Agenda item

To receive an update from representatives of the South London and Maudsley NHS Foundation Trust on their recent CQC inspection.

The Director of Nursing presented the findings and recommendations as well as the improvement work to date arising from the Care Quality Commission (CQC) Core Service and Well Led inspection of July- August 2018.

The Sub-Committee learned that the inspection took place over a two week period. Five pathways as well as 20 acute wards were inspected.

There were two key areas of concern which resulted in the issue of warning notices under the Health and Social Care Act which were:

•Concern about the governance systems in a small number of wards.

•Lack of oversight of senior management on the significant issue of lack of beds on 36 occasions, 12 months prior to the inspection.

Since the inspection and feedback received there had been eight meetings of the Trust management team to address the highlighted areas of concern and had focussed upon the following:-

•The adoption of a borough by borough model of operational directorate, as well as a Clinical Director supported by a multi professional leadership team to look specifically at Croydon issues.

•Addressing issues within the clinical leadership in order to achieve parity of esteem.

•Recruitment and retention of staff and the voice of the staff across the whole organisation.

•Receipt of the draft findings from the CQC inspection and working to a strict timeline to submit to the Board as well as the CQC the improvement plan.

•Addressing challenges arising from funding challenges

In response to a Member question about what was being done to strengthen the leadership of the Croydon directorate, officers advised that many of the senior posts had been recruited and there was now a robust senior management team in place who had been devising and working on the delivery of the implementation plan. The team would be tracking and managing facilities and teams as well as focusing on patient experience.

A Member commented that the report highlighted concerns that Croydon had specific difficulties with a lack of patient discharge plans. Officers agreed that the Trust had experienced commissioning issues and which had impacted on the quality of service. The introduction of a borough based leadership and management structure would ensure that these issues were managed as a priority.

In response to a Member concern about the financial implications in terms of displacement to other services if patients were accelerated through the system too quickly, officers stated that it was important to ensure that service users were not kept as in-patients for longer than required. Indications show that the Trust was not being proactive enough in moving patients on from one system to another and the CQC had made it clear there was a need to provide care to patients in the least restrictive environment.

It was commented that it was disappointing to learn about SLAM’s rating, which had usually been good, and it was questioned whether this could be attributed to the directorate having lost line of sight. It was confirmed that lack of oversight was a key issue and one which the Board and Executive will have to prove to the Sub-Committee that they had regained oversight.

Members’ requested that officer’s return to provide an update on progress made at a future meeting, in particular, understanding of their roles and how they were able to demonstrate the effectiveness of their leadership through visibility and transparency. Officers agreed that more work was needed to address problems and that the new structure should improve visibility. The senior management structure was now well organised, more targeted, focused and sighted on variance in front line teams. Additionally relationship building was key to understanding views of staff through leadership engagement to ensure positive outcomes for patients as well as staff.

Staff had been open and honest about the work environment and culture, including the acceptance of the pressure within the service, which the leadership had needed to take on board. There was also a need to be clear on the required quality of care across the whole organisation.

The Sub-Committee was informed that the results from the staff survey showed that BME staff reported a better experience of working in the organisation than their colleague, yet during the inspection had been vocal about the negative aspects of their working experience. It had been recognised across the Trust that more work was required to improve staff satisfaction and that it would take time to implement improvements to longstanding issues. The commitment from the Chair was evident through the championing of and focus upon addressing issues for BME staff.

It was agreed for further scrutiny to take place in December 2018, as the Trust would have had time to imbed some of the actions arising from the Improvement Plan.

In reaching its recommendations, the Sub-Committee reached the following

CONCLUSIONS:

1. The CQC ratings for SlaM were disappointing and concerning given that in recent years the performance of the trust had been good. This rating was despite the fact that they were the most improved NHS Trust in the last year.

2. There was concern that the Executive had lost its line of sight and this lack of sight had contributed to the key issues highlighted by the CQC in areas of inadequacy by the Trust.

3. The Sub-Committee welcomes the new structure which meant that Croydon will be geographically led. This way of working presented an opportunity to understand funding issues and implications. In particular, issues surrounding underfunding and its contribution to inequalities of health.

The Sub-Committee Resolved to recommend that:

1. SLaM to return to a meeting of the Sub-Committee in December 2018 to provide an update on the actions that have been put in place in response to the CQC findings.

2. SLaM to provide explicit reference of line of sight of senior management in order for the Sub-Committee to appropriately hold the Executive to account about the visibility of their leadership.