Agenda item

Professor David Chiddick, Chair of the Leicestershire Partnership Trust (LPT), Dr Satheesh Kumar, Medical Director, LPT, and Cheryl Davenport, Director of Business Change, LPT will attend the meeting to provide an update on the measures taken in response to the Care Quality Commission’s Notices issued in relation to the Bradgate Unit.

 

Following consideration of the LPT’s report at the last meeting position statements have been requested from other relevant bodies as listed below:-

 

Care Quality Commission                                                              Appendix D

NHS England                                                                                   Appendix E

Leicester City Clinical Commissioning Group                           Appendix F

 

A recent article in the Leicester Mercury on 24 September is also attached at Appendix G for information.

Professor David Chiddick, Chair of the Leicestershire Partnership Trust (LPT), Dr Satheesh Kumar, Medical Director, LPT, and Cheryl Davenport, Director of Business Development, LPT attended the meeting to provide an update on the measures taken in response to the Care Quality Commission’s Notices issued in relation to the Bradgate Unit.

 

The Director of Business Development introduced the report which updated the Commission on the Trust’s progress in responding to the Care Quality Commission’s (CQC) report and also in relation to the development of the Trust’s Quality Improvement Programme. (QIP)  The QIP was intended to be finalised by 31 October 2013, and contained a number of themed actions beyond the immediate 30 day action plan outlined at the last meeting.  The CQC had made a further visit in September 2013 to assess the progress made by the Trust in relation to the areas of concern contained in the two warning notices.  The Trust believed it had made improvements but was currently awaiting the CQC report on the second visit.  A draft report for factual checking was expected later in the week and the final report was expected to be published in November.  The Trust also provided details of the following in their report:-

 

a)    A summary of the NHS England Risk Summit in August.

 

b)    Details of the roles and responsibility of the Oversight and Assurance Group, an advisory body set up by the Trust Development Authority, to collectively share intelligence and support the Trust to ensure that they become a sustainable quality organisation.

 

c)    The Governance structure and themed work streams for the QIP.

 

d)    A response to the Commissions’ concerns raised earlier in the year in relation to Leicester LINk’s Enter and View Report submitted to the Commission’s meeting on 9 April 2013 (Minute 125 b) - refers).  The points raised at that time were all being addressed in the QIP. A number of meetings have been held with mental health organisations and the two acting chairs of Healthwatch to discuss the issues and make improvements for the future.

 

The Trust had consulted local authorities, the three CCG’s, the Trust Development Authority, the Voluntary Sector, Healthwatch and patient groups on the QIP.  The Trust were meeting again in two weeks to consider the feedback on the QIP and comments were welcomed on the QIP until 23 October.

 

The QIP demonstrated how the Trust were taking action to improve quality.  The issues were not just restricted to improving quality in the Adult Mental Health Division but they also affected other health divisions within the Trust.  Measures already put in place were:-

 

a)    A situation reporting matrix;

 

b)    A number of improvements for the crisis and home treatment service, which are shown in detail in the QIP, were being put in place;

 

c)    Monitoring of overall bed capacity, which was not just isolated to Leicester and the use of Step Down and Crisis House facilities to reduce the pressures on beds where appropriate;

 

d)    The appointment of the Chief Nursing Officer had already resulted in an increased quality of care;

 

e)    An early warning system was being developed to pick up issues within the system in order to deal with them before they escalated into more difficult issues.

 

Dr Satheesh Kumar, Medical Director LPT, gave an overview of work of the Oversight and Assurance Group and gave examples of where this work had already contributed to the development of the QIP and to the longer terms aim of achieving sustainable improvements.  The aim was to achieve a streamlined process and to take a patient pathway perspective from crisis to discharge in order to make the whole process less difficult for patients and also achieve the sustainable changes to the process.

 

Professor David Chiddick, Chair of the LPT, emphasised that the Trust wanted to be open and transparent with stakeholders and were keen to engage with them in developing the QIP.  He felt there had already been a step change in improvements with the new team and he recognised that, whilst the Trust were currently in the spotlight, the same issues were also being faced by other Mental Health Trusts.

 

Members discussed the various submissions that had been made to them and asked a number of questions of the LPT representatives to clarify some points.  Members made general observations that the QIP was matrix focused and, whilst it was successful in identifying the problems/issues, it did not address how these would be remedied, by whom and in what timescale.  

 

In response, the LPT representatives stated that:-

 

a)    The Acting Chief Executive had already overseen considerable changes in the last three months to address the issues in the CQC’s notices.   Staff had already been engaged in making cultural changes and some progress had been made.

 

b)    The provision of Mental Health and Community Mental Health services was very challenging.

