Agenda item

At the Health & Social Care Sub-Committee meeting on 25 September 2018 it was agreed to recommend a request for an update in December 2018 on the actions that have been put in place by the South London & Maudsley NHS Foundation Trust in response to the CQC Findings.

The Chair has agreed to take this item as an urgent matter of business to ensure the timescale specified by the Sub-Committee in its recommendations is met.

Beverley Murphy, the Director of Nursing at SLaM and Doctor Faisil Sethi, the Interim Service Director for the Croydon Executive Team of SLaM, were in attendance at the meeting to provide an update on the actions being implemented in response to the findings from a Care Quality Commission (CQC) inspection earlier in the year.

From the presentation the following information was noted:-

·         An overview of the management structure for the team responsible for inpatient and community services in Croydon and Behavioural & Development Psychiatry (BDP) was provided. SLaM provided reassurance to the Sub-Committee that the right team was now in place to deliver improvement going forward. 

·         An Action Plan had been developed which focussed upon achieving the ‘must do’ recommendations within the CQC report. This included achieving a consistent standard of care across the organisation with work also needed to address concerns regarding the Ward Directorates.

·         Weekly meetings chaired by the Chief Executive of SLaM had been set up to account for the implementation of the Flow Plan which had been created to improve the flow of patients through the service to discharge.  The short term results had been encouraging with a reduction in the amount of people waiting in A&E, but it was essential to ensure that this good work continued moving forward.

·         A Delivery Board chaired by the Director of Nursing, which met once a fortnight, had been set up to provide oversight of the improvement plans being delivered as a result of the CQC inspection.  There were six improvement plans in place, each with actions relating to their respective areas. The plan for Croydon included 194 separate actions which varied from the straight forward to multi layered, detailed actions. The Delivery Board focussed its attention upon those actions that were not on track.

·         From the 194 actions set out within the improvement plan for Croydon, highlights included having the Directorate Senior Management Team in place, continuous improvement around the recruitment and retention of a high quality and skilled workforce, continued improvement to address issues relating to patient flow and continued improvement in mental health transfers from emergency departments.

Following the presentation, members of the Sub-Committee were given the opportunity to question the representatives from SLaM. The first question concerned how SLaM commissioned services, with it confirmed that this would depend on the type of service being commissioned. Forensic and neurodevelopmental services would be commissioned on a regional or national level by NHS England, while others would be on a more local Croydon basis.

In response to a question concerning how data for mental health assessments was tracked, it was confirmed that daily reports were prepared for the Executive Management team. This information was also regularly reported to both the Board and the Quality Committee.

There was a concern raised that the work to improve patient flow was too management focussed and as such it was question whether improvements were being cascaded to frontline staff. It was confirmed that this was an important issue for SLaM with mechanisms being put in place to engage staff in the process. The new management structure had given clinical leadership more of a voice and a clearly defined role. Other changes included Matrons only working from one site and overseeing a smaller number of wards. Ward Manager posts had also been created to improve the oversight of improvements.

In relation to the 194 improvement actions for Croydon, the methodology being used to determine whether they were achievable or not was questioned. It was confirmed that the Quality Portfolio Board had approved a measurement strategy which accounted for the difference that would be made if all the actions were implemented.  This took into account a range of factors including the length of patient stay, the use of restraint, staff turnover and staff satisfaction. All of which would be used as indicators of overall improvement. 

In response to a question about how the objectives had been defined, it was advised that they had been identified following engagement with senior leaders in the organisation, partners and regulators, with both clinical and regulatory reasons for the four priority areas.

Regarding patient flow, it was questioned how the number of mental health assessments being cancelled could be reduced. It was advised that the reasons for cancellation varied, with some out of the organisations hands, such as needing police support for an assessment. However SLaM did have control over patient flow and would cancel an assessment if there were no beds available. By implementing the flow plan, it would improve the capacity of the service, reducing the need for cancellations as a result. 

It was questioned how SLaM would go about achieving its targets for patient discharges per week. It was advised that Trust were aware that there were cases of people occupying beds that no longer needed to be there and needed to move on. At the time of the meeting the discharge rate was 56 patients per week and an average discharge rate of between 50 to 55 patients per week was needed to manage capacity.

A request was made for the complete list of 194 actions relating to Croydon to be shared with the Sub-Committee, which was agreed. It was also agreed to invite SLaM back to a future meeting to provide a further update on their improvement plans.

The Chairman thanked the representatives for attending the meeting and answering the questions of the Sub-Committee.

Conclusions

Following the discussion of this item, the Sub-Committee reached the following conclusions:

1.    The Sub-Committee welcomed the progress made to date against the 194 actions in the Improvement Plan for Croydon and requested that a full list of the actions be shared with Members.

2.    The Sub-Committee welcomed the fact that SLaM had moved to a geographical structure, but had a concern that the new approach was management lead and did not present enough opportunities for clinical input.

3.    It was agreed to invite SLaM to a future meeting of the Sub-Committee to present a further update on the progress made with the improvement plan.

4.    It was also agreed that the Croydon Clinical Commission Group would be invited to the same meeting as SLaM to allow for a joint discussion on commissioning and outputs for the borough.