Issue - items at meetings - Care Quality Commission inspection of BSUH sites

The Chief Executive of Brighton and Sussex University Hospitals Trust (BSUH) and senior officers will update members on the findings from the Care Quality Commission inspection of the Trust. Two inspectors from the Care Quality Commission will tell members how the inspection takes place and what is assessed. Handouts from the presentation will be  available at the committee meeting.

19.1    Terri Salt, Inspection Manager (Hospitals), Care Quality Commission, spoke to the committee about the role of CQC and how it operates. Its role is to work with providers but not to manage the Trusts.

            BSUH was in the first cohort of the new inspection regime, which takes a risk based approach. There are CQC teams dedicated to analysing a range of data about a health provider to highlight risks.

19.2    During the BSUH inspection, 35 inspectors reviewed the services at four out of the 8 BSUH sites; Royal Sussex County Hospital, Princess Royal Hospital, Hove Polyclinic and Bexhill Renal Unit.

            There are five key domain questions, is the provider safe; effective; caring; responsive; and, well-led? Each domain is given an overall rating ranging from outstanding; good; requires improvement; or inadequate. There was a deliberate decision not to have a ‘satisfactory’ option, the CQC wanted to be clear about the quality of service offered.

            Most Trusts range between ‘good’ or ‘requires improvement’ in overall results. BSUH’s final results were ‘requires improvement’ though some areas were given higher gradings.

19.3    Matthew Kershaw, Chief Executive, Brighton and Sussex University Hospitals Trust (BSUH) spoke to the committee about the inspection results. He said that the Trust had had a mixed performance, and the CQC had identified it as a medium risk trust. All of  issues highlighted by the inspection had been ones that the Trust had known about and highlighted and some had existed for a number of years and had been working to address. A key factor in the Emergency Department inspection was that BSUH could not demonstrate that 95% of patients were seen within 4 hours; this preceded Mr Kershaw’s appointment but was something that needed to be addressed.

            As the committee had heard, the overall rating was ‘requires improvement’, but the Trust had been marked as ‘good’ in the domains of ‘effective’ and ‘caring’. There had been one ‘inadequate’ score for one aspect out of 90 in total, for the emergency department pathway, which, as seen, was a known problem.

            BSUH feels that the report is a fair and balanced one, there were no surprise issues in the report. There had been some positive comments but also a number of areas where improvements could be made. The hospital had drawn up a detailed action plan to address the various areas that needed to be improved. Mr Kershaw was happy to share this with the committee if they would like.

19.4    The committee members then asked Ms Salt, Mr Kershaw and Sherree Fagge, Chief Nurse, about the inspection and outcomes.

            Before beginning the questions, the HWOSC chair thanked Mr Kershaw and Ms Fagge for their ongoing openness and willingness to engage. The CQC had recognised this and it had always been apparent at HWOSC too.

·         What does CQC see as the direction of travel for BSUH? The same concerns have been raised before, so how can it be managed in a long term manner.

Ms Salt said that it was difficult to compare previous CQC inspection reports with the current one as the inspection process has changed significantly. However in terms of what will be done from now on, the CQC will closely monitor the action plan; they have a Lead Inspector who works with the Trust and the CCG.

Some of the negative comments were due to the lay out of the building and the age of some of the hospital including the Barry Building. The Inspectors knew that the 3Ts proposal will aim to address a lot of this but it has to assess the Trust on what it sees at the time of inspection.

Ms Salt also confirmed that CQC had no serious overriding concerns; in particular mortality rates are better than comparator Trusts.

·         Members asked how do you maintain the ongoing good practice as well as introducing improvements?

Ms Fagge said that the CQC inspection had recognised that the Trust was maintaining maintain positive work – 64 areas of work had been assessed as ‘good’, including end of life care, which was uniformly recognised as a good across all five domains.

There were regular internal meetings amongst senior Trust staff to look at how to improve other areas, this was discussed in training and appraisals etc. There is a member of Executive Team responsible for each workstreams associated with the action plan.

Mr Kershaw commented that even areas that had been assessed as ‘good’ were not complacent, they were looking to see how they could move to ‘outstanding’. He added that the Trust expected the follow up CQC inspection to take place in summer 2015, depending on the CQC’s capacity.

·         Members asked whether patients should be concerned by the Trust’s safety assessment – ‘requires improvement’. How much of a worry was this? They also asked how the Eye Hospital was categorised in the CQC inspection- in the PLACE inspections it had its own category.

Mr Kershaw said that the CQC look at the Brighton sites as one, including the Eye Hospital and the Royal Alexandra Childrens Hospital. Locally there is an excellent cataract service. The results of the CQC safety assessments were linked to unscheduled care.

Ms Salt said that every inspection decision is carefully scrutinised by the CQC before the final decision, and that they are entirely based on evidence not just opinion. In the case of mortality data, the information is reported by department and can now be reported under individual surgeon’s names.

In cases where ‘requires improvement’ is the final assessment, it means that most people are getting good care, but a few are not receiving the same level of care so it is inconsistent.

·         Members asked whether the CQC report had a negative effect on staff morale?

Mr Kershaw said that it was a fair and balanced report for both staff and patients. If it had not been fair, it would have had a negative impact on staff. Ms Fagge added that staff were keen for the CQC to come to their individual wards – and that the one ‘inadequate’ rating has galvanised people to take action.

·         Members commented that the report was not very understandable to the layperson – it felt that it was by professionals, for professionals.

Mr Kershaw said he agreed, which is why it was key for BSUH to have some clear headline messages and these have been communicated widely.

·         Members asked about the budgetary implications – does BSUH have to make savings elsewhere to deliver the actions needed?     

Mr Kershaw said that most areas did not require additional cost but just a different way of doing things. However some areas for example staffing and improving the environment have costs.

Mr Kershaw gave an example of one of the new initiatives being put into place regarding discharges from hospital. One area was to identify appropriate patients to discharge early in the mornings, and there was also a drive to build closer links with partners including Adult Social care. The CCG had an initiative ‘Discharge to assess’ which will help to support people who do not need hospital care to be discharged back home with further support.

• Members asked about staff sickness levels; Ms Fagge said that they were at a reasonable level, and under the national threshold targets. However there were still some hotspots including the Emergency Department.
• The Healthwatch representative asked how the Trust and CQC engaged with Healthwatch. Ms Salt said that the CQC had listening events to which Healthwatch was invited. CQC also used local Healthwatch reports on topics such as discharge planning.

It was agreed that Healthwatch and CQC would arrange to meet up at a later date.

• Members asked for the rationale behind the international recruitment drive. The Trust said that there were currently up to 200 vacancies across nursing, due to increased investment in nursing. Every internationally recruited member of staff had a high level of English. The Trust also ran local and national recruitment drives in a multi-pronged approach. There had only been a low number of applicants locally to date.

19.5      The HWOSC Chair brought the item to a close- there had been an hour and a half discussing the item and there was still a huge amount more to cover. HWOSC need to understand how the Trust is monitored going forward, especially with regard to 3Ts and Trust status.

The Chair proposed that there be an opportunity to have an additional public workshop looking at the CQC report and work going forward as well as additional reports to future committee meetings. Mr Kershaw said that he would be happy for the Trust to take part in a workshop of this kind, suggesting that East and West Sussex colleagues also be invited to share the learning. Ms Salt said that the CQC would also be happy to take part.

The workshop was agreed by all members.

The Chair thanked everyone for attending and taking part in the discussion.