The Care Quality Commission (CQC) carried out inspections of Bradford Teaching Hospitals NHS Foundation Trust (the Trust) in January and February this year.  The Trust was rated ‘Requires Improvement’.

The City Solicitor will submit Document “W” which presents the CQC Inspection Report (Appendix 1) and the report of the Director of Governance and Corporate Affairs at the Trust on the compliance actions required by the CQC and the Trust’s action plan (Appendix 2).

Recommended –

That Members receive the information provided in Appendix 1 and Appendix 2 of Document “W” and consider any comments and recommendations they wish to make.

(Caroline Coombes – 01274 432313)

The Care Quality Commission (CQC) carried out inspections of Bradford Teaching Hospitals NHS Foundation Trust (the Trust) in January and February 2018.  The Trust was rated ‘Requires Improvement’.

The City Solicitor submitted Document “W” which presented the CQC Inspection Report (Appendix 1) and the report of the Director of Governance and Corporate Affairs at the Trust on the compliance actions required by the CQC and the Trust’s action plan (Appendix 2).

The Director of Governance and Corporate Affairs expressed her disappointment at the outcome of the inspection and stated that not all of the Trust’s core services were inspected.  She informed Members that the Trust anticipated another inspection by the end of May 2019 plus one unannounced inspection.

She outlined the actions the Trust must take to improve, as stated in the inspection report (Appendix 1) following inspection of the following core services: maternity, urgent and emergency care, medicine and care of older people and surgery.  She assured Members that good progress had been made with the Compliance Action Plan (Appendix 2) and reported that:

Mandatory training – was now at a 97% compliance rate whereas previously it was below 84%.  Compliance with high priority training was at 83% and 88% for induction refresher training.  The annual staff appraisal rate was at 86.7% and the Trust would be moving to an ‘appraisal season’ so that staff appraisals were anticipated at the same time every year and not left until the end of the year when service pressures were at their highest.

Policies and guidelines – the inspection had found that there were a number of corporate and local policies that were past their date for review.  The Trust had 1,197 local guidance documents and the inspection had found that 93.7% of them were in date.  The target compliance rate had been set to 100% so that all areas were held to account.  All polices and guidelines in maternity services were now fully up to date.  HR policies tended to take longer to update but the Trust was confident that they would be up to date by December 2018. 

Equipment safety checks – a standard checklist had been created for resuscitaires which would be audited regularly and there were now areas demonstrating 100% compliance.

She stated that all actions were expected to be put in place by the end of December 2018 and the Trust was also focusing on cultural changes within its organisation.

The Chair queried why the Trust did not carry out follow-up work on areas it was rated ‘Good’, to aim for ‘Outstanding’.  In response, the Director of Governance and Corporate Affairs stated that the improvement work was carried out on identified risk areas.  She also stated that one of the areas the Trust was proud to have been rated ‘good’ was for being well-led.

A Member referred to the part of the inspection report which stated that “the respiratory service did not have access to a specialist respiratory consultant at the weekend or during bank holidays. However cover had been risk assessed and was provided by a medical rota.”  She asked what actions had been taken to overcome this issue.  In response it was reported that specialist respiratory consultants were on call on weekends and bank holidays and that a robust risk assessment had been undertaken which had found that the measures in place adequately mitigated against the risks.  She also stated that there were specialist nurses on that ward and that discussions had taken place with the CQC Inspectors since the report was published to explain how this issue was managed; therefore there were no plans to have specialist respiratory consultants on site at weekends or during bank holidays.

A Member questioned how the Trust was ensuring improvements would be sustained for the long-term, how it compared with other Trusts with a similar population and whether there was a sense of complacency.  In response, the Director of Governance and Corporate Affairs stated that, the Trust was by no means complacent and was proactively undertaking mock inspections and engaging with patients and staff and holding focus groups;  the inspection outcome had been a disappointment for the Trust but Members were assured that the Trust was doing all it could to put improvements in place.  Whilst the Trust was benchmarked with its peers, Bradford had a unique set of circumstances but its population could not be used as an excuse for the inspection outcome; and good governance was considered a pre-cursor to delivering good services.  The Trust had done a lot of work around embedding good governance and leadership and it was determined to move to a ‘Good’ CQC rating.

A Member stated that she was pleased to hear about the increase in training rates but had concerns about the amount of issues identified for improvement in the maternity ward, particularly as some of the issues were basic checks such as recording medicine fridge temperature checks.  In response, it was explained that there had been previous concerns and an action plan had been developed which the Chief Executive had led on.  The Royal College of Midwives had undertaken a review in 2017 and, since then, there had been a marked improvement with regard to safety and leadership in maternity services.  Assurances were provided that work was on-going to make further improvements in maternity services as it was crucial to get the basics right.  It was considered that part of actively trying to make these improvements required a culture change.

In response to questions from Members, the following responses were provided:

·         The Trust had increased the number of its own staff in its staffing ‘bank’ to cover sickness and unplanned absences.

·         The patient experience strategy had been launched around the spirit of kindness as that was what patients valued.

·         Changes had been made to the way some training was delivered in order to make it more accessible e.g. increased use of e-learning packages.

·         Mock inspections were carried out by approximately 30 different people including the Trust’s Governors and Healthwatch Bradford and District.

·         The Trust had recruited an obstetric theatre team to address the staff shortage identified in the inspection report and the maternity team was now fully staffed. 

In response to a Member’s question, the Director of Governance and Corporate Affairs stated there was work to do on the Accessible Information Standard which the Trust rapidly needed to take action on and a review was due to take place on the Trust’s Patient Accessible Information Group to ensure it was fit for purpose.  It was suggested that Sue Crowe, non-voting co-opted member on the Committee (representing the Strategic Disability Partnership) could assist with this. 

A discussion took place about the Trust’s mental health strategy and Members were informed that it was linked to ‘Treat as One’, a report from the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) which outlined the findings of a recent review undertaken of the mental health care provided to patients who received treatment for physical health problems in hospitals.

A discussion took place about the Committee’s next steps.  It was noted that the Trust was expecting to be inspected again in early 2019.  It was agreed that following publication of the subsequent inspection report, the Committee would decide any further action it wished to take.

Resolved –

That the progress made by Bradford Teaching Hospitals NHS Foundation Trust following the Care Quality Commission inspection report be noted.

NO ACTION