Angela Hillery, Chief Executive Officer, and Anne-Maria Newham, Director of Nursing (AHPs & Quality), from the Leicestershire Partnership NHS Trust (LPT) will give a presentation providing the Commission with details on the current Care Quality Commission position for LPT, assurance around actions that have been taken following recent inspections and the Trust’s approach to monitoring and embedding these actions. The Commission is recommended to consider the presentation and comment as appropriate.
Angela Hillery, Chief Executive Officer, and Anne-Maria Newham, Director of Nursing (AHPs & Quality), from the Leicestershire Partnership NHS Trust (LPT) gave a presentation providing the Commission with details on the current Care Quality Commission (CQC) position for LPT, assurance around actions that had been taken following recent inspections and the Trust’s approach to monitoring and embedding these actions. A copy of this presentation is attached at the end of these minutes for information.
During the presentation, Ms Hillery drew particular attention to the following:
· Full information on the results of the CQC regulatory inspections was available on the LPT’s website (www.leicspart.nhs.uk);
· The STEP up to GREAT strategy was the focus for the whole Trust. A director had been assigned to each area of the strategy, and these directors had responsibility and accountability for taking their areas forward. The Programme Management office supported them in doing this;
· Nationally, the use of dormitory accommodation in mental health units was considered unacceptable. The LPT endorsed this view and was trying to find capital funding to eliminate it in the Trust’s facilities;
· Staff were at the heart of change, so a number of Change Champions had been recruited across the organisation. Approximately 80 people had volunteered for this role and had provided useful insights in to the organisation culture, what worked and what did not work;
· The CQC had undertaken an unannounced inspection in June 2019 and had identified some encouraging improvements. For example, improvements had been made in recording patients’ physical healthcare and monitoring patients with ongoing physical healthcare problems, so mental health services did not just focus on mental health. Fire safety also was much improved, part of which was enforcement of the ‘No Smoking’ policy. However, most mental health units nationally found this difficult to implement, as people attending these units often were in distress and smoking provided them some relief from this;
· As the waiting list of children and young people waiting for treatment had increased and the demand for neurodevelopment assessment remained high, work needed to be undertaken with the Trust’s commissioning partners to improve access to these services and ensure they were appropriate;
· An intensive support team from NHS England had looked at the commissioning and provision of Child and Adolescent Mental Health Services (CAMHS);
· Awarding a rating was not part of the process of the inspection undertaken in June, but the Warning Notice was removed following that inspection; and
· The LPT would have a re-inspection sometime from October or November 2019 onwards, when it was hoped that some improvement would be seen.
Ms Newham assured the Commission that the LPT was not being complacent about this work. It was recognised that the Trust had not worked well co-operatively in the past, but this had been addressed. It also was recognised that the Trust had not provided good responses to complaints in the past, particularly telephone complaints, and this also was being addressed.
Rachel Bilsborough, Divisional Director Community Health with the LPT, stressed that staff on the ground were being fully supported to understand the continual cycle of improvement being undertaken, to ensure that they were aware that these were not one-off improvements and needed to be embedded in the organisation. This was a new approach for the Trust.
Ms Hillery recognised that the Trust had a lot of priorities and it could be hard for staff to navigate through them in order to contribute to the improvements being made. The priorities therefore needed to be simplified, so that all contributions also were clearer. To facilitate this, the complexities of management structures also needed to be made clearer, as did the way in which the various parts of the organisation worked together. There had been some separate attempts to explain individual elements of this, but these had not made it clear how those elements affected the Trust as a whole. The Change Champions therefore were now working with the directors leading change to remedy this.
Mark Farmer, Healthwatch, enquired how patient experience was captured and understood pro-actively by the Trust. In reply, Ms Hillery noted that Mr Farmer, was on the LPT Board, which helped improve the Trust’s understanding of patient experience. In addition, patient involvement teams from the Trust were visiting communities and trying to ensure that ‘harder to see’ patients were identified and their experiences captured. This work was ongoing. Ms Newham stressed that this needed to be done throughout the Trust, as it was a core area to which the Trust needed to give attention.
In response to an enquiry regarding whether district nursing was a stress area, Ms Bilsborough explained that district nursing services had been inspected by the CQC in 2018 and had been categorised as a Good component of community services.
