To consider a presentation following the Care Quality Commission (CQC) inspection of Wye Valley NHS Trust.

Councillor PE Crockett left the meeting for this item having declared a disclosable pecuniary interest as an employee of Wye Valley NHS Trust.

The Wye Valley Trust chairman, the medical director and the chief executive attended the meeting. The trust chief executive gave a presentation which described the Care Quality Commission’s (CQC) ratings, the trust’s response, the quality improvement plan for exiting special measures, and the challenges faced.

The scrutiny chair observed that the CQC’s report made depressing reading and that it suggested the trust was seemingly not engaged and needed more leadership.

The trust chief executive challenged some aspects of the CQC report, giving the example of mandatory safeguarding training; whilst there was room for improvement, there was greater engagement than reflected with regard to the board. The role of corporate parents and plans for improvement were in place.

Members made a number of comments and observations which in summary were that:

•           staff at the hospital were thanked for ensuring that the criterion of care was rated as good and it was important to recognise this; 

•           whilst there were genuine areas of concern, the CQC report appeared to pick up on some rather specific issues;

•           the extent of the relationship between financial pressures, the impact of the private finance initiative and the CQC’s findings were noted;

•           the impact of morale on recruitment and retention of staff was noted;

•           the absence of press to hear the facts presented at today’s meeting was noted. It was positive that things were moving forward which should not be glossed over, and this needed to be communicated to the press;

•           the CQC appeared to have made comparisons with other west midlands hospitals without taking into account the different geography and demographics such as an above-average population of older people impacting on mortality rates;

•           whilst complexities of the NHS were understood, assurances were given in October 2014 that the trust was doing all it could do to improve, but remained in special measures. There was therefore an imperative to ensure that the NHS in county was properly funded, bureaucracy reduced and investment made in front line services;

•           in terms of joint working and funding between public services, the concept of one Herefordshire was little understood by the public and more information was needed on this. There should be closer working between council and health colleagues so that the next CQC visit was more positive;

•           in some cases, for example 1 Ledbury Road,  there was a lack of communication with the public which the trust was trying hard to address, and attention needed to be given to the use of language which was meaningful to the public; 

•           patient advocacy was an important consideration as carers often had a different view on care provided in hospital and consideration was to be given to the use of independent people to take issues up with management;

•           the executive team had a lot to address, which was daunting, and it was hoped that the team was prioritising to minimise the effect on patients;

•           there were mixed reports on the quality of food served at the hospital and that food was an important factor for people staying in hospital in terms of recovery and morale;

Representatives from Wye Valley Trust made the following comments in response:

•           financial pressures caused by the private finance initiative were not a direct factor in the context of the issues raised by CQC as settlement of the contract would contribute just £3m to the 20m deficit;

•           the CQC findings were a difficult message for staff to handle and morale needed attention;

•           regarding demographics being a factor in mortality rates, the indicators were complex and reported retrospectively and counted the actual number of deaths against the expected number where people should not have died. New governance process had been introduced along with a multi-specialty team to look at concerns and systemic issues. Since March no patients were identified who would not have died. Assurance was given that the acute hospital was a better and safer place and where there had been lapses in care, things were improving;

•           public responses locally were heartening as they reflected what patients said, that they were being cared for and quality of care was good. However there was no room for complacency as there were issues that needed managing better. The ambition was to improve within months and the trust was in the realms of achieving that compared with the position in 2014;

•           there was some frustration in meeting the wider NHS system to explain activity as there was insufficient time within the frequency of reporting requirements to achieve the changes required. However, it was believed that there was progress despite the ratings;

•           being in special measures incurred costs on top of the need to invest in services such as emergency department staffing, a computerised tomography (CT) scanner and new beds in order to be a resilient general hospital that was essential in the county;

•           with regard to 1 Ledbury Road, the trust was working hard to change the care model to meet new demands and expectations within the national strategy, although it was recognised that communication was not sufficient to reduce public anxiety;

•           valuable insight could be gained as a result of increasing involvement of service users on performance and in redesigning services. Healthwatch played a vital role in providing objectivity and could be used more along with increasing the use of volunteers and healthcare assistants to get care right and spend more time with patients to provide a better patient experience;

•           the CQC report was felt to be fair and accurate but the ratings were not. The organisation has made strides regarding the immediate safety concerns. Initial feedback from a TDA (Trust Development Authority) and Clinical Commissioning Group (CCG) inspection of the emergency department yesterday suggested that there had been improvements since the CQC inspection;

•           improvements could be made in the approach to engaging staff in professional accountability to comply with policies, procedures and training to focus on individual accountability;

•           recruitment and retention needed wider input from the NHS national training authority and with the creation of new clinical roles to cross professional boundaries;

•           the trust board met for a prioritisation session in November in anticipation of the CQC visit to look at improving patient safety, improving recruitment and retention  and accelerating work with other organisations on the strategic future of clinical services and these would be reflected in the annual plan;

•           the council could help by working together on public services being more attractive places to live and work and also in supporting the provision of ward accommodation as capital was scarce. Changes needed to be developed through one Herefordshire as clinical services could not continue as they were being delivered and change would need support and understanding;

•           processes were in place to ensure that doctors were held to account for inappropriate behaviour, and individual issues would be heard separately and addressed; 

•           the medical director had read all complaints and assurance was given that they were addressed. Care had changed in the past ten months and work continued to ensure this was embedded, with a team of professional leads to ensure good medical practice as per the requirements of the General Medical Council (GMC);

•           it was agreed that hospital food was vital. The trust scored poorly in the patient survey on food and how it was served, so ratings were understandable. Catering was managed through the PFI contract on an average budget of £5.50 per patient per day and there were national standards for food, choice, delivery and support to eat. However, more assertive management of the service was needed through the contract to ensure there was an environment that supported such criteria as dietary assessment;

•           the report highlighted that the trust did not always do the right thing for patients and every instant examined and lessons learned. There was executive oversight of serious incidents and where there were matters of behaviour and compliance. All members of the executive were aware of incidents, with lessons learned and embedded actions. The CQC was complimentary of this process.

The chair of Healthwatch Herefordshire responded to members’ comments regarding patient advocacy. Healthwatch visited a ward with clinical leads and executive directors. They interviewed staff and assessed the environment and passed on views, and would continue to monitor and carry out further ward visits. Healthwatch did a lot of visits and linked to the trust board and the special measures oversight group.  A pre-inspection visit with board members gave a better impression of the hospital than reflected by the CQC and so there was disappointment that the trust was not taken out of special measures.  As an independent assessor, Healthwatch had great confidence in leadership and management to carry improvements forward.

The chairman thanked representatives from Wye Valley Trust for attending and for being honest.

RESOLVED

THAT:

a)         the presentation be noted;

b)         trust staff be thanked and that the report be recognised and an improvement plan anticipated; and

c)         trust senior officers provide an update on progress in six months.