Agenda item

14.1.    The Committee considered a report providing an overview of SECAmb’s Care Quality Commission (CQC) report findings, following a rating of inadequate in the well-led domain, and the Trust’s Improvement Plan.

14.2.    The Committee asked how staff are involved in the improvement plan.

14.3.    Matthew Webb, Associate Director of Strategic Partnerships and System Engagement, confirmed SECAmb is absolutely listening to staff and not just transmitting to them. The Trust has now spent the last 6 months listening to staff, as it began its improvement journey last year through the ‘Better By Design’ programme prior to the release of the CQC report in June. Matthew Webb said that Better By Design did not address all the concerns identified by the CQC Report but demonstrated there was a recognition of the fundamental concerns and issues that needed to be addressed as an organisation. He confirmed the Trust recognises staff can contribute to each of the four improvement pillars and are helping to co-design them. There are also leadership visits being undertaken by middle managers and Board members to meet staff and listen to their challenges and concerns, as well as opportunities for staff to communicate via email with executives and receive a response to their concerns. Cultural change will take time, so in the short term ahead of winter, the Trust is aiming to ensure staff have the right toolset, resources and support to enable them to respond to patients effectively.

14.4.    The Committee asked when SECAmb is aiming to exit the Recovery Support Programme (RSP).

14.5.    Matthew Webb explained the Trust has worked through a number of criteria with NHS England covering how it will exit the Recovery Support Programme (RSP). It is working towards a period of 9-12 months before it will leave the RSP, at the earliest. However, a target end date is currently being agreed with NHS England and commissioners. The CQC has also issued warning notices that must be achieved by November 2022. Issues around culture, however, will likely take 24 months or more to fix.

14.6.    The Committee asked why the Trust’s CQC rating slid backwards to inadequate following achieving good in 2019, and asked what reassurance could be given it will not happen again.

14.7.    Matthew Webb agreed that the Trust made a number of improvements between 2016 to 2019, however, it did not as an organisation maintain or sustain them. This is because at the time SECAmb developed a CQC Action Plan to rectify the issues raised by the CQC, which it treated it as a transactional plan to satisfy the CQC’s warning notices. This time, however, SECAmb has developed an Improvement Plan, which is a long term plan recognising the significant journey the Trust is on not just to address the cultural issues raised by the CQC, but also to improve the quality of care it provides and develop the best support it can to staff. The Improvement Plan aims to ensure these changes are embedded and sustained over the long term.

14.8.    The Committee asked whether the training for managers outlined in the Improvement Plan is sufficient and whether enough is being done to embed whistleblowing and other measures that allow staff to raise concerns.

14.9.    Matthew Webb said SECAmb recognises the position it is in, including the disconnect between the board and senior leadership team and staff, but it is by no means an outlier amongst ambulance trusts in terms of the pressure it is under.

14.10.  Matthew Webb said that the Trust will adopt national frameworks for the National Culture Transformation Programme and Freedom to Speak up, rather than develop its own. The Trust is working with NHS England to implement the frameworks, including developing comprehensive training that will be rolled out to staff.

14.11.  Matthew Webb said the Trust is engaged with subject matter experts nationally who will deliver that training to ensure it is tailored to the needs of the staff.

14.12.  The Committee asked what effect bullying culture has on staff recruitment and retention.

14.13.  Matthew Webb said SECAmb is not an outlier amongst ambulance trusts in the difficulties it faces recruiting and retaining staff. He agreed it was the case, however, that the culture is not where it needs to be and more than likely it is having an impact on retaining staff. One of the four improvement pillars includes a workstream on recruitment and retention, and the Trust is focussing on the retention of staff together with recruitment, because of the difficult recruitment market. Work around retention includes understanding why people leave and what can be done to make SECAmb the employer of choice, and providing clinical staff with the opportunity for portfolio working that helps to expand their knowledge of different clinical areas.

14.14.  Matthew Webb added that, whilst not responsible for the culture of the trust, a number of changes to the senior management have taken place. This includes a new Interim Chief Executive, Interim Chief Finance Officer, Executive Director for Planning and Business Development, and Chief Nursing Officer.  There has been some positive feedback from staff about the visibility of the Leadership Team and the opportunities to engage with them.

