Bradford District Care NHS Foundation Trust will submit Document “AF” which provides an action plan to address the areas for improvement in response to the Care Quality Commission’s inspection report undertaken in October and November 2017

Recommended –

That the findings of the recent Care Quality Commission inspection and the actions that are being taken by Bradford District Care NHS Foundation Trust to correct all areas of concern, in a timely and sustainable manner, be noted.

(Dr Andy McElligott – 01274 228293)

The Medical Director, Bradford District Care NHS Foundation Trust presented Document “AF” which outlined the outcome and response following the Care Quality Commission (CQC) inspection.  He informed Members that the Trust was disappointed with the outcome, as it had been rated as ‘good’ for a number of years and it had prevalent leadership, values and ethos.  A Regulation had been broken, therefore, the Trust had been rated as ‘requires improvement’.  This was due to some policies and procedures not being followed, however, they could be rectified in a short time period.  The Medical Director explained that a 51 point Action Plan had been developed in response to the CQC report and this was evolving on a daily basis.  A number of actions had already been completed and were to be signed off by the Trust Board, others would be resolved over the next few months.  Members noted that the Trust hoped that all actions would be finalised prior to the CQC revisit.  It was aspiring to be an outstanding organisation and viewed the inspection outcome as an opportunity to put things right.

Members raised the following concerns:

·         What was the Trust doing to improve staff understanding of the Duty of Candour and other policies?  Was language an issue?

·         What was the Trust doing to improve basic life support?

·         What was the reason for the repeated Disclosure and Barring Service (DBS) check?

·         Only three incidents of restraint had been logged but they had not been properly recorded.  Had only three occurred?

·         How much notice was given prior to the inspection taking place?

·         How would the Trust fair if a surprise inspection was undertaken tomorrow?

·         Could bank staff access training?

·         The Trust had been shocked by the rating, but had it been aware that its staff were lacking in training?

·         The Trust was exceptional and there was a great deal of disappointment from all areas at the rating.  The management and staff had not lived up to expectations, but an apology had not been made.

·         The lack of oversight was a leadership issue, which should have been dealt with by the Board and senior managers of the organisation.  Had the lack of oversight been apparent or just not addressed?

·         Why was training a weakness? What were the demands on the staff, as absences were high? 

·         Not all serious incidents had been investigated effectively and within timescales.

·         How was staff training monitored?

It was explained to Members that:

·         There were training issues around Duty of Candour and other policies.  The Trust had a high reporting rate.  Staff needed to be helped to understand the language and a Communications Programme would be established.  The majority of staff were trained in relation to the Mental Capacity Act, however, the Trust was unable to show records of the numbers trained.  A robust process was in place to ensure staff were trained.

·         More training had been facilitated regarding basic life support, which was monitored and the compliance had improved.

·         The Trust’s policy required everyone to be DBS checked every three years and some had been out of date.

·         The number of incidents of restraint could not be clarified due to recording issues.  The electronic record was not helpful to staff and the Trust was due to change to a user friendly system in the summer which would be beneficial to staff.  Many of the recording issues would be resolved by the introduction of the new system.

·         A formal inspection of a ward would be given 30 minutes warning and community services were given a few days notice.  The Trust had been given fair warning of the inspection and it had a good relationship with the CQC.

·         A number of issues had been completed immediately, some required improvements and others were ongoing.

·         Bank staff could access records, however, the issue had been in respect of obtaining log on details for them and this had now been resolved.

·         The rating had been a shock and the Trust should have been aware of the issues, however, the matters raised would be resolved.

·         The Trust apologised for the areas where it had failed and the Board had accepted that it was their responsibility and not that of staff or managers. 

·         There had been some oversight, however, some areas had been a shock to the Trust.

·         Failings were rarely due to one cause.  Frontline staff faced many pressures and they would always choose to look after a service user above the completion of online mandatory training.  It was not always easy to access training and management’s awareness of staff training had been highlighted.  Awareness needed to be spread through the organisation.

·         The recording of a small number of serious incidents had not been completed within the timescales, which had been due to their complexity.  All of the serious incidents had been scrutinised by the CQC and received positive feedback, so the outcome in this area had been a surprise.

·         Training was electronic and could be monitored monthly, so the Trust knew exactly which members of staff had not undertaken the training.  All appraisals and training was undertaken via IT and staff training information was circulated monthly.

Resolved –

That an update report on the Trust’s Action Plan be submitted in six months.

ACTION: Medical Director, Bradford District Care NHS Foundation Trust