the local improvement plan and will account to both the Managing Director and the theme Executive Sponsor.
Following discussion, it was noted that the Trust Development Authority was working with the Trust to support improvements. Members agreed that the Scrutiny Panel be kept up to date with the improvements at the Bart’s Health NHS Trust.
Action: Dr Somen Banerjee, Director of Public Health
RESOLVED –
1. That the report be noted.
2. That officers be requested to keep the Health Scrutiny Panel up to date with the improvement programmes at the Barts Health NHS Trust.
Supporting documents: