Issue - meetings

1.1.        The Committee considered a report on the Care Quality Commission’s (CQC) follow-up inspection of East Sussex Healthcare NHS Trust (ESHT).

1.2.        Catherine Ashton, Director of Strategy, and Alice Webster, Director of Nursing, answered questions from the Committee.

Performance of A&E Department

1.3.        Alice Webster explained that shortages of available clinical staff, including consultants, are a major reason for the performance of the A&E Department. The difficulty in recruiting and retaining staff is a nationwide issue and is the result of a shortage of available candidates not lack of resources. Alice Webster added that the CQC had inspected the emergency departments at a particularly busy period when there were a large number of patients and flow issues throughout the Trust that were causing delays in A&E.

1.4.        Alice Webster outlined some of the ways that the Trust is working to improve A&E performance:

·         increasing consultant cover at both A&E departments, and recently recruiting an additional emergency consultant;

·         strengthening clinical management by employing a clinical lead to manage the whole department whilst retaining a clinical lead for both A&E departments at Eastbourne District General Hospital (EDGH) and Conquest Hospital who are present at all times;

·         put in place an extra nurse on each shift to see patients who are waiting but are not in a cubicle, e.g., waiting in an ambulance, or ‘off loaded’ onto the department;

·         monitoring the number of patients in A&E four times a day to improve patient flow and ensure patients are safe; and

·         entering discussions with NHS Improvement about the physical appearance of both A&E Departments.

1.5.        Alice Webster said that it was important to make clear that A&E Departments do not work in isolation of the rest of the Trust. Staff will try to identify patients that can move out of A&E to elsewhere in the hospital or could go home, and implement this with immediate effect, to manage the throughput of patients in A&E. ESHT also works closely with South East Coast Ambulance NHS Foundation Trust (SECAmb) to manage hospital handover; the A&E department has an action plan that encompasses hospital handover.

1.6.        Alice Webster confirmed that there has been change in staffing at the Ambulatory Care Unit at Conquest Hospital but people continue to receive care at the Unit.

1.7.        Amanda Philpott, Chief Officer, Eastbourne, Hailsham and Seaford Clinical Commissioning Group (EH CCG) and Hastings and Rother CCG (HR CCG) said that urgent care is a system-wide service that hospital A&E departments play a major part in. Every health system is required to have a local A&E delivery board to oversee urgent care and the East Sussex A&E Delivery Board is working on five workstreams to improve urgent care, including:

·         improving the minor injuries discharge rate within 4 hours from 95-98% to 100%;

·         developing protocols for ensuring consistency in seeing, diagnosing and treating patients;

·         establishing equal clinical leadership on both hospital sites;

·         improving discharge planning to begin when  ...  view the full minutes text for item 33

1.1.        The Committee considered a report by the Assistant Chief Executive that recommended it consider and comment on the Care Quality Commission (CQC) Quality Report on services provided by East Sussex Healthcare NHS Trust (ESHT).

Care Quality Commission (CQC)

1.2.        Tim Cooper: The following findings are taken from our inspection of 24-26 March 2015. We held a Quality Summit on 18 September 2015 to present our findings to stakeholders.

1.3.        During this inspection we only looked at the four services that had caused us concern from our visit in September 2014: urgent and emergency services; surgery; maternity and gynaecology; and outpatients and diagnostic imaging (we now include diagnostic imaging in our outpatients inspection but did not during our first inspection).

1.4.        The inspection process for this Trust has been protracted but was not meant to be. We have apologised to East Sussex Healthcare NHS Trust (ESHT) for our delays, and internally we have learned some lessons for how we can improve the process in the future.

1.5.        We submitted our report from the three day follow-up inspection – undertaken from the 24-27 March 2015 – for comment to ESHT at the end of June with the intention to publish it in July. However, the Chief Executive of the Trust resigned before the intended publication date, and we felt it would be more helpful to hold a Quality Summit in September when the Trust Board was in a more stable state to be able to respond to the issues. Nevertheless, we continued to discharge our duty between July and the Quality Summit in September by working with the Trust on some of the issues in the report.