 

c)    The Trust had provided an additional £1.1m funding for additional staff in the Mental Health Division against a backdrop of achieving 6% efficiency gains.

 

d)    The CQC report on the second visit would be made public and reported to the Commission.

 

e)    Audit tools were being used for discharge and re-admissions and a sample of care plans were also being analysed as part of this process.

 

f)     The appointment of the two Ward Matrons that were reported at the last meeting, were beginning to deliver improvements.  The Matrons had no management responsibilities and were responsible for providing professional input and support for staff.  The quality of care plans had already improved.

 

g)    Extra psychology support staff were currently being recruited to support the additional therapeutic staff already in place.

 

h)   The Trust were changing the staff mix from a 40/60 to 60/40 mix of experienced staff to auxiliary staff.  More qualified staff were joining the ward.  Inpatient staff have support from the specialist Personality Disorder services for reflective practice skills.  More nurses would also be delivering therapeutic measures.  A RGN Champion Nurse was also working with others to offer support and improve care standards.

 

i)     The physical health of patients was being addressed.  All patients were seen by a doctor on admission, patients were reviewed every day by a registrar/consultant and they also had 1 to 1 sessions with nurses.  A Therapeutic Liaison Officer was also available to offer activities.  Patients nearing discharge were able to leave the ward to enjoy a full programme of activities.  Access to specialist doctors was also available if required.

 

j)      The role of the Involvement Centre was acknowledged by the CQC. The Recovery College was only 1 of 3 in the country and offered an exemplary programme of courses.  Full monitoring was in progress to assess the before and after effects and rapid progress had been observed.  Discussions were also taking place with Leicester College to deliver short bite sized courses.

 

k)    The appointment of Dr Peter Miller as Chief Executive for Trust would be beneficial in the long term as he had experience and a background in psychiatric health care and had been a leading executive in high performing trust with the same spectrum of community and mental health interests as the LPT.  Dr Miller was not able to attend the meeting through a prior holiday arrangement before he joined the Trust.

 

l)     Recruitment processes were also being revised to remove any bottlenecks in order to get new staff in place as soon as possible.

 

m)  The Trust was continuing to work collaboratively with other agencies such as the CCG and TDA etc to secure sustainable improvements.

 

The Chair welcomed the measures being put in place but felt there was a need for the Trust to eventually show a correlation between increased investment and staff resources against improved outcomes for patients. He also felt that the Trust should make greater use the immense resources for mental health support that were available within the community and voluntary sector.  These had been underutilised in the past, but the services they provided outside of the health service could have a considerable effect upon support and admissions.  The Chair had met Dr Chiddick following the last meeting and would be writing to him to outline the Council’s priorities.  He would share the correspondence with Members.

 

Members received and noted position statements from the following bodies on their response and involvement with the Trust on the measures it has taken in response to the CQC Notices:-

 

            Care Quality Commission

            NHS England

            Leicester City Clinical Commissioning Group

            LAMP

 

Denis Chaney from LAMP gave a brief overview of their position statement and circulated an information pack to everyone present on the services that could be provided by LAMP.

 

During the overview it was noted:-

 

·         LAMP provided advocacy for 1,038 clients;

·         Two thirds of clients lived in the City;

·         40% of clients were from BME communities;

·         Advocacy could be provided for clients on, discharge arrangements, care plans, access to services and complaints.

·         LAMP were developing a peer advocacy project with people who had personal experience of mental health issues to supplement the paid advocates.

·         LAMP had experienced inconsistencies in systems at the Bradgate Unit, especially in how ward rounds were organised and timed when patients had requested an advocate to be in attendance.  LAMP were keen to be part of the system to achieve improvements for patient care.

 

A recent article from the Leicester Mercury on 24 September 2013 was also noted.

 

The Chair circulated the legal advice he had received in relation to the deputation submitted by Mrs Addey at the last meeting asking the Commission to request a public inquiry into the Bradgate Unit.  The advice was noted and the Chair would raise the issues with the Executive to explore a way forward.

 

The Chair thanked everyone for their participation in the discussions, reminded members that comments could be submitted to the Trust on the QIP and that further progress by the Trust would be reviewed at the next meeting.

 

RESOLVED:-

 

1)    that the reports and submissions be received and the Trust’s progress to date be welcomed and noted;

 

2)    that the Chair discuss with the Executive the legal advice that had been received on the request for the Commission to ask the Secretary of State for a public inquiry;

 

3)    that Mrs Addey be kept informed of the legal advice that had been received and the options available to the Commission; and 

 

4)    that a further progress report on the Trust’s progress and outcome of the CQC’s second visit be submitted to the next meeting.