Agenda item

The Chief Executive of the Leicestershire Partnership NHS Trust (LPT) submits a report that provides an update on workforce and estates, previously identified as key risk areas. The commission is asked to note the actions by the LPT in responding to the estate and workforce risks, and comment as it sees fit.

Dr Peter Miller, Chief Executive, Leicestershire Partnership, NHS Trust (LPT) submitted a report that provided an update on workforce and estates. These were two specific risks which had been previously identified and risks which the Scrutiny Commission had sought additional assurance from the LPT.

Dr Miller presented the report and Members considered the workforce issues first. Points made included the following:

·      The Trust had approximately 200 nursing vacancies; this equated to an overall percentage of approximately 11%. This reflected an upward trend compared to about 8% three years ago.

·      A considerable amount of work had been carried out to halt the trend and for example, pharmacy technicians now dispensed medication on wards instead of nurses.

·      The numbers of nurses coming through apprenticeships and universities were not sufficient to close the vacancy gap.

·      There were approximately 700 registered nurse vacancies across Leicestershire, Leicester and Rutland and it was not possible to rely on recruiting from other countries or neighbouring counties.

·      In spite of the nursing vacancies, Dr Miller gave his assurance that there were enough staff on the wards; albeit some of the staff were                              temporary.

·      The Chair commented that the commission were considering looking into work force pressures in Leicester.  The Chair referred to the removal of nursing bursaries and Dr Miller explained that there had been a cap on recruitment due to the limited amount of money available to finance the bursaries. The cap on recruitment had been lifted because now nurses took out student loans like other students. There had been speculation as to whether the removal of the cap would result in an increase in recruitment but to date that had not happened and Dr Miller said that time would tell if the initiative had been successful.

·      In response to a question about nursing degrees, the Commission heard that student nurses gained practical skills working on wards as well as studying at university. There was an apprenticeship route into nursing as well.

·      It was suggested that there should be opportunities for people to gain experience by working in a less skilled role with lighter duties to enable them to decide whether nursing was for them. A further suggestion was for hospital staff to go into primary schools to attract children’s interest in nursing at an early age. Dr Miller commented that he agreed that it was necessary to attract young people’s interest early; he went to jobs fairs and a new career pathway had been launched for young people aged 16 plus. He acknowledged that there was a room for improvement on this strategy.

·      The Chair stated that when the Commission considered the workforce, they would look at the university pathway to see whether it might discourage people from entering the nursing profession.  

·      The Vice Chair asked whether the outcome of the CQC Inspection, for example at the Bradgate Unit, had affected staffing. Dr Miller responded that work was needed in the Bradgate Unit as it was not a good environment for patients or staff. In children’s mental health there were about 1400 children awaiting treatment; these children were monitored but staffing was an issue and having large numbers of temporary staff impacted on moral.

·      The Chair commented that she did not believe that the CQC would have concerns about the LPT’s staffing complement, but she thought it would be useful, when the Commission looked at workforce issues, to have more contextual information as to where Leicestershire was placed nationally.

Dr Miller then provided an update on issues relating to the LPT’s estates. Points made included the following:

·      The Trust was trying to reduce the number of estates in order to spend more on staffing. At the same time, they wanted to improve the quality of their estates.

·      The Business case for CAMHS had been approved. The new site would be between County Hall and the Glenfield Hospital and the Trust had worked with families, children and staff on the design.

·      It was hoped that digging on site would start in December 2018, if final approval was received.

·      The Chair asked to see the business case for CAMHS; the Commission had sent in a letter to speed up the process but she believed that sight of the business case would ease some of the Members’ concerns. Dr Miller confirmed that he would send this information. 

·      In respect of the Bradgate Unit, the CQC had made it clear that dormitory accommodation was not acceptable; therefore the only option was to build a new unit. A strategic outline case was being put together which was a significant piece of work. 

·      Dr Miller said that he would like to create in in-patient unit for older people on the Glenfield Hospital site and they would be consulting on this. The Chair stated that she would like consultations and engagements to be held as early as possible and Dr Miller responded that the proposals needed to be consulted on and would be brought to scrutiny.

·      Regret was expressed by a Member and Dr Miller that there had been a significant increase in children going into psychiatric care now that Educational Psychologists no longer worked with children as they used to.

·      The Chair stressed the importance of ensuring that the Bradgate Unit was fit for purpose in the interim period and asked for a report on some of the issues raised in the last CQC inspection.

·      The Chair asked it to be noted that in the interest of clarity and to avoid any misunderstanding, an amendment was required to the last paragraph the report relating to the NHS Reconfiguration Tests. The paragraph read:

‘Both the Leicester and Leicestershire health overview and scrutiny committees have written to confirm that a 4-mile relocation of the unit does not constitute a substantial variation in service and as such, public consultation is not required’

The Chair stated that a full stop was needed after the word ‘service’ to amend as follows:

Both the Leicester and Leicestershire health overview and scrutiny committees have written to confirm that a 4-mile relocation of the unit does not constitute a substantial variation in service.

Dr Miller was thanked for his report.

AGREED:

1)    that the report and comments of the Scrutiny Commission be noted;

2)    that the Commission request a report on the issues raised by the Care Quality Commission at their previous inspection; and

3)    that the Commission be sent a copy of the Business case that had been submitted for the relocation of CAMHS.

4)    that the strategic outline case be brought to the Commission as soon as possible.