Agenda item

To consider a report by the Head of Scrutiny and Member Development which provides additional information requested at the last meeting of the Board around the action plan relating to nursing staff (focusing on Older People's medicine.

(Report attached)

Further to minute 83 of the Scrutiny Board (Health and Wellbeing and Adult Social Care) meeting held on 21^st March 2012, where the Board considered a report of the Care Quality Commission (CQC) that identified improvements needed at St James’ University Hospital (as part of Leeds Teaching Hospitals NHS Trust (LTHT)) to consider a report of the Head of Scrutiny and Member Development providing further information around the action plan relating to nursing staff with a focus on Older People’s medicine. 

Appended to the report was a copy of a press release dated 29^th March 2012, which followed a formal warning issued by the CQC to LTHT following an unannounced inspection at Leeds General Infirmary.  During that inspection, inspectors considered that patients’ needs were not always being met and attributed this to poor care and on two of the three wards inspected on this visit to insufficient staff.  As supplementary information (Item 87 refers), the Board was in receipt of the CQC’s Review of Compliance report outlining the actions LTHT had been asked to take at the LGI and a briefing note from LTHT on nursing staff levels.

Attending for this item to provide further information and respond to the Board’s queries and comments were:

Maggie Boyle (Chief Executive) – Leeds Teaching Hospitals NHS Trust

Karl Milner (Director of Communications and External Affairs) – Leeds Teaching Hospitals NHS Trust

Wendy Dixon (Compliance Manager (Yorkshire and the Humber)) – Care Quality Commission

Apologies due to illness were received from Jo Coombs (Director of Quality and Nursing) NHS Airedale, Bradford and Leeds.  It was also reported that Ruth Holt (Chief Nurse (LTHT)) was unable to attend the meeting due to a CQC visit taking place at the same time.

The Chief Executive of LTHT began by informing the Board that:

• she had been horrified by the findings of the CQC;
• immediate actions had been taken to address the situation, including the closure of Ward 53 and assurance work undertaken across adult inpatients wards to give surety that the findings of the CQC were not evident in other areas of the Trust;
• staff had been made aware of the outcome of the inspection and of the remedies required;
• the warning notices issued required the Trust to declare compliance by 31 March 2012.  It was reported that this had been achieved and the CQC was currently on site to check that the Trust was now compliant with the required standards.

The Board was informed of the circumstances around Wards 53 and 55, which had been inspected by the CQC, these being:

• in late December 2011, due to increased patient numbers, including patients with fractured neck of femur, a decision was taken to temporarily open a third ward, which was planned to close at the end of March 2012;
• staffing levels of 30 staff (this figure was rounded up for easier understanding) per ward would have been the usual level.  As only 60 staff were available, the decision was taken that rather than remove this much needed capacity, three wards would be in operation with 20 staff per ward and the additional 10 posts per ward to be filled by use of overtime and the nursing bank.  In the event, it had not proved possible to always provide cover for staff shortages, especially where absences had occurred at short notice;
• the CQC visited on 29^th February – 1^st March 2012 and following its findings, Ward 53 was closed.  As some patients were on Ward 53 awaiting discharge, through the spot purchase of 20 beds by Social Care colleagues, it was possible to discharge these patients and move others to different wards.

Details of the actions which were taken were provided and included:

• Reiterated in writing to all staff the standards of care which were expected within the Trust;
• Visited all adult inpatients, focussing on the three areas of concern highlighted by the CQC;
• Emphasised the importance of documentation being completed to ensure that the evidence existed of the care being delivered.

The Chief Executive also outlined other initiatives to address the issues raised by the CQC, which included:

• Building on the initiatives within the Managing for Success Programme, i.e. more efficient use of the bed base and better management of discharge planning
• Looking at how to achieve standardisation of care
• Reinforcing the Mission Statement
• Created new website where people can raise issues without the need to go through the lengthy complaints procedure
• Implementing monthly recruitment campaigns
• Use of electronic rostering with additional funding being directed to this to bring this facility on-line more quickly
• Every Ward Manager to be assessed to see if additional support is required
• Measures to address the quality of care being provided, including the introduction of patient feedback upon discharge and feedback from staff at the end of each shift
• Tackling attitudes and behaviours to ensure greater nurse/patient contact
• Re-examining the nursing blueprint to ensure staffing levels are properly distributed across all areas and finding a mechanism for ensuring that staff cover was provided where needed, even if it was on Wards which were less popular among nursing staff
• a review of the oversight mechanisms, with an acceptance that the issues raised by the CQC should have been picked up earlier

Reference was made to the quality of care, with the Chief Executive stating that staffing levels alone did not always account for quality of care.  It was highlighted that leadership on Wards was of paramount importance and, in the cases seen by the CQC, better standards of care could have been provided. 

The Board discussed the report and the information provided at the meeting, with the main discussion points being:

• the disgraceful situation as reported by the CQC; that this followed a CQC inspection at St James’ where failings had been found and the need for reassurances to be given to the Board that these issues were being addressed;
• the monitoring mechanisms in place and how Senior Management would have discovered what had been taking place had the CQC not visited at this time;
• patient discharge planning; evidence given to a previous Scrutiny Board inquiry indicating this began once patients were admitted, yet several patients on Ward 53 were awaiting discharge at the time of the inspection;
• staffing levels and the statement in the supplementary information supplied to the Board by the Leeds Teaching Hospital NHS Trust that ‘Staff levels were not the pivotal factor in determining how a patient was treated ….’
• the distribution of staff across the organisation with concerns raised that this was not always carried out effectively;
• concerns about the quality of care provided; the attitudes of some staff to patients; the amount of information patients were given about their care and the level of involvement with patients;
• the importance of team working on wards, including clerical and portering staff as well as the medical teams;
• the mechanisms for patient complaints; the deep-rooted view that existed, that to complain could have an impact on the care received;
• the need to have mechanisms in place to ensure that the many dedicated, hardworking members of nursing staff could raise concerns in confidence and know that their voices were heard without fear of repercussions for their jobs

The Chief Executive recognised the Board’s concerns and gave her assurance that these issues would be addressed.

Wendy Dixon stated that once a Compliance Report was issued and was in the public domain, it was usual for further concerns and issues to be raised and drawn to the attention of the CQC.

In summing up the session on behalf of the Board, in deploring the situation as set out by the CQC, the Chair stated that there were many diligent and caring staff, some of whom were working in difficult situations and that the Board wanted to see that their concerns were being addressed and that that staff were being supported.

The Chair thanked the representatives from LTHT and the CQC for attending the meeting and contributing to the Board’s consideration of the matters raised.

RESOLVED -  

(i)  That the report and information presented to the meeting be noted;

(ii)  That the Scrutiny Board maintain an overview of the performance of

  the Trust and its future compliance with the CQC standards.

(During consideration of this matter, Councillor Chapman withdrew from the meeting)