Members expressed some concern that ligature risks had been highlighted as an area needing attention for a number of years. Ms Newham and Ms Hillery explained that the service was not necessarily missing ligature risks, but as environments changed, (for example, through works to buildings), patients found different ways in which to use fixed and non-fixed ligatures. There had been no fixed ligature incidents in the Trust for a number of years, but continual audits of premises were undertaken and external advice taken, including from other trusts. The CQC had identified some potential ligature points, such as radiators positioned away from walls, but welcomed the plans that had been produced for each ward identifying all points of concern.
Members raised concerns that problems at the Bradgate Unit had been known about for some time, but did not appear to have been addressed before now. It therefore was questioned whether the LPT could be confident of getting funding needed and improving the service rating. Ms Hillery explained that the Sustainability and Transformation Partnership and the Better Care Together programme agreed priorities for the population, but the LPT had to develop the business case for this expenditure. This then had to receive system support for the work to be identified as a priority, followed by approval from the system partners. This funding bid would be separate from bids for other projects or programmes.
The business case for funding for improvements to the Bradgate Unit was being prepared and it was anticipated that the LPT would consider it in September, following which it could be shared with other partners. Other trusts had reduced the number of beds available in order to create single accommodation, but beds in Leicestershire already were under significant pressure, which was an important consideration. It was noted that it could take some time to acquire the necessary funding, so clear plans also were needed for the interim period.
The Commission enquired how the Trust approached equalities, particularly for women. In reply, Ms Hillery explained that the LPT had a very good champion and lead on this, who was assessing what work was being done in this area. Work also was being done with NHS national teams, such as the Race Equality team, to identify any further action that could be taken. An update on progress with this could be given to the Commission in due course.
The Commission noted that the LPT was working in partnership with Northamptonshire Healthcare NHS Foundation Trust (NHFT), having a shared Chief Executive. Ms Hillery explained that this was a “buddy” relationship. When NHS Improvement (NHSI) felt that a trust needed support, a near-by trust with a Good or Outstanding rating was asked to provide “buddy” support. The LPT had been approached before the support was put in place to ensure that it was comfortable with the arrangement.
Although a shared Chief Executive role provided the infrastructure for support for the LPT, but care was taken to ensure that this was not to the detriment of the NHFT. Ms Hillery stressed that the “buddy” arrangement was not a take-over by NHFT or a merger of the two trusts, although it was a formal arrangement. NHSI provided some resource towards backfilling time in relation to the joint Chief Executive role if needed and the regulators would require reasons to be given if either party withdrew from the arrangement.
As an example of the type of work now being undertaken, Ms Newham noted that the LPT and the NHFT had worked together on nursing, enabling ideas to be shared without having to go through development processes already undertaken by either trust.
It was noted that the current “buddy” arrangement was for 12 months. Monthly monitoring was undertaken to ensure that learning was happening and a yearly review, based on the financial year, would be undertaken to ensure that the arrangement was making a difference. During this time, work with other trusts would continue, such as that on reducing CAMHS waiting lists, and a CQC inspection was anticipated during the partnership period.
Ms Hillery explained that the LPT needed more robust governance. Her experience from other organisations was that it took approximately three years to move to an Outstanding rating, although a Good rating could be achieved in the interim. As this involved a change in culture, it would not be an easy change to make, but the Board had been very receptive to changes and suggestions made.
Tim Sacks, Chief Operating Officer at East Leicestershire and Rutland Clinical Commissioning Group, emphasised that change would take time, but he also noted that very real change and engagement already had taken place, which was a welcome start to the process. Tamsin Hooton, CCG Director Lead for Community Services Redesign, agreed with this, noting that work with nurses was key to the process and had started straight away.
1) That the presentation be received and noted;
2) That the improvements made to date be welcomed;
3) That the Leicestershire Partnership Trust be asked to provide:
a) an update on its work on equalities at an appropriate time;
b) a report at the end of 2019 on progress with the redevelopment of the Bradgate Unit, this report to include the design of accommodation at the Unit and the business case for, and progress with, the acquisition of the funding required; and
c) information on why some service areas had not been rated during Care Quality Commission regulatory inspections.
4) That the Leicestershire Partnership Trust be asked to present for scrutiny by this Commission at the appropriate time details of any further changes and/or improvements made in response to Care Quality Commission regulatory inspections.