Agenda item

The Committee received a report from the Chief Executive, County Durham and Darlington NHS Foundation Trust regarding the CQC inspection report (for copy see file of Minutes).

The Chief Executive, CDDFT reported that the overall rating for this trust was requiring improvement.  The CQC had however rated the trust well-led with the leadership team showing a range of skills and expertise, were leaders at every level and were approachable.

The Chief Executive highlighted the summary of findings and the areas for improvement.  She advised that maternity services had won the service improvement award in the annual staff awards and had been shortlisted for the Royal College of Midwives annual midwifery awards.  She informed the committee that the trust had requested that the CQC carry out an inspection on End of Life Services.

The Chairman congratulated Maternity Services as some areas had been outstanding.

In relation to surgery, Councillor Crute said that there were concerns raised about both sites and that there had been a deterioration in staffing levels, safeguarding and training and said that this indicated a failure at the leadership level.  He asked what measures would be put in place to address this.  The Chief Executive said that the board shared these concerns about all areas where improvements were required.  She advised that a separate review had been undertaken on the overall leadership that gave a confidence. She referred to significant concerns around maternity services at the last inspection that had now improved to outstanding in some areas, and the same concerns were now being expressed in surgery.  A number of actions had taken place specifically around self assessment and never events had reported fewer numbers.  The trust were keen to see improvements and regular meetings were taking place with the medical director.

Councillor Grant said that it would be good to see comparative data and asked if most trusts required improvement.  The Chief Executive confirmed that most trusts that had been assessed required some improvements, and she confirmed that comparative data was available that she could share with the committee.

Councillor Huntington asked what happened inside the trust as she was concerned that areas for improvement were not picked up by the leadership team.  The Chief Executive confirmed that any issues were reported via appraisals and were linked to what was going on in the trust.  She added that in relation to surgery, there were self assessments carried out in June every year and the deterioration was due to the level of never events that had occurred.  An action plan was put in place and managers had picked up on those.  She reminded members that the CQC were looking back whilst undertaking the inspection.

Councillor Patterson referred to the number of changes that had taken place recently, including changes to urgent care, removal of A&E at Bishop Auckland and asked how the table on page 17 of the pack compared to the last CQC report.  The Chief Executive reported that only urgent and emergency services had been looked at in Durham and Darlington and had been rated slightly better than at the last inspection.  She added that more people were seen now within four hours, and this was a comparison to patients waiting to be seen in other areas.  There were fewer urgent care attendances coming through A&E but more people were being seen within the four hour target.

With regards to training, Councillor Temple asked for assurances that the culture around this was being addressed. The Chief Executive said that there had been concerns following the never events and work around the culture had been taking place.  The CQC had seen evidence of this work and the comprehensive approach being undertaken.

Councillor Temple asked if there were any signs that the figures were changing and was advised that data could be shared with the committee.  She added that with regards to mortality there had been some positive outcomes and again said that this data could be shared with the committee.

The Chairman asked what had been put in place to address the lack of consultants available in A&E.  The Chief Executive explained that it was difficult to recruit to A&E but that there was a detailed targeted plan which aimed to make the jobs more attractive.  Nurse specialists had been recruited and there was now technology in place to ensure the flow of patients out was facilitated in a better way.  The Chairman asked if the trust could come back to committee with a report on how this was going to be addressed.

The Chairman went on to ask about the lack of training for all board members and that staff at UHND had commented that they had not seen an executive director present at the hospital.   The Chief Executive explained that executive directors spend half their time in Durham and half in Darlington.  The CQC did not challenge this at interview however, the team were now publishing where they would be for team and board meetings.  She reminded members that th CQC had described the leadership team as approachable.

Referencing the recently published re-inspection report for North Tees and Hartlepool NHS Foundation Trust which had improved from “requires improvement” to “good”, the Chairman asked if good practice could be learnt and shared from that trust.  He reminded the trust that they had said they would be outstanding after the last inspection and asked what actions would be put in place to achieve this result.  The Chief Executive said that it was their aspiration to be outstanding in the next two years however as the inspections regimes change there was no guarantee that this would happen.  She reported that their own inspections for end of life care were good but they could not force the CQC to carry out on inspection in this area.  With regards to North Tees and Hartlepool Trust, the Chief Executive said that they were part of a Learning from Others programme and this had helped them access the move to a good outcome.  She advised that CDDFT had also applied to be part of this process.

Councillor Darkes referred to sepsis and was concerned that following a personal loss, nothing appeared to have changed or improved within the last nine years.  The Chief Executive confirmed that they did look at all key signs including pathology systems and prompt clinicians.  She added that this was an audited system and included a bespoke system whereby the Head of NHS Improvement viewed important steps forward.

The Chairman asked what the Boards opinion was and what action the CCG would take following the outcome.  The Chief Clinical Officer, DDES CCG said that they shared the disappointment that there no improvement to the overall score had been shown.  He assured members that there was a huge amount of quality work being carried out and meetings and discussions were taking place regularly to discuss the quality.  The CCG acted as a critical friend and it had been recognised that a lot of changes were cultural.  He believed this was a unique opportunity to allow working together to improve the quality of the services.

Resolved:-

(i)            That the report be noted.

(ii)          That the CQC re-inspection report for County Durham and Darlington NHS Foundation Trust and the associated Improvement Action plan be added to the Committee’s 2018/19 programme.