Agenda item

Avey Bhatia (Chief Nurse, Maidstone and Tunbridge Wells NHS Trust), Dr Paul Sigston (Medical Director, Maidstone and Tunbridge Wells NHS Trust) and Ian Ayres (Accountable Officer, NHS West Kent CCG) were in attendance for this item.

(1)       The Chairman welcomed the guests to the Committee. Ms Bhatia began by explaining that the CQC inspection took place in October 2014. The CQC published the public reports on 2 February 2015 which included a summary report and separate inspection reports for Maidstone Hospital and Tunbridge Wells Hospital including stroke services at Tonbridge Cottage Hospital. A Quality Summit was held on 29 January 2015 to discuss the reports and the actions to be taken. A number of stakeholders attended including NHS West Kent CCG, Healthwatch Kent, NHS Trust Development Authority and Health Education England. The Trust’s overall rating was Required Improvement which the Trust thought was a fair assessment.

(2)       Ms Bhatia highlighted a number of areas which the CQC recognised as good practice including strong patient experience, good nursing levels and collaborative working. She stated that the Trust was really proud of the Good rating for caring throughout the organisation which showed that staff were caring and compassionate and treated patients with dignity and respect.  The staff were praised by the CQC for using the process to help identify and drive improvements. A number of areas of outstanding practice were identified including the Maidstone Birth Centre, Maternity Services at Tunbridge Wells, dementia care and breast care services. She noted that the Maidstone Birth Centre service reconfiguration had been a very difficult process but since its implementation the Birth Centre had provided a very high standard of care for families and delivered good outcomes.

(3)       Ms Bhatia reflected on the key areas for improvement at the Trust. A number of key organisation wide improvements were identified in the report: patient flow and capacity particularly in intensive care, record keeping and access to clinical guidelines, directorate leadership, clinical governance and inconsistency.

(4)       A number of compliance actions (areas and services which required urgent improvements in specific areas) had been identified including the working patterns of consultants in critical care, the lack of washing facilities in Intensive Care for patients who were unable to be discharged onto other wards, translation services and the admission of surgical patients onto children’s wards. Ms Bhatia stated that the Trust was developing a Quality Improvement Plan with stakeholders which would respond to all the ‘must do’ (compliance) actions and ‘should do’ actions identified by the CQC. The plan would be submitted to the CQC on 16 March. She reported that the Trust was working at pace to make changes but acknowledged that some areas such as governance and capacity would take longer to make changes.

(5)       Mr Ayres stated that West Kent CCG thought that the Required Improvement rating was a fair representation of the Trust.  A number of the issues had already been identified prior to the CQC inspection. He reported that the CCG were working closely with the Trust to develop the Quality Improvement Plan; all the actions were achievable and 90% would be completed within a year. He noted that the Trust had made huge progress over the last seven years including tackling infection control and merging two hospitals into one PFI hospital. He was pleased that caring, staffing levels, maternity services and dementia care were identified as good and outstanding practice. Mr Inett reported that Healthwatch Kent had worked closely with the Trust to develop the Quality Improvement Plan; the Trust had been supportive and facilitative of Enter and View visits undertaken by Healthwatch.

(6)       Members of the Committee then proceeded to ask a series of questions and make a number of comments. A Member enquired about concerns raised by some staff to CQC inspectors about the lack of an open culture and the sustainability of some services being run across both hospital sites. Ms Bhatia explained an unknown number of the Trust’s nursing staff had raised concerns about the culture within the organisation. In the National Staff Survey, 66% of staff felt that they could raise concerns safely which was just under the national average of 67%. She noted that 68% of nursing staff within the Trust felt they could raise concerns safely which was one of the highest percentages in the Trust; the lowest percentage was amongst administrative and facilities staff. She reported that the Trust was embarking on a piece of work on culture and engagement with staff as part of the Quality Improvement Plan. The Trust had set up a patient safety think-tank and had implemented the Step up to Safety Campaign. She noted that all Trusts, following the Freedom to Speak Up Review, would be required to appoint independent whistleblowing guardians and have dedicated Executive and Non-Executive Directors for whistleblowing.

(7)       Mr Ayres stated that services were constantly under review by the Trust and CCG. He highlighted the improved outcomes following the centralisation of cancer services at Maidstone Hospital and centralisation of stroke services in London. He noted that NHS England was undertaking a review of stroke services in Kent and Medway. A further question was asked about the sustainability of improvements. Dr Sigston stated that the Trust was reviewing the winter surge of activity and identifying sustainable improvements to utilise acute beds and community providers in future years. He noted that improvements become sustainable once they were embedded as normal practice. He stated the importance of communicating service changes to the public so that they understood the rationale behind the proposals. He reported that the Trust had been working with Healthwatch Kent to engage with the public about improvements to stroke services.

(8)       A number of comments were made about translation services. Ms Bhatia explained that the current contract with the translation service provider required a translator to be physically sent to the hospital which took time and was expensive. She stated that the Trust was looking to procure a new telephone based translation service, as used by Trusts’ in urban areas, which would be faster, provide access to more languages and be less costly. She noted that independent translators were required, rather than family members, to enable patients to give consent. Mr Ayres explained that translation services were provided for free as part of national policy. He stated that he would provide the cost of translation services to the Committee.

(9)       In response to a specific question about the Maidstone Birth Centre, Dr Sigston explained that it was a midwife led centre which delivered over 500 babies a year. He noted that with the early identification of problems mothers were transferred to Pembury immediately. He stated that mothers’ could choose where they wanted to give birth.

(10)     A number of comments were made about critical care consultant contracts, out of hours GP services and whistleblowing. Dr Sigston explained that the outcomes for critical care patients were good. He stated that consultants’ contracts had no bearing on working patterns. He noted that the CCG was looking to locate out of hours GP services in close proximity to the A&E to enable collaboration on the same site. He noted that senior management encouraged and welcomed whistleblowing as it provided an opportunity to make improvements. He stated that staff had access to their personnel files under the Data Protection Act.

(11)     A Member enquired about morale. Ms Bhatia stated that the Trust’s Executive had spent a lot of time, following the publication of the CQC inspection reports, speaking to staff including open forums with the Trust’s Chief Executive, Glenn Douglas. She stated that staff felt that it was a fair reflection of the organisation but were disappointed that the Trust had not done better. The staff had had a difficult couple of months due to an extremely busy winter but morale was good at the moment. Mr Ayres stated expressed his support for the Trust and recorded the CCG’s thanks to the Trust and its staff for their committed work.

(12)     RESOLVED that:

(a)          the Committee sends it thanks and appreciation to the hardworking staff of Maidstone and Tunbridge Wells NHS Trust

(b)       the report be noted and the Maidstone and Tunbridge Wells NHS Trust be invited to attend a meeting of the Committee in six months to give an update on their Quality Improvement Plan.