Agenda item

Susan Acott (Chief Executive, Dartford and Gravesham NHS Trust) was in attendance for this item.

(1)       The Chairman welcomed Ms Acott and asked her to introduce the item. Ms Acott began by setting out the new CQC inspection process which was  being overseen by Professor Sir Mike Richards. Dartford and Gravesham NHS Trust was selected as one of 18 Trusts to pilot the new inspection regime. The Trust was also selected to be one of three Trusts to pilot of the new rating system; Royal Surrey County Hospital NHS Foundation Trust and Heart of England NHS Foundation Trust were also included in this pilot.

(2)       The inspection was preceded by an Intelligence Monitoring report and a very detailed data pack produced by the CQC which listed the Trust’s achievements, outcomes, mortality statistics and demographic information on the population it serves. The inspection involved 40 inspectors who met with the public and held focus groups with junior and senior staff.

(3)       Ms Acott was very pleased, on the whole, with inspection: staff were found to be engaged and loyal, the organisation was caring, effective, safe and efficient. The following areas for improvement were also identified: A&E, qualifications of staff and a focus on the symptoms of very high occupancy. Pilot status enabled the Trust to shape and feedback to the CQC and Professor Sir Mike Richards directly. Ms Acott reported that there was lots of goodwill towards the inspection and that confidence in the CQC inspection regime was returning.

(4)       Members then proceeded to ask a series of questions and made a number of comments. An area identified for improvement by the CQC was the cascading of learning from a serious incident in a timely manner. The CQC found that it could take up to a year for learning from a serious incident to be implemented and staff often did not hear the outcome. A Member enquired about the steps that had been taken to address this. It was also suggested that the Committee look into key lines of enquiry used by the CQC.

(5)       Ms Acott explained that the key lines of enquiry were drawn from the data pack produced before the inspection which was published on the CQC website for transparency.   When a serious incident takes place, the Trust had to go through a specific investigatory process involving NHS England and the CCG. The investigation process was led by clinicians who carried out Root Cause Analysis. Following the CQC inspection, the Trust had introduced end dates to investigations, begun electronically reporting incidents and changed the Terms of Reference for its governance meeting to enable it to feedback outcomes and learning from incidents to staff.

(6)       A series of questions were asked about the cost of a CQC inspection and serious incident inspection. Ms Acott explained that a serious incident inspection did not have a financial cost, only an opportunity cost to the Trust. The cost of a CQC inspection is unknown.

(7)       The progress of single sex wards was raised. It was explained if there was  a clinical need to mix the sexes, which mainly occurs at night, patients were  moved to single sex wards as soon as possible. Incidents of mixed sex wards were reported to Ms Acott and resolved as soon as possible. Clinical need overrides the requirement for single sex wards.

(8)       A question was asked about the Trust’s response to the CQC inspection. Ms Acott explained that within 21 days of the CQC inspection, the Trust had to submit a compliance plan to the CQC with details of how it would resolve issues. Once the Trust informed the CQC that they had completed the compliance actions, the CQC would come back on an unannounced visit to check. The Trust also had to submit an Improvement Plan which was a developmental piece. The improvement plan had to be agreed with the CCG, NHS England, ambulance and mental health services and sent to the CQC. It is expected that the CQC would return in the summer or autumn to ensure any issues were concluded.

(9)       A comment was made about the inclusion of older people’s care in the medical care section of the inspection findings. Ms Acott explained that the CQC had chosen not to distinguish these types of care; she was surprised that they had not been separated. However inspectors distinctively looked at frail and elderly patients during their inspection.

(10)     RESOLVED that Ms Acott be thanked for her attendance and that an update be submitted to the Committee at an appropriate time.