Agenda item

Lesley Dwyer (Chief Executive, Medway NHS Foundation Trust) and Shena Winning (Chairman, Medway NHS Foundation Trust) were in attendance for this item.

(1)       The Chairman welcomed the guests to the Committee. Ms Dwyer began by outlining the background to the inspection. She explained that the Trust had been subject to many inspections and the latest inspection in August 2015 had resulted in the Trust maintaining the inadequate rating and remaining in special measures; prior to the inspection the Trust had self-rated itself as inadequate. She noted that the Trust accepted the report in its entirety.  A quality summit was held on 8 January with over 90 stakeholders who were asked to make a positive commitment to help the Trust improve. She stated that the Trust had been rated good in the caring measure which was a strong foundation for improvement. She highlighted that areas of outstanding practice had been found during the inspection including maternity services which had been noted as having strong leadership and a focused team to improve results; wider learning from these services would be shared across the organisation.

(2)       Ms Dwyer reported that the Trust had 28 days to submit an improvement plan to the CQC which was aligned to the Trust’s existing 18 month recovery plan; 73 ‘must do’ and ‘should do’ actions were identified including the modernisation and expansion of the emergency department.   She noted that the Trust had put in place a specialist team, including staff from the buddy Trust at Guy's and St Thomas' NHS Foundation Trust, to coordinate and drive the improvement plan. She stated that there were a number of key milestones in the next few weeks including a new medical model which would reduce the number of handovers for patients; the opening of a new waiting area in the emergency department; and the launch of an in-house bank of locum nurses. She highlighted that the Trust was criticised by the CQC for its reliance on agency staffing; up to 50% of A&E staff and 25% of nurses across the Trust were agency. She reported that the Trust had held a number of events and open days which had led to the recruitment, subject to checks, of 70 – 80 nurses. The Trust was also looking to make joint appointment with Trusts in London where staff would rotate between sites and was working with the local universities to attract university students to the Trust. She noted that for the fourth month in a row more staff were arriving than leaving the Trust which was a significant improvement.

(3)       Members of the Committee then proceeded to ask a series of questions and make a number of comments. In response to a specific question about when the Trust would be removed from special measures, Ms Dwyer stated that she was confident that the Trust now had the right level of clinical leadership to step up and take responsibility for change and improvement at the Trust. She noted that the Trust was developing positive relationships with its partners. She stated that the improvement plan set out what needed to be done and the Trust was required to report weekly on how it was achieving against the plan.

(4)       A Member enquired about the variability of services and support from NHS Swale CCG. Ms Dwyer identified areas of good practice including the maternity team, neonatal unit and the frailty pathway. She stated that the Trust understood the potential impact if something went wrong. She noted that there were indications of sustained improvement at the Trust; the Trust was no longer an outlier for mortality rates. She reported that reviews were undertaken after every death and serious incident to learn from and make changes. She highlighted that both the Chair and Accountable Officer from NHS Swale CCG attended the Quality Summit. The Trust recorded data about why patients chose to go to the emergency department which was shared with the CCG; she noted that 25% of attendances to the emergency department were referred to the onsite GP centre. She stated that the Trust was working closely with GPs to make changes to the medical model including improved access for GPs to speak with consultants, the development of drop-in and wellness centre and geriatricians working in the community.

(5)       A number of questions were asked about staff retention and morale, the buddy trust and the modernisation of the emergency department. Ms Dwyer explained that the Trust was working with local universities and developing its apprenticeship scheme to improve recruitment. She noted that she met with all new staff for lunch after three months and nine months at the Trust to find out about their experiences and if they were being supported within the organisation.  She reported that there had been less than positive articles about the Trust in the press which impacted on staff; she stated that half of all comments received by the Trust were praise and half were complaints. Ms Dwyer stated that the Trust was responsible for improvement but required additional support. She reported that Guy's and St Thomas' NHS Foundation Trust were very committed to the Trust; the Trust had recently appointed the medical director and the  nursing director who had been recruited from that Guy's and St Thomas' NHS Foundation Trust. Ms Dwyer explained that the new waiting area in the emergency department was one part of the modernisation. She noted that the minor injuries unit, which was being refurbished during the CQC inspections, now had a shared triage desk and the new paediatric emergency department had opened. The next area of refurbishment was the major trauma and resuscitation area which was due to be completed by the end of 2017. 

(6)       RESOLVED that the report be noted and Medway NHS Foundation Trust be requested to provide an update to the Committee in six months.