Agenda item

A copy of the full CQC Inspection Report is attached for members information

The Committee received a presentation from Tees, Esk and Wear Valleys NHS Foundation Trust on the CQC Inspection and Improvement Action Plan. A copy of the full CQC Inspection Report had been circulated with the agenda (for copy see file of minutes).

Brent Kilmurray, Chief Executive, Tees, Esk and Wear Valleys NHS Foundation Trust and Beverley Murphy, Chief Nurse, Tees, Esk and Wear Valleys NHS Foundation Trust were in attendance to deliver the presentation.

The presentation provided details of the CQC Core Service and Well-led Inspection 2023; CQC Core Services Inspected 2023; CQC Ratings Comparison; Must and Should Do Actions; Positives and Learning Themes; CQC Improvement Plan Reporting Framework; Improvement Plan Governance; Delivering the Trust’s CGQ Improvement Plan and Improvement Action Delivery.

Councillor Early indicated that it looked like everything was moving in the right direction and asked how confident the Trust were that it would continue to move that way as it was a big complex operation.

The Chief Executive responded that they have structured appropriately to ensure they had good lines of sight and senior and clinical leadership across the geography. He was confident they had done the foundation work to ensure the improvement plan would be delivered and had already seen some progress. He recognised that there was a lot of work to do and was happy to come back to the Committee in six months’ time to provide assurance to the Committee that they were on track.

The Chief Nurse responded that they had a culture that was open and transparent and if they found any risks associated with quality of service in any of their locations, they needed to be open and respond and had a number of mechanisms in place. They had mechanisms for checking the quality and indicated that she would never give her board a 100% assurance that everything was fine but what she could assure was that she had good people and strong mechanisms for checking and testing and had a culture where people were not afraid to speak out and seek improvements and change where necessary.

Councillor Crute indicated that he was concerned about staff training and asked what measures they had in place to ensure that the mandatory training was carried out.

The Chief Nurse responded that the mandatory and statutory training was put together by a subject matter expert. She continued that they have a live data system so every time training was completed the system would be updated and every manager could track training updates on the system. They have an operational structure where they know who is on duty and where there were gaps. They have a trajectory to improve their compliance with training and as part of this they had taken the opportunity to be more flexible with their training passport and were porting training across that was more effective and efficient.

Councillor Crute asked if there was any evidence that the training was underpinned by a culture of lifelong learning and personal development.

The Chief Nurse responded that the report commented on the culture of the organisation and one of the things that CGC looked at was the annual staff survey that was anonymous. The staff survey showed that staff felt safe at work and were able to raise concerns and felt supported and had no intention of leaving. The results of the survey were reported nationally and were measured against other organisations and last year they were the most improved Mental Health Trust.

The Chief Executive stated that they saw this as a strong proxy for staff satisfaction and advised Members that this year they would be launching their learning and leadership academy.

Councillor Haney stated that it was great so see improvements and asked about the ligature and blind spots on wards and seclusion facilities.

The Chief Nurse responded that they had a very clear approach to environmental safety and stated that the CQC In November 2023 issued some new standards on managing the risks of ligatures in mental health and learning disability environments. The Trust were mapping their approach the CQC set out and they feel that they had attended to the environmental risk issues, and they needed to also continue to focus on the therapeutic relationship as this was ultimately what was going to keep people safe.

In explaining the Trust’s approach to assessing risk they understood where the risks were and were addressing them on a proportionate and priority basis. The CQC identified that there were some blind spots in one of their older persons units and they had talked to the CQC regarding this and the use of blind spot mirrors which could be seen to compromise privacy and dignity of people in that setting. She then advised members that they had closed a seclusion room in their secure services as they recognised the location of the room was impacting on people’s privacy and dignity when they had that level of restriction in their care and stated that they had a clear approach.

The Chief Executive indicated that the Trust had invested £20m over the last 5 years to replace bathrooms, doors and implementing assisted technology in a number of their settings in attempt to mitigate risk.

The Chief Nurse advised Members that they had looked to see where they sat in comparison to other organisations and all 54 Mental Health Trusts across the county, 23 had similar issues with ligature risks in their in-patient units. They were confident in their investment and approach, they had to identify, mitigate, manage and remove those risks from their environment.

Councillor Haney asked if the ligature risks had been removed.

The Chief Nurse responded that they had replaced all the sanitaryware in their in-patient units. There was an issue with bedroom doors being an anchor point, but they would not remove bedroom doors as this would reduce patients’ safety, privacy and dignity and this was where therapeutic relationship was key in understanding and managing that risk.

Ms McGee stated that they had seen an increase in negative feedback from the public whilst acknowledging that a lot of positive work was going on. She continued that there was a disparity between the strategic level and what was happening on the ground and asked for reassurances that the strategic level learning would be disseminated to community teams.

The Chief Executive indicated that Members would be hearing from Jo Murray this morning in respect of the Trust’s Community Services Transformation plan and would come back to the question if anything was missed following her presentation.

The Chief Nurse responded in terms of the experience of people receiving the service on a day-to-day basis, the report showed that the CQC Inspectors spoke to a number of people who received community services who were positive about the services they received. The CQC supported that things had improved.

The Chair referred to the issues around physical examinations and asked if they were looking to address this.

The Chief Nurse responded that Dr Helen Day had led a piece of work internally to look at the skills, experience and approach they take to physical health care and they had looked at this at their Quality Assurance Committee that fed into the Board. This had also been discussed at a recent partnership day and the Trust were now working with partners to ensure that anyone in the community with mental health issues can access the appropriate health care at the right point.

The Chair then asked if they had looked at a physical assessment module within the mental health programme in universities and adult nurses.

The Chief Nurse responded that they work with universities and have committed funding for two physical health clinical skills trainers within the organisation. When people first register to be nurses that first year of their practice was supported and part of that was looking at their confidence around physical health care.

Councillor Hovvels commented that some of the issues that they needed to get right were at a basic level.

Resolved: That the contents of the CQC Inspection report and presentation be noted and a further update on the Inspection Improvement Plan be brought back to the Committee as part of the 2024/25 Work Programme.