Agenda item

Dr Phillip Barnes (Acting Chief Executive, Medway NHS Foundation Trust), Patricia Davies (Accountable Officer, NHS Swale CCG), Fiona Armstrong (Clinical Chair, NHS Swale CCG) and Gillian Wells (Governing Body Independent Lay Member, NHS Swale CCG) were in attendance for this item.

(1)       The Chairman welcomed the guests to the Committee. Dr Barnes began by giving an overview of the last 15 months. As a Trust investigated by the Keogh Mortality Review, the Trust was inspected in June 2013. A Quality Improvement Plan (QIP) was developed in response to the inspection report and had been worked through by the Trust and external stakeholders. A re-inspection took place in April 2014 and the inspection report was published on 8 July. The Trust was rated as inadequate with particular concerns about emergency and surgical services.

(2)       Dr Barnes highlighted a number of themes from the report including leadership instability; over the last 18 months there had been 32 different board members. It was announced that the Council of Governors had appointed Shena Winning as the new Chairman of the Trust on Thursday 4 September. Interviews for a substantive Chief Executive would take place at the end of October. A new management structure will be introduced which would include a Chief Operating Officer. The Trust was receiving best practice guidance and support from University Hospitals Birmingham NHS Foundation Trust with its management and governance structure. The Trust had produced a very detailed action plan in response to the CQC inspection report. The action plan detailed proposals to improve staff engagement and ownership; and surgical leadership with seven day working for consultants.

(3)       It was reported that a further unannounced inspection of the emergency department by the CQC took place in August. In response to the inspection, the Trust had implemented a support team to challenge and hold the emergency department to account; changed the front of house assessment process; and made improvements to discharge as part of seven day working. The Trust had also received advice and guidance from Homerton University Hospital NHS Foundation Trust in Hackney.

(4)       The Chairman invited Ms Davies to speak. Ms Davies explained that  NHS Swale CCG’s concerns were with the speed and pace of delivery at the Trust. The CCG was working very closely with the Trust, Monitor, CQC, NHS England, NHS Medway CCG and wider CCGs to make improvements and reduce pressure on the Trust. NHS Swale CCG had released additional funds to extend the Integrated Discharge Team, provided nursing and quality support and expanded psychiatric liaison. She stated that NHS Swale CCG was using its commissioner levers to engender change; Monitor the regulator for NHS Foundation Trusts had the jurisdiction to enforce regulatory measures.

(5)       The Chairman invited Mr Bowles, a local Member, to speak. He thanked Dr Barnes for his openness at the meeting with HOSC and at a briefing with Swale Borough Council.

(6)       Members of the Committee then proceeded to ask a series of questions and make a number of comments. A question was asked about the completion of actions in the Trust’s Improvement Plan which had been marked as commenced. It was explained that any actions which had not been completed were incorporated into the CQC Action Plan. One of the areas which had been commenced was the development of an estates strategy for the Medway site. This would include the construction of buildings fit for purpose and efficient working which would require a minimum of two years to acquire loan funding. Dr Barnes provided an update on serious incident training; a central team of investigators had been embedded within each of the clinical directorates.

(7)       Concerns were expressed about the Trust’s ability to make a change. Dr Barnes acknowledged that the Trust had previously lacked calibration and had not worked with outside partners sufficiently. He stated that the Trust had moved from a culture of denial; whilst the Trust had a world class neonatal unit, there were many areas which required improvements. The CQC rated the Trust good for caring which gave assurance to patients and staff.

(8)       A number of comments were made about the monitoring of lower levels of the action plan; jeopardy of the Trust and board members; and staff morale. Dr Barnes stated that the Trust’s most recent submission to the CQC contained both Trust level actions and detailed actions for each clinical divisions which would be adjusted accordingly if not delivered.It was explained that jeopardy would be dependent on the level of failure. If there was ultimate failure, every staff member would be at risk of losing their job. The Trust’s use of Schwarz Rounds was highlighted as a method to boost morale. Sessions for staff from all disciplines were available to discuss difficult emotional and social issues arising from patient care.

(9)       In response to a specific question about the Listening into Action methodology, it was explained that it had been discontinued by the Trust as it had not been effective. The methodology brought together a group of staff who would be given a local problem and work towards an outcome for the Trust to implement. For a number of Trusts who had pioneered the methodology, it had been an effective way of engaging staff.

(10)     A number of Members raised concerns about the CQC and the new acute regulatory model. Mr Angell stated that he had attended the Quality Summit and was impressed with Trust’s response to CQC inspection report at the Summit.

(11)     RESOLVED that guests be thanked for their attendance at the meeting, that they be requested to take note of the comments made by Members during the meeting and that they be invited to attend a meeting of the Committee in six months and submit a two monthly report to the Committee.