Agenda item

24.1     The Committee considered a report by the Assistant Chief Executive providing an update on the progress of the Scrutiny Review Board established to examine East Sussex Healthcare NHS Trust’s (ESHT) quality improvement planning in response to recent Care Quality Commission (CQC) inspection reports. The report also included an update from ESHT on the progress of their Quality Improvement Plan (QIP).

24.2     Richard Sunley, Chief Executive of ESHT, and Alice Webster, Director of Nursing, provided the Committee with a PowerPoint presentation on the progress of ESHT’s QIP to November 2015.

24.3     Richard Sunley, Alice Webster, and Susan Bernhauser, Interim Chair, provided the following additional information in response to questions from HOSC:

Recruitment

·         ESHT is recruiting 40 nurses from the Philippines. This is the maximum number that can be recruited at this time, but the Trust will look to recruit a similar number in 2016.

·         The nurses recruited from the Philippines must first obtain visas and so are unlikely to join the Trust until March or April 2016. They will not become nurses registered with the Nursing & Midwifery Council until summer 2016 as they must first complete a period of consolidation and competency and sit a competency exam at the University of Northampton.

·         These nurses will not be affected by the Government’s recent changes to visa requirements as nurses are on the special occupational list.

·         ESHT has increased the number of student nurse placements it provides and is in discussions with Health Education England to increase the number of student nurses it receives to fill these placements. However, these additional students will take three years to fully train so the benefits of the increase in student nurses will not be felt until 2018. The Trust recruited all 23 student nurse graduates in October 2015.

·         There is a national problem recruiting middle grade doctors – particular in A&E – that is putting considerable and increasing pressure on the hospital services. ESHT has had great difficulty in recruiting sufficient numbers of middle grade doctors and the Kent, Surrey and Sussex Deanery (KSS) has found it difficult to provide staff to fill middle grade training posts; between 70-80% of locum staff at ESHT are middle grade doctors.

·         The shortage of middle grade doctors is predominantly due to the fact that middle grade doctors are joining employment agencies. These agencies pay considerably higher wages than NHS trusts are permitted to pay permanent members of staff under the NHS pay scales scheme, which makes it financially attractive for middle grade doctors to join an agency.

·         ESHT is working with the KSS to focus the limited resource of middle grade doctors, for example, by developing a physician’s assistant role. A physician’s assistant would carry out some of the middle grade doctors’ non-clinical roles which would allow them to focus on clinical care.

Culture

·         ESHT’s Trust Board recognises that addressing the cultural issues that the CQC identified will be a slow and difficult process, but it is putting in place a number of initiatives:

o   Holding Quality Summits at the EDGH and the Conquest Hospital; and holding a weekly Open Staff Forum led by Richard Sunley – or another Board Executive – that is attended by anything from three to 33 staff.

o   Beginning a “You Said, We Did” programme in response to feedback from the Quality Summits that involves Trust management providing evidence to staff about what they have done to deal with a query or complaint that has been raised. This information is publicised in various formats – such as posters and newsletters – throughout the Trust.

o   Looking to hire additional staff to increase the capability of the communications and engagement team to promote the changes that are being made to improve the culture at ESHT. The current team has 2.3 full-time staff out of 7,000 total staff across the Trust.

o   Developing a quarterly survey for staff that will contain the key questions of the annual NHS Staff Survey. This will allow the Trust Board to view incremental changes to staff morale throughout the year.

o   Hiring a new Speak Up Speak Out Guardian. This role provides a route for staff to raise issues outside of their management structure if they are concerned that they will not be dealt with in a satisfactory way by their line manager.

o   Setting up a clinical leaders’ training programme for the clinical unit clinical leaders in partnership with the Faculty of Clinical Leadership and Management that is due to begin in December 2015. In 2016, a similar training programme will be provided for general management and heads of nursing.

o   Providing a number of national NHS Leadership Programmes at the request of frontline staff on Bands 6 & 7.

·         The deadline for the annual NHS Staff Survey closed this month so it is unlikely that any of the changes that have been made will make much difference to the results this year, but the Trust Board is starting to hear more positive feedback from staff and hopes to see some difference in next year’s survey.

·         The Trust Board recognises that ESHT had admirable objectives that were similar to those of many successful NHS trusts, but the Trust was let down by its governance structure that was supposed to track and deliver those objectives, for example, the Quality and Standards Committee failed to perform to the standards set in its own terms of reference.

·         The Trust Board has commissioned Capsticks to review ESHT’s governance arrangements and the Board expects that some revisions to all of the committees will need to be made during 2016.

