Agenda item

To receive a report from Dr Peter Miller, Chief Executive of the Leicestershire Partnership NHS Trust that provides an overview of the systems of assurance for the CQC Action Plan following the comprehensive inspection in November 2016.

Before the Chief Executive of the Leicestershire Partnership NHS Trust (LPT) presented the report, the Chair gave a brief summary of issues and concerns that the Commission had previously raised relating to the CQC inspection of the Leicester Partnership Trust:    

·      The Commission had historically considered the CQC reports following their inspections of the Leicestershire Partnership NHS, including those relating to the Bradgate Mental Health Unit.

·      Some of the concerns that had been previously highlighted by the Commission related to the recurrence of issues such as reducing ligature points, missing equipment, uncompleted paperwork and fridge temperatures not being monitored adequately. These issues had been identified in successive reports as needing improvement and the lack of improvement of safety concerns at the Bradgate Unit had continued to surface.

·      The Commission had previously identified concerns about the number of children awaiting assessments at the Children and Adolescents Mental Health Service (CAMHS) and the lack of pro-activity in dealing with them as identified by the CQC. This issue had been considered earlier that month in a joint meeting with the Children, Young People and Schools Scrutiny Commission.

·      The issue of retention of staff was a concerning factor and one which the Commission had been told was under consideration by the LPT.

·      Whilst it was recognised that improvements were listed in the action plan, it was evident through the CQC reports that on a day to day basis, those improvements had not been translating through.

The Chief Executive of the LPT then presented the report and points made included the following:

·           The inspections that had recently taken place were inspections in their own right and not ‘follow up’ inspections. The CQC came annually to inspect certain services and their recent inspection had taken place across five of the services including the Bradgate Unit and CAHMS. It was expected that their report would be publicly available in January 2018.

·           The action plan included in the agenda followed on from the 2016 inspection.

·           Since 2016, improvements had been made including improvements to CAHMS, with for example significant reductions in the numbers of children awaiting treatment and with more knowledge of those who were waiting treatment and assessment.

·           In 2016 there had been particular concerns relating to the Bradgate Unit, where there were ligature points and old dormitory type wards.  Some improvements had been made such as new door handles, but there were still some problems with the estate. It was expected that the report would state that some changes were needed, which would include changes to the dormitory wards.

·           The numbers of out of area placements had been significantly reduced. There was a period where there were none, but currently during a very busy time there were 6 out of area placements. The LPT were committed to reducing the figures to zero by 2020.

·           Other improvements included the opening of a new psychiatric unit for women (which was currently full), investment in ‘moving-on’ beds and improvements in the Liaison Service.

·           Areas for improvement included District Nursing where the service was under significant pressure resulting in issues around staff retention and recruitment. Other areas for improvement were in care planning, although significant progress had been made. There were also concerns about waiting times in children’s services.  

·           The Inspectors had commented that staffing levels were appropriate, but agency staff were being recruited to maintain these levels; this could impact of levels of consistency.   The Chief Executive added that this was not a criticism of agency staff as some were excellent, but there could be issues around team work and financial costs to the NHS. The levels of agency staff were reducing and more staff were being recruited than ever before, but at the same time, more staff were leaving. This was a challenging time for staff who were working under considerable pressure.

The Chair thanked the Chief Executive for the update and asked for a further update when the Inspection Report was published. The Chair suggested that depending on the outcome of the inspection, it might be useful to invite a representative of the LPT Board Quality Committee to the commission to add a level of understanding to the report. The Chair added that it was good to note that there was a new psychiatric unit for women but it was disappointing that there was nothing for mothers and babies to help those suffering from postnatal depression.

Members raised a number of comments and queries which included the following:

·         In response to a question, the Chief Executive explained that the ‘CompAss’ rating in the Action Plan was the Compliance Assurance Committee rating which was made up on Non-Executive Directors  whose purpose was to focus on all the details of the Action Plan.

·         A Member asked whether overtime could be offered to staff as an alternative to hiring agency staff and also whether agency staff were up to date with their training. The Commission heard that there were a range of incentives relating to overtime for their own staff to be bank staff across the local NHS system, and they only used agencies  where the training was in line with the LPT. The majority were nurses but there were agency psychiatrists as well. In response to a suggestion for the LPT to set up their own agency, the Chief Executive responded that the possibility of a joint bank of agency staff across Leicestershire, Leicester and Rutland in all areas of the local NHS was being considered. The Chief Executive was asked as to how confident he was in retaining sufficient staff to cope with the challenges that the LPT faced and he responded that while there was an issue relating to the number of staff approaching retirement, there was a retention strategy and he remained confident but acknowledged that there was a need to invest in training.

·         A Member questioned whether in order to address the problem of delayed discharges for people in acute services; the LPT might support and wish to talk to the City Council about providing a model similar to that offered by the St Mungo’s homeless charity. The Chief Executive responded that he did not see why not, although the LPT did not commission those services. He added that the LPT would not discharge people if it meant they would end up living on the streets and approximately just 10% of those in the Bradgate Unit were affected by delayed discharge.

·         Comments were made relating to problems with administration in CAMHS and adult mental health services. The Chief Executive explained that there was a transformation programme to address those issues. Some improvements were already being seen, but the whole programme was designed to take effect over a three year period.

·         Concerns were raised about patients in dormitory wards in the Bradgate Unit and the décor which was considered to be oppressive.  The Chief Executive responded that he was conscious of those concerns and because of the very considerable expense that would be incurred to reconfigure the unit, there was a push to re build it instead but this was dependant on securing funding. The Chair commented that good estate gave out the message that the patients mattered.

·         A Member commented about the importance of good communication with the patient’s family, especially where there was a ‘Do Not Resuscitate’ request. The Chief Executive agreed that where the patient gave permission, it was very important to involve families and they were looking at ways of providing greater information.

·         A Member congratulated the Chief Executive on the reduction of numbers of children on the waiting list for CAMHS and asked how this had been achieved. The meeting heard that the model of care had been changed to provide a higher volume and lower intensity service. Some patients would be given less intensive care and treatment where it was considered to be appropriate. Monitoring would be carried out as regards to any re-referrals.

·         In response to a question about monitoring of patients after they had been discharged; the meeting heard that there were teams in place to monitor patients though this could not continue indefinitely. There was support for people with high risk issues but there was also a need for capacity for new people coming into the system.

The Chair drew the discussion to a close and the following recommendations were agreed upon:

AGREED:

1)  that the Commission note the report and request a further report be brought back in the Spring 2018

2)  that in respect of the reduction in the numbers of children on the waiting list for CAMHS, the Commission be given details on the number of those who are referred back.

3)  that the Commission receive an update report on progress in establishing an agency bank across Leicestershire, Leicester and Rutland; and

4)  for the Commission to receive details of the capital funds available for improvements to the Bradgate Unit.