A representative of the Trust will give a response the recent rating received by the Trust from the Care Quality Commission.
Minutes:
North East London NHS Foundation Trust (NELFT) officers explained that the Trust supplied community health and mental health services across Outer North East London and Essex. A portfolio brief summarising the services provided by NELFT could be supplied to the Committee.
The report of the recent inspection of NELFT by the Care Quality Commission (CQC) had been shared with the Trust who had given back to the CQC considerable information around the factual accuracy of the report. The CQC had not however altered the final report which had given the Trust an overall rating of ‘requires improvement’.
It was noted that only one psychiatrist had been present on the CQC inspection team. The CQC had visited 62 NELFT wards, teams and clinics and spoken with a total of 265 patients and service users. All boroughs covered by NELFT were inspected.
Officers accepted that there was a nursing shortage at the Trust although this was also a major issue nationally. There were approximately 800 nursing vacancies across the Trust which led to a reliance on the use of agency and bank staff.
The CQC had found that NELFT did not have systems in place for referral times but officers rejected the finding that there were significant waiting times for the district nursing service.
Due to concerns raised by the CQC, NELFT had taken the decision to temporarily close the Brookside adolescent unit. Many problems at the unit were due to staffing issues where a 54% vacancy rate had led to a lot of reliance on agency staff. The CQC had found that the unit wasn’t sufficiently clean but officers indicated this was due to a lot of estates work being undertaken at the time of the inspection. Comments by the CQC that the unit was overly restrictive were accepted by the Trust.
Concerns had been raised by the CQC over the number of ligature points (which could potentially be used as a means of strangulation) in the unit but this was being addressed by NELFT to ensure such areas had sloping surfaces etc. It had also been found that care plans should more fully reflect patients’ personal preferences. The CQC had found that NELFT had a strong governance structure but had also concluded that the fit and proper person test for directors was not being met in all cases. Officers felt that this was due to a small number of out of date Disclosure and Barring service checks and this was being addressed via the Trust’s internal auditors.
Officers were disappointed that the CQC report had not highlighted areas of good practice by NELFT although this had been picked up in the recent Quality Summit where areas such as the good systems in place for safeguarding had been praised by chief nurses for several local Clinical Commissioning Groups. The review had not covered end of life care or community dental services and it was noted that any rating of ‘requires improvement’ would result in an overall rating of this for the Trust, even though other Trust areas had received the highest ‘good’ rating.
Officers accepted that the Trust had a lot of work to do and would share the Trust’s action plan once it had been approved by the Board. It was expected that the CQC would revisit the Trust prior to the end of 2016 in order to see if the situation had improved.
It was emphasised that the Trust’s overall vision remained unchanged and that the Trust would not be complacent or seek to deny the contents of the report.
The decision to close the Brookside unit had been taken internally by the Trust and the Trust was seeking to use a crisis response service more than in-patient settings. The unit had also been extensively refurbished during the closure period and now offered a very different environment with 11 female and 4 male beds. There was also a dedicated parents’ wing to allow family support on site. In-patients had their own fobs to allow access to authorised parts of the unit and hence did not need to be escorted. The unit was also now completely open plan.
There were a number of NELFT services which had exhibited good practice. Dementia services in Essex had been nominated for a Health Service Journal award and the CQC had praised the caring attitude displayed by staff. Post-bereavement services run by the Trust had also been praised by the CQC. Officers accepted that more skilled staff needed to be recruited and retained and that the Trust needed to improve its learning from complaints and serious incidents.
Other successes achieved by NELFT included the Trust’s acute mental health care pathway being nationally recognised and all NELFT community dementia services being accredited by the Royal College. Work to integrate health and social care in Redbridge was also cited as a success.
Questions and discussion
NELFT officers felt that there were some inaccuracies in the CQC report and that inspectors had misunderstood the process notes but it had been decided not to issue a legal challenge against the report. NELFT had challenged the CQC warning letter re the Brookside unit but the CQC had not accepted this. The refurbished unit had reopened on 29 September.
The service model redesign was staff-led with more emphasis on supporting people in their own homes. Focus groups had been conducted with Brookside service users and their parents.
It was accepted that the NELFT recruitment process had previously been too long and bureaucratic and this had now been streamlined. Training and development opportunities had been promoted in order to seek to increase recruitment but the Trust would not offer ‘golden handcuffs’ or guaranteed promotions as seen at other Trusts. Exit interviews were also now held to ascertain the reasons people were leaving.
Some 25 nurses had recently been recruited from Ireland and recruitment in areas such as Manchester was taking place in conjunction with other providers. Further international recruitment was also an option though again, this would be in partnership with other Trusts. The NELFT Chief Nurse was also developing training opportunities with the BHRUT Acute Trust. NELFT had also recently been accepted as a national pilot for the Associate Nurse scheme.
As regards commercial strategy, the Trust would continue to look for new business but only if it was felt this complemented NELFT’s existing work and would add value to the organisation. It was clarified that the forensic ward at Goodmayes Hospital – Morris ward had received an ‘outstanding’ rating from the CQC and was commissioned by NHS England.
Excessive use of restraint was being addressed by the new model of care at NELFT which would see more care delivered at home. Information on the numbers and training of therapists at NELFT could be provided. The transformation of the acute care pathway at NELFT, including access teams for initial referral, had led to a reduction in suicide rates.
A lot of work was in progress regarding the Sustainability and Transformation Plan (STP) but NELFT remained a Foundation Trust with an accountable Board. It was agreed that the local Health Economy needed to be sustainable and NELFT was a part of the STP but services were also, as required by law, continuing to be put out to tender.