Agenda item

Sir David Dalton, Interim Chief Executive Pennine Acute NHS Trust will report at the meeting.  CQC Report and presentation attached.

Professor Matt Makin, Executive Medical Director, Pennine Acute NHS Trust attended the meeting to provide members of the Committee with an update in respect of the Care Quality Commission inspection report and subsequent action plan.  A copy of the CQC inspection report had been circulated to Members prior to the meeting.  The presentation contained the following information:

Following a comprehensive inspection, the CQC rated Pennine Acute Hospitals NHS Trust inadequate in both safety and well-led domains. In line with CQC policy the inspection team considered recommending the trust go into special measures, such is the level of concern identified around quality and safety.  Immediately following the CQC inspection, Salford Royal NHS Foundation Trust was asked to assume leadership of the Trust. Salford’s leadership team, rated outstanding by the CQC put in place a comprehensive plan for further investigation into the challenges faced by Pennine Acute.

The Salford Royal Diagnostic, identified additional critical risks to patient care & safety; unsafe/unreliable staffing, variation in care delivery and outcomes for patients; governance systems that are broken or do not exist; Board that is disconnected; Poor leadership; Cultures that normalised sub standard care; Staff that are disengaged and poor external relationships and unreliable service design and structures.

A summary action plan has been developed with six key themes.  Four services have been identified as “fragile”; maternity services, urgent care, paediatrics and critical care.  An Improvement Board has been established, under the Chairmanship of Jon Rouse, Chief Officer, Greater Manchester Health and Social Care Partnership.

The Executive Medical Director reported that systems in place at Salford Royal would be implemented at Pennine Acute NHS Trust, these include systems in respect of, Risk Management and Assurance, Nursing Assessment and Accreditation; Open and Transparent Reporting, Visible Leadership and Quality Improvement Methodology.

The Executive Medical Director reported that part of the action plan is the proposed break-up of the centralised management within the Trust. The creation of a new site placed leadership with the appointment of nurse directors, medical directors and managing directors at each site; as well as a clear accountability framework to deliver on improvement plans and strengthen locality relationships and planning.

Since the inspection report 104 new registered nurses and midwives have been recruited, 14 doctors (consultant and middle grades) as well as 69 health care support workers.

The Chief Operating Officer reported that two main themes have emerged from the CQC, staff shortages and poor leadership.  The CCG have confidence in the new leadership to address the issues and concerns highlighted in the CQC report.

Those present were given the opportunity to ask questions and make comments and the following points were raised:

In response to Member’s concerns in respect of the new management arrangements, the Executive Medical Director reported that the proposed site management system would allow for greater autonomy on a site by site basis.  Discussions are still ongoing as to where the overall responsibility will sit in respect of the Trust Board.

With regards to staff feeling unable to raise concerns, the Executive Medical Director reported that there were a number of issues; high turnover of senior and middle grade management, inconsistency of information and a lack of visibility of senior staff.  The new interim Chief Executive has made regular visits to all sites, as well as other senior staff.  Lines of accountability within the Trust have been improved as well as the development of governance and risk management processes coupled with the new site management structure.  Improvements have been put in place but it may 2 to 3 years before the full benefits will be realised.

In response to Member’s concerns in respect of funding, the Chief Operating Officer reported that there is a significant shortfall in monies being available within  social services department, this has resulted in delays in discharging patients back in to the community at a cost to the Acute Trust. 

The Executive Medical Director reported that the Trust spent £20 million on Locum Agency staff last year.  The reasons for this is multi-factorial; there is a national shortage of nursing staff, the working environment in some of the Buildings at the NMGH site could be improved as well as problems with recruiting in what is a very competitive market.  The Trust is working to retain existing staff and plans to visit India to recruit a number of middle grade doctors.

The Executive Medical Director reported that a significant amount of work has already be undertaken to make the required improvements, new systems have been put in place, including systems to ensure lessons have and would be learnt from serious untoward incidents; specialists from other hospitals are providing support to departments identified as fragile.  Senior staff  have been out meeting patients and GPs to engage and discuss concerns at the Trust.

Members of the Committee expressed their concerns that the problems at the Trust had escalated to such a degree that it should not have taken a visit from the CQC to identify the issues at the Trust.  The Chief Operating Officer Bury CCG reported that they had raised concerns with NHS England, the Regulator, the CQC and the Scrutiny Committee.   The CCG reported that the biggest challenge was problems with the Leadership, this has however improved significantly with the appointment of Salford Royal staff.

The CQC report also highlighted problems with the Leadership on the Trust Board, including problems with oversight and a clear direction from the Board, these problems as well as problems with the management at the Trust have been allowed to develop over a number of years. 

Councillor Mallon wanted to place on record his concern that there had been systematic failures across the Trust. In responding to those concerns, the Executive Director reported that significant lessons had been learnt from the CQC inspection process.

Councillor Walker reported that a number of the issues highlighted within the report had been discussed at meetings of the Joint Committee for Pennine Acute. The Trust have always responded to concerns raised however it is very difficult as lay representatives to sometimes challenge the information presented.

It was agreed:

An update report on the Pennine Acute NHS Trust Care Quality Commission Action Plan will be considered at a future meeting of the Health Overview and Scrutiny Committee.