Agenda item

To receive a report from the University Hospitals of Leicester NHS Trust (UHL) providing an overview of the outcome of Care Quality Commission (CQC) comprehensive inspection of the Trust.

The Commission received a report from the University Hospitals of Leicester NHS Trust (UHL) providing an overview of the outcome of Care Quality Commission (CQC) comprehensive inspection of the Trust.

Julie Smith Director of Nursing UHL NHS Trust and Sharon Hotson Director of Clinical Quality, UHL NHS Trust, attended the meeting to present the report and respond to Member’s questions.

It was noted that:-

a)         The Inspection took place in June 2016 and the Inspection Report was published on 26 January 2017.  The Inspection had been carried out at all 3 UHL sites.  The Trust had received an overall rating of ‘Requires Improvement’.  However, a number of individual practices had been rated as outstanding; including the CHD service at Glenfield.  It had also been rated as outstanding in the previous inspection in 2014 and had maintained making many improvements since then.

b)         It was considered that good progress had being made in the general direction of travel since 2014 and the Trust acknowledged there was always more to do.  There was a positive culture within the Trust and its leadership had made sure that staff knew about the challenges being faced and what was being done to address them.

c)         The Trust had made a number of improvements since June 2016 and it had provided evidence to the CQC on these improvements.  It was pleasing that the conditions previously imposed on the Trust’s licence by the CQC in 2015 had been removed in November 2016.

d)         The Trust had been highly praised for ‘caring’ by staff and there were still challenges around the emergency pathway.  The Trust had been praised for its robust plans for the care of deteriorating patients.  Sepsis had been an area of considerable focus and challenge and UHL had made such considerable improvements in responding to the national performance indicators that it had been nominated for a national safety award.  The Trust still had many challenges around its aging estate.

e)         A Quality Summit had been held on 28 March 2017 and the initial feedback from the CQC indicated that they were satisfied with the progress being made and the Trust was making good progress to meet its aims of being rated ‘Good’ in future inspections.

Members made the following comments:-

a)         It was not helpful when inspection regime criteria changed as this made comparisons with previous inspection reports difficult and the inspection process unsustainable.

b)         The comments of ‘outstanding’ in relation to CHD services were extremely welcome; particularly in the context of the current national review which was seeking to close the service at Glenfield.

c)         It was important to remember that the proposals to reduce acute care from 3 to 2 sites would not resolve all issues facing the Trust and the proposal still required public consultation before it could happen.

In response it was noted that:-

a)         The new Emergency Department at the Royal Infirmary site was due to open on 26 April 2017 and that should allow considerable improvements to be made within the hospital.  It provided a far larger space which should make the hand-over of patients from EMAS far easier and reduce the amount of waiting times of ambulances at the hospital so that they could return to active service much quicker than in recent times.

b)         There should also be efficiencies for new models of care with the nearness of other services to the new emergency department.  However, demand was still increasing and the department was seeing 200 more patients per day than when work started on building the new facility.

c)         Improvements were also being introduce to provide hot food out of regular hours, especially when a patient had missed a meal through going to another appointment in the hospital or their bed had been moved.  In some instances staff were feeling empowered to keep patients until they have eaten their meals.  The hospital had taken back the provision of meals and different processes were now in place.  Further work was being undertaken to see what further improvements could be made within the current financial resources.

The Chair commented that it would be relatively simple with the current inspection regime to concentrate on outliers of poor performance and lose sight of the fact that UHL is one of the largest acute Trusts in the Country facing huge and complex issues.  It was important to focus on the Trust’s recognition of the challenges being faced and the steps being taken to address them.  ‘Requires Improvement’ was a disappointing term to use in the current inspection regime when compared to the previous equivalent rating of ‘adequate’; which as considered a far less emotive term.  At times of rising need and lack of resources, ‘adequate’ could be considered to be good enough.  4 NHS Trusts had been placed in special measures during the week and the performance ‘bar’ was constantly moving which was not considered to be helpful.

It was felt the Trust could do more to engage with the public on the possible reduction from 3 acute sites to 2.  People generally became concerned when there were proposals to 'close' facilities but if the transfer of services led to better and improved care, then this needed to be clearly explained in the communications strategy for the proposal.

AGREED:

1)         That the representatives of the UHL be thanked for their report and response to Members’ questions

2)         That a further report providing an update on the improvement under the Action Plan be submitted in a year’s time together with a commentary of any barriers that have hindered progress.