1.6.        Our findings in the report relate to our March 2015 inspection. Judging by what we heard at the Quality Summit, some of the findings may no longer be relevant as ESHT appears to have taken a lot of action to address them.

1.7.        Overall, our ratings are exactly the same as they were before. We found limited progress during our March inspection and again rated ESHT inadequate overall; inadequate for the safe and well-led domains; requires improvement for the effective and responsive domains; and good for caring. The ratings for both Eastbourne District General Hospital (DGH) and Conquest Hospital remained the same as they had been in September 2014.

1.8.        During our March 2015 inspection we made a number of key findings. We saw:

·      There was an issue with staff engagement. When we spoke to members of the Trust Board – and in particular the Chief Executive – during the March 2015 inspection, they recognised that there was an issue; however, we found that it was much greater than the Trust Board understood. We heard a lot of positive discussion from people at senior management level and a lot more negative discussion from people on the ground. We found there was a widespread disconnect between the Board and staff; a culture where staff were afraid to speak out and share their concerns openly;  ...  view the full minutes text for item 17

A report on the activities of the HOSC working group established to scrutinise the ESHT Quality Improvement Plan

8.1       Members considered a report from a HOSC working group which recommended the establishment of a Scrutiny Review Board to scrutinise the East Sussex Healthcare Trust (ESHT) CQC reports and the trust’s subsequent implementation of its Quality Improvement Plan.

8.2       The Chair told members that he had purposely not invited ESHT to this meeting as there was no new news of the CQC process; and the item being considered, although relating to the scrutiny of ESHT, did not require ESHT’s active participation at this point.

8.3       The Chair informed the committee that the CQC was anticipating holding a Quality Summit in the week commencing July 13. The second inspection report would be published shortly after the Quality Summit. The Chair proposed reserving July 23 for a special meeting to consider the second CQC report, should the report be published on time. Cllr Ensor also stressed his eagerness that future scrutiny of this issue is undertaken in co-operation with Healthwatch and with East Sussex CCGs, suggesting that HOSC members might consider signing-up as Healthwatch members.

8.4       Julie Eason commented that she was frustrated that the Chair and Chief Executive of ESHT remained in post and that it was not possible for local stakeholders, including the HOSC, the county council, or district and borough councils, to influence this situation. She wanted it recorded that there was consensus amongst HOSC members that the ESHT Chief Executive and Chair should stand down, but that HOSC had no powers to enforce this.

8.5       The Chair responded that, in his view, it was a better for the HOSC to wait until the publication of the second CQC report before making further comments on the management of ESHT. The intention was that the ESHT Chair and Chief Executive would be invited to attend the special HOSC meeting on 23 July, should this meeting go ahead as planned.

8.6       Cllr John Ungar noted that he was concerned that the faults identified by the CQC may have had an adverse impact upon the care and safety of ESHT patients, and called for the Secretary of State to be asked to investigate ESHT mortality and morbidity data to see if care had in fact been adversely affected. Amanda Philpott noted that, whilst the CQC report provided very useful information on quality at ESHT, it was only one part of a suite of indicators. Looking at the full range of data, there is no strong case for escalating the matter to the Secretary of State. East Sussex CCGs are happy to work with the proposed Scrutiny Review Board to help members better understand how commissioners use the full range of quality data. The Chief Nurse has offered to lead on this.

8.7       Amanda Philpott noted that it was disappointing that the initial Quality Summit had not taken place, and there had consequently not been the opportunity for stakeholders to come together to explore the implications of the inspection report prior to its publication. It was to be hoped that there would  ...  view the full minutes text for item 8

The purpose of this report is for HOSC to consider and comment on the Care Quality Commission Quality Report on services provided by East Sussex Healthcare NHS Trust. HOSC will hear evidence from a number of witnesses.

Witnesses will give evidence in the following order:

a)    The Care Quality Commission (CQC)

b)    East Sussex Healthcare NHS Trust (ESHT)

c)    East Sussex Clinical Commissioning Groups (CCGs)

d)    Trust Development Authority (TDA)

e)    Healthwatch

1.         

