Agenda item

To receive the Care Quality Commission’s (CQC) report, issues in April 2016, of their unannounced inspection of the Emergency Department at the Leicester Royal Infirmary on the evening of 30 November 2016.  Following the inspection an urgent Notice of Decision was issued to the Trust on 4 December 2015.

A copy of the University Hospitals of Leicester NHS Trust’s presentation to their response to Notice of Decision is attached at Appendix A1 (Page ???).  Mark Wightman, Director of Marketing and Communications, University of Hospitals Leicester NHS Trust will be present at the meeting.

Members received the Care Quality Commission’s (CQC) report, issued in April 2016, of their unannounced inspection of the Emergency Department at the Leicester Royal Infirmary on the evening of 30 November 2016.  Following the inspection an urgent Notice of Decision was issued to the Trust on 4 December 2015.

Mark Wightman, Director of Marketing and Communications, University of Hospitals Leicester NHS Trust (UHL) gave a presentation on UHL’s response to the Notice of Decision.

During the presentation it was noted that:-

a)         The CQC report had highlighted 3 areas where conditions were imposed on the Trust’s registration as a service provider.  These were

·         Patient Assessment

·         Emergency Department Staffing

·         Sepsis Management

b)         The Trust had been aware of these issues prior to the inspection.  It was well known that the A&E department was the busiest single A&E site in the country and had originally been built to accommodate 100,000 attendances per year but the attendances between November 2014 and October 2015 were 217,832.  The large attendances at A&E in recent years had prompted the building of new Emergency Department to improve the operation and efficiency of the A&E unit.

c)         The Trust had taken the following actions in response to the CQC’s Notice of Decision:-

            Patient Assessment   

Additional staff resources were taken from hospital wards to work in the assessment area in the A&E unit to improve the performance of patients being assessed within 15 minutes of arriving in the Emergency Department.  At the time of the inspection the actual performance was 55%-60% against the standard of 90%.  Following the inspection, performance was significantly improved and performance during the last 6 months had fluctuated between 85%-95%. A graph showing the performance was circulated with the agenda.

Emergency Department Staffing

A graph showing the performance was circulated with the agenda and indicated the improvement in performance that had been achieved in staffing levels.  The CQC had been concerned with the number of staff and the skills mix of staff dealing with the poorliest patients. Additional senior nurses had been moved into these areas and more consistent levels of performance were now being achieved. 

Sepsis Management    

Sepsis was a life threatening condition that can occur when the whole body reacts to an infection.  The symptoms of sepsis are similar to the symptoms for a number of ailments and if not spotted quickly, the patient can deteriorate very quickly.  The performance was improved but was not yet consistent.  The national standard was for 90% of patients who presented with sepsis to receive their medication within 1 hour of arriving at the Emergency Department.  Patients with symptoms of sepsis may not always present themselves within the A&E, major injuries or resuscitation units and additional education and training was being rolled out across all staff to assist them in identifying patients with sepsis.

Following comments and questions from Members the following responses were noted:-

a)         The peaks and troughs in patient assessment performance were mainly related to the varying numbers of patients attending the emergency department. 

b)         One of the troughs in the sepsis performance was related to an East Midland wide flu outbreak which had affected both patient numbers and staff absences.  

c)         The Trust employed over 13,000 staff and always had a large number of vacancies within its workforce; these were currently in excess of 400. Moving senior nurses within the hospital had little impact upon finances.  By putting more staff resources into the assessment, resuscitation and majors units did mean, however, that patients waited longer for treatment in minor ailment units.

d)         Ambulance crew personnel were also trained in identifying sepsis and any suspected cases would be notified to UHL staff on arrival at the hospital.

e)         The incident relating to the breech of procedures for administering medicines on page 10 of the CQC report had been the result of human fallibility.  This had been addressed through training and encouraging all staff to act in self-regulation and challenge instances where they observed staff not adhering to established policies and practices.

f)          There had been a campaign last winter to encourage people who did not feel well to see a GP or a pharmacist in an attempt to reduce the numbers attending the emergency department.  Although the campaign was felt to be the best that had been delivered in recent years, the numbers attending the emergency department had increased.  This increase had also been experienced nationally.

g)         The numbers of people attending the Emergency Department was now becoming relatively constant throughout the year, although the types of admissions did change with the seasons.

h)        Staff absences also fluctuated throughout the year and were higher in the winter when attendances at the Emergency Department also increased through winter illnesses.

i)          The report of the recent inspection was not expected for some months. Initial comments from the inspectors had mentioned that they had not seen any examples of poor, inconsiderate or uncompassionate care and for an organisation employing 13,000 staff this was considered unusual.  It was expected that the report would identify poor performance in the emergency department waiting times, ophthalmology department for waiting times and general quality of the building it operates from and the appearance of public areas of the hospital.  These issues were already known within the hospital.  The facilities management had been brought in-house because whilst the previous contractor had performed well in relation to the cleanliness of the wards, they had performed less so in relation to the corridors and public areas.  The in-house service was gradually improving the appearance of the public areas.      

Members made additional comments as follows:-

a)         It would be helpful for Members and community groups to be given simple information on sepsis and meningitis to raise awareness and enable them to identify symptoms. 

b)         It would also be useful to have simple information on other pathways to receive medical advice and treatment to help reduce the number of people attending the emergency department.  This could include promoting the services of local pharmacies, GPs and home safety advice to reduce accidents in the home.    For example, a simple information card could be devised and distributed to the elderly and vulnerable people to give 5 simple and clear messages.   

c)         It was recognised that health services staff were working in difficult circumstances and the improvements that had been made were welcomed.

d)         Whilst welcoming the improvement in increasing the numbers of patients seen within 15 minutes from 55% to approximately 90% within 3 weeks, this raised the question of why it had initially fallen to 55%.

The Healthwatch representative stated that Healthwatch had made 2 unannounced visits to the emergency department and 2 notified visits to the Merlyn Vaz Centre and the Walk in Centre.  Visits had also taken place on a number of wards at the Royal Infirmary and Glenfield Hospitals.  Healthwatch had also launched an open day with UHL.  UHL had also helped Healthwatch to involve patient panels in their work.  Reports on visits were available on the Healthwatch website.

AGREED:

1.         That the Director of Marketing and Communications be thanked for the presentation and his frank and informative responses to Members questions.

2.         That a further report be received in December to enable the Commission to be satisfied that the improvements made in response to the CQC report are being sustained.