·         The NHS Trust Development Authority (TDA) will carry out a capacity and capability review of the Trust Board as part of the package of assistance it provides to trusts in special measures. The TDA has appointed Ruth Carnell, Director at Carnall Farrar, to carry out this review of the Board early in 2016. The review will enable the Trust Board to demonstrate to stakeholders how it conducts itself and how it communicates with the rest of the Trust.

·         All changes to the Trust need to be made with a lot of care and consideration, and the Trust Board is keen to avoid ‘new initiative overload’ because there remains some uncertainty about what systems still work well and which ones need fine tuning.

Medical records

• ESHT provides acute services from two main sites and patients are sometimes required to move between these sites to receive care. The Trust needs to be able to move medical records between the sites too, and the less this involves the movement of physical records, the better.
• From September 2016, the Trust’s strategy is to move some services on to electronic records, which will involve scanning paper records into a central electronic database. The move towards electronic-only records is a long-term goal across the NHS.
• The Trust has invested in an electronic tagging system that makes records much easier to find. Physical medical records are tagged as they are retrieved from the archives for use by clinicians– the programme has been a success so far and the Trust is accelerating its implementation.
• In addition to the proposed scanning of physical records, and the ongoing tagging of them, the Trust Board is also working with staff on the arrangements for the centralising of medical records. The main reasons for centralising services are:
  • There is insufficient space on both hospital sites to safely store all medical records, which is a health and safety issue. 
  • There are at least four different numbering systems being used on the two sites for the medical records.
  • Investment in medical records over last 12 years been very low.
  • The two medical record store rooms are on prime clinical real estate on the two hospital sites – the Trusts’ Clinical Investment Plan includes making space within the two hospital sites to expand the accident& emergency and radiology departments. 
• The centralising of medical records is the best course of action from a logistics perspective. The Trust will be able to have a proper, well organised, and clean medical records store room for the first time at a separate site from the two acute hospitals. 
• The Trust Board needs to do something to improve the current medical record storage system – due to the health and safety issues – but the centralising of records to a single site is a cause of concern for the Trust’s medical record staff. The Trust Board understands the issues that staff have – they are not the highest paid staff within the organisation and the potential implications of the centralising of records for them is that they will have to travel further to their place of work.
• The Board is in discussions with the medical records staff to develop a medical record system that all parties agree on and that meets the Trust’s strategy. The Board will meet with Eastbourne staff and Hastings staff in early December to discuss issues such as whether transport arrangements can be put in place for staff.

Midwifery

• The Trust has recruited a lot of extra trainees to the midwifery department. ESHT has reduced considerably the number of midwife vacancies over the past 12 months to 2.2 across the Trust.
• ESHT signed up to the Productive Ward programme. This means that when the Trust refurbishes a ward it is committed to try and ensure that generic equipment storage locations – such as linen and drug cupboards – are in similar places from ward to ward. The purpose is to reduce the amount of training required for new staff to learn the layout of the ward.  However, it is difficult to ensure continuity for more ward specific equipment that has to be stored in particular ways.

Next CQC inspection

• The Trust Board has set up monthly meetings with the CQC – with the next one due to take place in January – and is talking to them regularly. However, the next CQC inspection date is unknown as it will be unannounced. Fewer people are raising issues about ESHT to the CQC which makes it less likely they will return sooner.

Radiotherapy

·         Capital money has been difficult to obtain across the NHS since the Government began its spending review.  Now that the spending review has concluded, capital should become available for schemes that have already begun, such as the Radiotherapy Ward in EDGH. Brighton & Sussex University Hospital NHS Trust (BSUH) is managing the construction of the ward, but ESHT meets monthly with the BSUH radiotherapy team to talk through the logistics of managing the site.

Junior Doctors strike

·         The announcement of the cancellation of the junior doctor strike was not timely enough for ESHT to reinstate appointments that were cancelled in anticipation of the strike. The Trust had cancelled 30 operations, mostly for inpatients, and 300 outpatient clinics.

Winter planning

·         ESHT is part of the local resilience group and is working with the CCGs to secure funding for extra capacity. There is extra capacity available at the EDGH, but little available at the Conquest Hospital.

·         The CCGs are also supporting ESHT to develop the resilience of its community services, for example, by making beds available within nursing and residential homes. These extra beds free up hospital beds by providing clinicians with a location where they can move patients categorised as “discharge to decide”, i.e., who are medically fit but require a care or nursing home placement before they can be formally discharged.

24.4     The Committee RESOLVED that it had considered and commented on the report, its appendices, and the presentation.