2.         

3.         

3.1.        The Committee considered a report of the Assistant Chief Executive that recommended it consider and comment on the Care Quality Commission (CQC) Quality Report on services provided by East Sussex Healthcare NHS Trust (ESHT).

3.2.        Councillor Michael Ensor: The CQC report was published on 27 March but – because of the pre-election period – this is the earliest opportunity HOSC has had to meet to discuss and consider the report and its implications.

3.3.        The CQC has carried out a follow up inspection of ESHT, but the report has not yet been published and so cannot be discussed at this meeting.

Evidence from the Care Quality Commission (CQC)

3.4.        Tim Cooper: The Care Quality Commission (CQC) has made a pledge to inspect every acute trust by the end of the 2015/16 financial year. We inspected ESHT (in September 2014) as the inspection regime prioritises high risk trusts, and the Trust was setting off some of our risk triggers.

3.5.        We had a team of 52 people for the inspection of ESHT. The Chair of the inspection was a senior doctor from a high profile London hospital who had been their Medical Director for many years and had a high international standing.

3.6.        The CQC admits that it got the timing of the inspection process wrong. Due to unforeseen circumstances within the inspection team, and some of our internal processes, the sending of our draft report to ESHT (for checking and factual accuracy) was delayed significantly.

3.7.        We met ESHT after it had added comments into the draft report regarding its factual accuracy. The meeting involved senior CQC inspectors and the Trust’s Board and was convened to help understand some of the positions we might have misrepresented.

3.8.        Some people are concerned that we did not hold a Quality Summit. We took this difficult decision at the very highest level of the organisation because – due to the delay in the submission of the draft report to ESHT – we had decided to carry out an unannounced inspection to update our position on the Trust. This meant that holding a Quality Summit the day before returning to inspect the Trust would not have been helpful.

3.9.        Instead of a Quality Summit, The CQC held a meeting with ESHT on 23 March 2015 to discuss their action plan and then began a two-day follow up inspection the next day. The CQC report on the September 2014 inspection was published on the 27 March.

3.10.     The CQC recognises that the publication of the report came at the very beginning of purdah, but we felt that the risk of publishing it then was outweighed by the risk of not publishing, for 8-10 weeks, a completed report that contained important information. Nevertheless, the CQC extends its apologies to those who were inconvenienced by the timing of the release of the report.

3.11.     There are a number of headlines that can be extracted from the CQC report under each of the five  ...  view the full minutes text for item 3

38.1     The Board, at Cllr Turner’s request, discussed the publication of a report by the Care Quality Commission (CQC) Report on East Sussex Healthcare NHS Trust (ESHT).

38.2     The Chair said that the CQC Report was an important issue for the local health and social care economy and that HOSC, as the Committee with the remit to hold the health service to account, was holding a special meeting on 22 May 2015 to discuss it.

38.3     The Chair reminded the Board that the CQC will publish a further report in the next few weeks, having made a follow up inspection of ESHT in late-March, and that it was up to the CQC how they acted on the recommendations in the report.

38.4     Cllr Turner expressed his concern that ESHT had been rated ‘inadequate’ by the CQC. Cllr Turner said that he understood that there were funding issues facing ESHT but that responsibility for the shortcomings highlighted in the report ultimately fell on the management of the Trust and he believed that the time had come to look closely at the position of its leadership.

38.5     Darren Grayson, Chief Executive of ESHT, said that he was disappointed with the overall CQC rating, but he argued that the report was not all negative. Mr Grayson said that ESHT’s care was rated “good” in all of the services that were inspected, and in some services, such as intensive care, the level of care that staff provided was rated very highly. Mr Grayson added that the report had noted that all patients interviewed by the CQC had been happy with the care that they had received. Mr Grayson acknowledged that some areas did need to improve and that, in the seven months since the first inspection, staff had made significant improvements and hoped that they would be included in the follow up report.

RESOLVED: To welcome the Health Overview and Scrutiny Committee’s scrutiny of the CQC report.