Agenda item

Glenn Douglas (Chief Executive, Maidstone and Tunbridge Wells NHS Trust), Paul Sigston (Medical Director, Maidstone and Tunbridge Wells NHS Trust), Avey Bhatia (Chief Nurse, Maidstone and Tunbridge Wells NHS Trust) and Jayne Black (Director of Strategy & Transformation, Maidstone and Tunbridge Wells NHS Trust) were in attendance for this item.

(1)       The Chairman welcomed the guests to the Committee and asked them to introduce the item. Ms Bhatia began by giving an overview of the three CQC inspections, which had taken place since November 2013. The inspections took place unannounced in November 2013 at the Tunbridge Wells Hospital, in February 2014 at Maidstone Hospital and in April 2014, which looked at safeguarding in North and West Kent. The Trust believed that the Royal College of Surgeons report was the trigger for the CQC inspections.

(2)       Ms Bhatia stated that the main theme of the inspections was the provision of paediatric services. A concern highlighted in the Maidstone Hospital inspection was the shortage of paediatric-trained nurses in A&E which was a national issue.  The Trust was reviewing the emergency care pathways for children to enable a separate emergency paediatric and adult pathway at both sites. The Trust was exploring the option of a dedicated paediatric A&E department at Tunbridge Wells Hospital.

(3)       Ms Bhatia explained that other issues identified in the inspection report, including governance, had been developed into a 20-point action plan with the CQC to deliver improvements. The improvement plan was updated monthly and shared with the CQC. The Trust was expecting a re-inspection towards the end of the year under the new model of inspection to assess compliance with CQC standards. 

(4)       Members of the Committee then proceeded to ask a series of questions and made a number of comments. A specific question was asked about the recruitment of paediatric-trained A&E nurses. Ms Bhatia explained that paediatric-trained A&E nurses wanted to work in dedicated paediatric emergency department rather than in a mixed model. Ms Bhatia stated that when the model changed to a dedicated emergency paediatric unit, the Trust would be able to recruit. The CQC had become prescriptive about the recruitment of paediatric-trained A&E nurses to all Trusts.  Mr Douglas explained that Tunbridge Wells had a fully staffed paediatric unit with paediatricians and paediatric nurses, which received good shortlists when jobs were advertised. A rotation of staffing between the proposed emergency paediatric department and paediatric unit at Tunbridge Wells was being considered.

(5)       Mr Angell thanked the guests for facilitating a visit to Maidstone Hospital with Miss Harrison in November 2013.  He explained that he had recently met with the Trust’s Finance Director who had stated that a high proportion of patients at both sites had dementia and he enquired about dementia training for staff. Ms Bhatia explained that there was lots of training for staff on dementia. Engaging with family members and carers was essential as they knew the needs of the patients. The Trust had introduced the ‘This Is Me’ booklet, a nationally developed booklet to record key information on memory, mobility and other factors to ensure that the right care was provided for the individual patient. The Trust had a Lead Nurse in Dementia Care. A Dementia Café and Ward had been developed at Tunbridge Wells Hospital and the Activities Co-ordinators at Maidstone Hospital had been key to moving patients out of beds into other areas of the hospital to interact. The Trust had a paper published in the Nursing Times about the Trust’s work on dementia. Mr Inett referred to a report on the range of dementia services provided in the community which was presented to the Kent Health and Wellbeing Board in July 2014.

(6)       Dr Sigston was invited to provide a brief overview of the Royal College of Surgeons report. The Trust Board was proactive in commissioning the Royal College of Surgeons (RCS) report in response to unexpected deaths following upper gastrointestinal cancer surgery in 2012/13. The Trust commissioned the report in April 2013 and the report was delivered by the RCS in December 2014. In line with the RCS recommendations, the Trust was working with St Thomas’ Hospital in London to provide upper gastro intestinal cancer surgery. He stated that only a small minority of patients required this type or surgery.

(7)       A Member enquired about the employment status and management of the consultants mention in the RCS report. Dr Sigston confirmed that the three gastro-intestinal surgeons continued to work for the Trust but no longer carried out complex cancer resection surgery. Dr Sigston explained that the document used to manage doctors, ‘Maintaining High Professional Standards in the Modern NHS’, was not fit for purpose and made it difficult to manage doctors.

(8)       In response to a question from a Member, Dr Sigston explained that under guidance, issued by the General Medical Council and the Royal College of Nursing, a competent child was able to give consent and request that information remained confidential regardless of their age.

(9)       Mr Douglas confirmed that that, the Trust was not aware of the qualifications and backgrounds of the inspectors carrying out unannounced inspections. The Trust was able to make comments on the draft report.He stressed that the Trust was committed to work with the CQC to make improvements to services and develop a good relationship with them.

(10)     RESOLVED that the guests be thanked for their attendance at the meeting, and that they be requested to take note of the comments made by Members during the meeting and that a written update be received by the Committee in December.