14.15.  The Committee asked for confirmation whether staff pay for their own training, as outlined in the CQC report, or whether there is a lack of communication about the available opportunities.

14.16.  Matthew Webb said he was not aware of staff needing to pay for their training where it relates to their primary role and SECAmb, like others in sector, has a mechanism for professional development. However, the governance procedures around how staff undertake continuing professional development (CPD) was not clear, resulting in disparities and variation in staff training. The policy for CPD, including sign off and funding, is being developed as part of the Improvement Plan.

14.17.  Ray Savage added that there is statutory and mandatory training for all clinicians that involves a 2-day classroom-based training session. Online mandatory training is also required for clinical and non-clinical staff. Registered clinicians must also engage in CPD in order to maintain their registration.  Where the CPD is related to their role it is funded by the Trust, including some external training run by acute and community trusts. However, applications for CPD less relevant to the role may not be funded by SECAmb.

14.18.  Matthew Webb argued there was a need to acknowledge that when the CQC undertook the inspection in February 2022 the country was only just transitioning from the COVID-19 response recovery. During the COVID-19, the Trust was working to the highest level of escalation an ambulance trust can operate at, REAP 4. When operating at this escalation level, there are certain actions that an ambulance trust must undertake to ensure it remains as responsive as it can for patients. This includes cancellation initially of non-mandatory training but potentially all training for staff to make sure they can be reassigned to service delivery. This meant the feedback the CQC received would have been reflective of this period of the COVID-19 response.

14.19.  Matthew Webb said the Trust has continued to operate at REAP 4 and REAP 3 during recent months and demand on the Trust is high, but statutory and mandatory training has been preserved since the Trust moved into COVID-19 recovery. This ensures that clinical and non-clinical staff have the skills they need to undertake the job to the best of their ability.

14.20.  Matthew Webb added that the Trust is committed to ensuring staff receive their statutory and mandatory training, but its Improvement Plan involves doing more around the provision of CPD training and how the Trust supports its staff in undertaking it. There is also a need to ensure non-clinical staff, who do not need to undertake CPD to retain a professional registration, have the same opportunities to develop and progress.

14.21.  The Committee asked whether staff-side union representation is involved in developing the four improvement pillars.

14.22.  Matthew Webb said the four pillars have been informed by the CQC inspection, the key challenges and concerns identified in the NHS Staff Survey, and the feedback and intelligence of union colleagues. He added that there is a need to include staff members and their union representatives in the improvement journey and the communications and engagement plan includes opportunities for staff and union colleagues to contribute and codesign the workstreams of the four pillars.

14.23.  The Committee asked for details of the current staff turnover and vacancy rates.

14.24.  Matthew Webb said this information was not available to hand but could be provided to the Committee. He agreed an improvement in these two factors would be useful metrics to indicate an improvement in the culture of the Trust, however, the NHS is not in a good place currently with regards to workforce and the systemic challenges to the healthcare services.

14.25.  Ray Savage added that there were still a good number of staff applying for internal development from other roles to become registered paramedics. This showed that staff were keen to work within the organisation. There is also an issue of paramedics leaving for other parts of the healthcare system, meaning they are not leaving just because they are unhappy with SECAmb but they want to broaden their clinical expertise, such as in a GP Practice.

14.26.  The Committee asked how the Trust will measure its improvements.

14.27.  Matthew Webb said the Trust will measure quantitative improvements via a newly developed dashboard that contains key metrics to measure significant improvement. For example, an increase in staff reporting incidents and a reduction in the number of staff coming to detriment as a result of the reporting or incident in the first place. The Trust Board is also monitoring the improvements the Trust is making on a monthly basis. The Staff survey will also show quantitative improvement, although it is not likely to be significant in the upcoming staff survey, as cultural changes take time. The themes and trends of the various listening activities undertaken by the Trust’s leadership will also be reported back and listened to.

14.28.  The Committee RESOLVED to:

1)         Note the report;

2)         Request that details of the current staff turnover and vacancy rates are circulated via email, including numbers of staff leaving to other clinical roles in the healthcare system;

3)         Request a further report on the progress of SECAmb exiting RSP at its 29 June 2023 meeting;

4)         Request that any future SECAmb CQC reports, and SECAmb’s monthly Board assurance updates are circulated via email.