Agenda item

To receive an update from Croydon Health Service NHS Trust on the action taken following the Care Quality Commission (CQC) inspection in July 2018.

The following representatives from the Croydon Health Service NHS Trust were in attendance at the meeting to provide an update for the Sub-Committee on the Trust’s response to their Care Quality Commission (CQC) inspection earlier this year:-

·         Dr Nnenna Osuji, Deputy Chief Executive,

·         Michael Fanning, Director of Nursing, Midwifery & Allied Health Professionals and

·         Wendy Frost, the Quality, Experience & Safety Programme Manager

The Sub-Committee were given the opportunity to question the representatives on the information provided in report, with the first question relating to what the Trust was doing to regain public trust following the previous inspection of core services by the CQC which had received an overall rating of ‘requires improvement’, particular as the rating had not improved following the inspection in July 2018. It was acknowledged that there was disappointment within the Trust that the overall rating had not improved, but also highlighted that the standard of care provided remained high.

Going forward it was necessary to ensure that the delivery of future improvement was robust and could be delivered within necessary timescales. As a result a number of key changes had been put in place, including the introduction of defined improvement methodology, the integration of the Quality team and a review of the use of data to enable the availability of real-time data.

In response to a question about whether the Trust had experienced issues with staff recruitment, it was confirmed that recruitment was a big issue across the health sector with the use of bank and agency staff increasing. The Trust had a preference for using bank staff, who as former hospital staff were familiar with services. As a follow up, it was questioned whether any steps had been taken to mitigate against any further staff issues potentially arising from Brexit. It was confirmed that the Trust had written to all staff who could be effected by Brexit to reassure them that they would help with the any registration costs.

In light of staff shortages, the Trust was working a scheme for international recruitment. The process for this was informed by the experience of other partners and organisations, with the first recruitment drive due to start in December. The focus of the recruitment drive would be to bolster the number of substantive staff members, with a view to alleviating the pressure on the existing workforce and provide continuity of care.

Given the ongoing staffing issues, the moral within the team was questioned. In response it was confirmed that morale was low across the NHS, but the team in Croydon were fairly resilient and able to rise to the challenge.

In response to a question about the use of technology, it was confirmed that the Skyguard application had been introduced to provide greater protection for staff lone working in isolated locations. Work also continued around the integration of patient data with the integration of community and in-patient data now complete. The next step was to integrate data with GPs and colleagues at the South London and Maudsley NHS Foundation Trust, with this stage of the project expected to be delivered in 2019.

Regarding the possibility of changes to the Accident and Emergency (A&E) and maternity provision at either Epsom, St Helier or Sutton Hospital and how it may affect the Croydon University Hospital, it was highlighted that no decision had yet been made, but work was being prepared to understand the implications from any possible changes.

It was noted that the One Croydon alliance was becoming known for its cutting edge approach to service provision, but questioned whether the administrative and IT infrastructure was in place to continue to deliver improvement. It was confirmed that the Trust had moved towards digital communication as far as possible, with fax machines use limited to communication with certain external organisations. Work was also underway to improve communication with Community staff with the provision of phones with the Skyguard application being rolled out.

In response to a question about performance monitoring, it was confirmed that information was provided on a weekly basis and an Improvement Programme had been developed which was reviewed by the Commissioners on a monthly basis. The CQC report also acknowledged the work undertaken to mitigate risks on a daily basis.

Concern was noted that there did not seem to be synergy between the clinical and community services and as such it was questioned why this had not improved despite being raised in the CQC Inspection reports. It was acknowledged that achieving greater synergy was a challenge, but the new IT infrastructure being introduced was a step in the right direction. There were areas, such as between the Community team and the Geriatric Team, which worked very well together, but improvement was needed on a wider level.

It was highlighted that it important for clinicians to have an understanding the work of the Community teams, which was a priority for the new Chief Executive, Matthew Kershaw.  Also as the health service increasingly focussed on prevention rather than treatment, the Community Service would become increasingly important.  It was agreed that the Trust would be invited back to a future meeting of the Sub-Committee in six months to provide an update on work to integrate the Community and Clinical teams.

It was confirmed that the new A&E unit was due to open in early December and would provide services catering for both adults and children. The unit would also have improved facilities for patient with mental health needs.

Conclusions

The Sub-Committee reached the following conclusions:

1. That an update on the Trust’s plans for the integration of Community and Clinical services would be requested for a meeting in 6 – 9 months.
2. That the Croydon Clinical Commissioning Group will be invited to attend future meetings.