Agenda item

Stuart Bain (Chief Executive, East Kent Hospitals University NHS Foundation Trust) and Helen Goodwin (Deputy Director of Risk, Governance and Patient Safety, East Kent Hospitals University NHS Foundation Trust) were in attendance for this item.

(1)       The Chairman welcomed the guests to the Committee. Mr Bain began by giving an update on the action plan. He reported that Monitor had appointed Sue Lewis as Improvement Director; she would work at the Trust for three days a week until Special Measures were lifted. Her role was to hold the Trust to account for making progress against the improvement plan. The Trust would have a monthly meeting with Monitor to discuss the progress of the action plan. An updated action plan would be published monthly on the NHS Choices and Trust’s website. He explained the references used in the action plan:  ‘M’ was a must do action and ‘KF’ was a key finding.

(2)       He stated that the Trust had previously recognised many of the actions highlighted in the CQC inspection report; they were challenging the accuracy of some findings. The Trust had already developed plans to address two key areas before the inspection: outpatients and staffing. A £28 million investment had been agreed to develop outpatient services; £23 million was spent on the new Dover Hospital and a further £5 million would be spent to improve existing outpatient facilities.

(3)       Following a nursing review in January 2013, the Trust’s board agreed a £2.9 million investment to fund additional nursing posts. The Trust had recruited all locally trained nurses and nurses from Ireland, Portugal and Spain; 75 % of the posts were filled and the Trust continued to recruit. Mr Bain highlighted the national shortage of nurses and A&E staff. There was a high turnover of staff from the Trust; staff gained experience at the Trust and then moved onto the London Teaching Hospitals which were seen as a more attractive option.

(4)       Mr Bain expressed concern about the inspection findings which found poor engagement with staff and a lack of of openness and transparency. He stated that he did not tolerate bullying and encouraged staff to speak about their   concerns. He recognised the criticisms in the report regarding the estate; he noted that improvements to the estate were under continual renewal.

(5)       The Chairman invited Mr Angell to speak as he had attended the Quality Summit on behalf of the Committee with the Scrutiny Research Officer. Mr Angell stated his disappointment that the Trust had been rated inadequate and offered his support to the Trust. He noted concerns about A&E in the inspection report and enquired if the Emergency Care Centre at the Kent and Canterbury Hospital could be upgraded to an A&E. Mr Bain explained that there was an unrelenting pressure on Urgent and Emergency services which was beyond the control of the Trust. It was reported that the Emergency Care Centre was an integral part of the system and was viewed as a successful model by experts. He stated that the former A&E at the Kent and Canterbury Hospital was underutilised.

(6)       Members of the Committee then proceeded to ask a series of questions and make a number of comments. A Member asked for clarification on two key findings in the action plan: poorly maintained buildings and equipment (KF17) and long waits between pre-assessment and surgery (KF21). Mr Bain reported that a new facilities management system CAFM would go live next month; the system would replace paper based fault reporting for buildings and equipment and would provide real time updates for staff.   He noted that the long waits between pre-assessment and surgery affected one clinic only; patients would now be given a specific time slot. He noted that timeframes for actions would be confirmed within six weeks and included in the monthly reports.

(7)       In response to a specific question about the level of seriousness for each action, Mr Bain explained that all the findings in the action plan were pertinent. He highlighted a number of key findings from the inspection report which needed to be urgently addressed and the action being taken:

§  Data accuracy (KF02) – The Trust had commissioned an independent assessment of data accuracy for all data used in reports to the Board.

§  Cultural issues (KF03 and KF04) - The Trust was carrying out a root cause analysis of the culture gap; a staff engagement strategy would be developed using the findings of the analysis. It was explained that a change of culture would take time.

§  Out of date policies across the Trust (KF14) – The Trust would remove all out of date paper policies from walls. It was explained that all staff had access to a central electronic database of the Trust’s policies which were updated year on year.

§  Patients being moved at night (M21) – The Trust had developed a Delivery Board with partners to look at the demand, capacity and flow across the whole system.

(8)       Mr Lyons informed the Committee that the Council of Governors had written to every member of staff following the publication of the inspection report in support of the Trust. He enquired if staffing levels had been taken into consideration by the CQC. Mr Bain explained that the Trust had adequate staffing for the contracted number of beds. When the CQC inspected in March, additional beds (above the contracted level) were put in place to facilitate the number of patients who required admission. It was reported that the additional beds, resulting from winter pressures, meant that the patient experience was not as good and staffing levels were not at the appropriate level.

(9)       Mr Bain concluded by stating that the Trust was not complacent and taking the inspection report very seriously. He reported that the Trust had a 20% lower mortality rate than the national average and delivered good clinical outcomes for patients.

(10)     RESOLVED that the 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 be invited to attend a meeting of the Committee within six months with a progress report.