Appendix A
Report from: Matt Webb, Associate Director of Strategic Partnerships and System Engagement (SECAmb)
Author: Ray Savage, Interim Head of Strategic Partnerships (SECAmb)
The Trust has made progress in its Improvement Journey, with the Care Quality Commission (CQC) recognising the improvements and agreeing that the four warning notices issued did not require extending. The Trust is continuing to participate in the NHS England Recovery Support Programme.
The Trust has strengthened its executive team through the appointment of Simon Weldon as Chief Executive Officer, Saba Sidiq as Chief Finance Officer, and Dr Rachel Oaten as Chief Medical Officer. Rob Nicholls, Executive Director for Nursing and Quality, has taken up a secondment opportunity at St Barts Health NHS Trust. Margaret Dalziel, the Trust’s Deputy Director of Quality and Nursing has agreed to cover the role.
1.1. The CQC inspections in February 2022 highlighted numerous failings within the Trust, resulting in a ‘well-led’ rating of 'inadequate'. The staff surveys from 2022 and 2023 also highlighted failings within the Trust. The findings from the CQC inspections and staff surveys identified areas of concern that required urgent attention. It is important to note that the CQC recognised the excellent care provided by Trust staff to patients.
1.2. Some of the main areas of concern highlighted were:
· A failure to demonstrate a thread of quality throughout the organisation.
· A disconnect among senior leaders and the wider organisation.
· A lack of understanding of the Trust's vision.
· A non-demonstration of the Trust's values.
· Staff dissatisfaction with working at the Trust.
1.3. The Trust was issued with four warning notices concerning board effectiveness, quality of information, risk governance, and organisational culture. In addition, must-do notices were issued.
1.4. The Trust has participated in the NHS England (NHSE) Recovery Support Programme (RSP), and progress has been made in the four pillars of improvement: Quality Improvement, Responsive Care, People and Culture, and Sustainability & Partnerships; with each of these being overseen by an executive director. Further set out in the Improvement Journey framework (refer to appendix A).
1.5. The Trust established the Improvement Journey Steering Group, which has been meeting weekly to monitor progress and discuss key areas of focus, and the Trust has made progress in each of these key areas for improvement.
1.6. The CQC returned to the Trust in February 2023 and observed a Board meeting. Both the CQC and the NHSE Improvement Director acknowledged the progress made by the organisation, and it was agreed that the four warning notices did not need to be extended. Jointly, the Trust and the CQC agreed the two areas for priority development – continued improvement of organisational culture and development of a comprehensive strategy.
1.7. Additionally, RSM UK has been appointed to oversee progress and ensure appropriate governance is in place. The Trust has also employed the services of KPMG for additional support with the key deliverables in the Recovery Support Programme.
1.8. The Improvement Journey Steering Group has been meeting weekly since its establishment and enables the opportunity for executives to update on progress, highlight risks, and discuss key areas of focus. It is anticipated that this group will be superseded by the Quality Assurance Framework during this year.
· The Improvement Journey framework aimed to address short term actions in response to the CQC and staff survey findings/feedback and build a platform for continuous improvement beyond the initial recovery period.
1.9. The Trust is committed to continuous improvement and creating a positive and inclusive culture.
1.10. The Trust is currently scoping its overarching Corporate and Clinical Strategy for the next five years.
1.11. Progress made in each of the key areas for improvement (pillars):
Quality Improvement:
· The Trust has been working on an internal Quality Compliance Framework. The Trust recognises that its quality governance also needs to align with the governance structures of the integrated care boards to enable appropriate quality assurance.
· The Trust has significantly improved its response to serious incidents through the introduction of new systems and processes.
· The Trust has conducted Quality Improvement training sessions.
· The Trust has introduced the Integrated Quality & Performance Report, which includes Statistical Process Control (SPC) and methodologies for making data meaningful. These are discussed in Trust meetings attended by executives, senior leadership, and the Trust Board.
· Trust Board, including Board Assurance Framework, reporting has been revised to align with the Trust's four priorities (the four pillars).
Responsive Care:
· The Trust has experienced operational pressures in 2022 and continuing into 2023, attributed to patient demand, ambulance handover delays, industrial action, and workforce absenteeism.
· In February 2023, the executive and delivery leads conducted a review of priorities in this area, leading to a renewed focus on operational efficiency and monitoring of vehicles and equipment.
· This review also involved an organisation-wide assessment of all frontline staff rotas, resulting in the introduction of new shift patterns to align frontline resourcing with activity demand.
People and Culture:
· Due to the sustained pressure that the Trust has been operating under, retaining staff, and managing higher levels of sickness has been a challenge, particularly in both the 999 and 111 contact centres.
· The Trust has developed a new People & Culture Strategy to address the concerns highlighted by the CQC and feedback from staff surveys.
· In March 2023, a Programme Director for Culture Transformation was appointed to support the delivery of this strategy as a priority during 2023/24.
· The Trust's Executive Management Board has also established a Culture Working Group to support the delivery of the strategy.
· Development opportunities have been provided, with over 500 Trust managers attending sexual safety workshops and over 100 attending the Fundamentals leadership development programme.
· Hood and Woolf, a communications and engagement consultancy, has been appointed to support the Trust with its Communication & Engagement Strategy, ensuring alignment with the Trust priorities outlined in the Improvement Journey framework.
Sustainability and Partnerships:
· The Trust's commitment to this programme is fundamental to delivering high-quality healthcare to patients.
· Following a period of interim appointments, the Trust now has permanent positions filled for the Chief Executive Officer, Chief Finance Officer, and Chief Medical Officer.
· The internal 'well-led' self-assessment review has helped shape the Trust's Board Development programme for the current year.
· The Board has also reviewed its reporting arrangements to ensure internal alignment with the Trust's priorities and how it contributes to the broader system through the monthly System Assurance Meeting, where the Trust engages with the wider system and the lead ambulance commissioner.
· A Clinical Advisory Group has been established to ensure a clinical 'voice' throughout the organisation.
· Working with all its people across all directorates and seniority levels, the Trust has developed its priorities for 2023/24, with a focus on building a culture that fully reflects its values.
1.12. The Trust remains committed to creating a positive and inclusive culture, one that invests in its people through development and support, as well as fostering a culture of transparency and engagement.
1.13. The Trust is currently in the process of developing its comprehensive, trust-wide strategy that will guide its progress over the next five years.
2.1. Simon Weldon has been appointed as the Chief Executive Officer for the Trust. Simon brings extensive experience in the acute and commissioning sectors from various trusts in London and across the country. He joins us from the University Hospitals of Northamptonshire Group, where he served as the Group Chief Executive. Simon replaces Siobhan Melia, who has returned to her substantive role as the Chief Executive of Sussex Community Foundation Trust after her interim period as Chief Executive at the Trust.
2.2. Dr Rachel Oaten has also joined the Trust as the Chief Medical Officer.
2.3. Saba Sadiq will join the Trust as Chief Finance Officer in July 2023.
2.4. Rob Nicholls, Executive Director for Nursing and Quality has taken up a secondment opportunity at St Barts Health NHS Trust. Margaret Dalziel, the Trust’s Deputy Director of Nursing and Quality has agreed to cover the role.
3. Recommendations
3.1. The committee is asked to note and comment on the update provided.
Lead Officer Contact
Ray Savage, Interim Head of Strategic Partnerships (SECAmb)
Background papers
None.
Appendix A