Agenda and minutes

13.1     Apologies for absence were received from Cllr Pam Doodes (substitute Cllr Bob Standley) and Jennifer Twist. Cllr Peter Pragnell substituted for Cllr Bob Standley as an East Sussex County Council representative of HOSC.

Disclosures by all members present of personal interests in matters on the agenda, the nature of any interest and whether the member regards the interest as prejudicial under the terms of the Code of Conduct.

14.1     There were no disclosures of interest.

15.1     The Committee agreed the minutes of the meetings of 22 May 2015 and 16 June 2015.

Notification of items which the Chair considers to be urgent and proposes to take at the appropriate part of the agenda. Any members who wish to raise urgent items are asked, wherever possible, to notify the Chair before the start of the meeting. In so doing, they must state the special circumstances which they consider justify the matter being considered urgent.

16.1     There were no urgent items.

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.

18.1     The Committee considered a report by the Assistant Chief Executive summarising the recent CQC Report on Sussex Partnership NHS Foundation Trust (SPFT) services and SPFTs Action Plan developed in response to the report.

18.2     In addition to the report by Colm Donaghy, Chief Executive of SPFT, the following points were made in response to Members’ questions:

·        SPFT was in the process of developing its Strategic Plan at the time of the CQC inspection in January 2015. The CQC recognised that the Plan was in development, but indicated that they would comment on the current situation and so reported that SPFT “lacked strategic direction” at the time of the inspection.

·        Wards for People with Learning Disabilities were rated as inadequate for effectiveness because of the performance of the 11-bed Seldon Centre in Worthing. The CQC noted in their inspection that the way that staff were treating patients at the Centre was causing risk. SPFT has now carried out the necessary training to address staff practices and the Centre has improved as a result. The Centre does not require capital investment in order to improve.

·        Long Stay/Rehabilitation Mental Health Wards for Working Age Adults were rated inadequate on safety grounds because of one facility: Hanover Crescent in Brighton, which is now closed. Hanover Crescent was a community rehabilitation facility where patients were stepped down in preparation for community living. SPFT procured the facility several years ago and safety regulations have been tightened in the intervening period. Consequently, the facility was deemed to have had too many ligature points to be deemed safe, although there had not been any serious incidents at the facility. SPFT could not put this right without major capital investment, so the decision was made to close the facility.

·        Wards for Older People with Mental Health Problems were rated inadequate on safety grounds primarily due to dementia inpatient beds in East Sussex. SPFT has proposals in place to ensure that the two inpatient facilities are centralised, which is due to take place soon. This reconfiguration will require capital investment.

·        SPFT is currently hiring three Non-Executive Directors. This is not because of CQC recommendations to replace the Non-Executive Board, but because three current Non-Executive Directors have left simultaneously for different reasons:

o   one Non-Executive’s term of service is up, so their role is being advertised;

o   one has been appointed to a senior post elsewhere and cannot commit to the workload;

o   the third has resigned due to ill health.

·        SPFT is carrying out a Governance Review to ensure governance arrangements in the organisation work as effectively and as efficiently as possible. Monitor requires foundation trusts to review their governance each year, but this review has additional motivation:

o   the CQC report identified the SPFT did not deal with risk as well as it should;

o   the new Chief Executive considered the governance process to be slightly unwieldy.

·        In cooperation with the Grassroots, SPFT has produced a suicide prevention app called StayAlive that provides information to users about  ...  view the full minutes text for item 18.

19.1     The Committee considered a report by the Assistant Chief Executive setting out the plans of High Weald Lewes Havens CCG (HWLH CCG) and the new provider, Sussex Community NHS Trust(SCT), for community services in the High Weald, Lewes and Havens locality.

19.2     In addition to a presentation on the new community services, Siobhan Melia, SCT, confirmed that SCT was in the process of appointing a new senior leadership team of operational and clinical leaders in the High Weald Lewes Havens locality to manage the new community services. The current ESHT management staff provided more than two thirds of their duties outside of High Weald Lewes Havens – as they operated community services across East Sussex – so TUPE rule state that they cannot be transferred across. As current managers cannot be TUPE’d there is a shortfall of staff. Whether or not there would be redundancies in the community services senior leadership team at ESHT – as a result of the loss of High Weald Lewes Havens – would be for that Trust to confirm.

19.3     The Committee RESOLVED to:

1) to note the report and its appendices;

2) thank Sussex Community NHS Trust for their presentation;

3) request that HWLH CCG confirm via email whether pace maker and audiology clinics will continue to be commissioned at community hospitals as part of elective services, as this issue had not yet been clarified.

20.1     It was agreed that the following items should be added to the Committee’s work programme for 3 December 2015, in addition to the reports already requested:

·         A report by the CCGs on the plans in place by the NHS to cope with winter pressures;

·         A report by the CCGs on the NHS Strategic Investment Plan – which sets out the budget across the health and social care economy – and the Year End Projections for the 2015/16 financial year;

·         A report by the CCGs on the devolved commissioning of GP services to the three CCGs, which begins on 1 April 2016 – to also include the issue of GP vacancies.