Agenda item

·         CQC Report

·         Quality Account 2018-19

The Chairman invited the following to the table:

·         Dr Chris Streather - Chief Medical Officer and Deputy Chief Executive, Royal Free London NHS Foundation Trust

Dr Streather reported that the final version of the RFH Quality Account was on the Trust’s website with both Barnet and Camden HOSCs’ comments incorporated. He presented his Briefing Paper on the CQC Inspection Report and referred to the HOSC’s comments on their Quality Account.

Dr Streather noted that the Trust has a one-year contract with the Community Care Foundation which is working to help to formally engage patients in its improvement work.

The Chairman noted that it was helpful to see the actions outstanding but that some of the issues raised by the CQC were avoidable as they had already been noted as requiring action. Dr Streather agreed that some of the criticisms were ‘own goals’. The ‘must do’s’ from the recent CQC inspection were all complete – this included mandatory training and medicines management issues. Each of the three Trust’s sites had developed an improvement plan following the report as detailed on his Briefing Paper.

At a meeting with the CQC following the publication of its Report, ‘should do’s’ had also been discussed by the Trust. These were good practice but not compulsory; Trusts not doing the actions had to give reasons for not doing them. Unfortunately, the Trust had failed to provide these explanations in some areas.

The CQC had noted that staff were adequately trained and safeguarding was good.

The Chairman asked about actions and how the public would be notified, for example in an online report? Dr Streather reported that an Action Plan would be circulated to commissioners and this was discussed with the CCG monthly. He would respond following the meeting on what might be the best public forum for sharing the information.

Action: Dr Streather

A Member asked about the Trust’s position on Never Events and equipment maintenance. Dr Streather responded that the CQC had fed back in its Report that the Trust did well in investigating serious incidents and this was an example of ‘very good practice’. The Trust had had two Never Events in the past eight months and had previously gone a whole year without one Never Event, which was good for a large complex site. Previously there had been a cluster of Never Events so this demonstrated that the learning is embedded.

Dr Streather reported that money had been spent on equipment to ensure that patients could not be given air instead of oxygen, as this had previously been raised as a concern. As Chairman of the Medical Equipment Board, Dr Streather had secured a small increase in the budget for medical equipment. In addition, the Trust’s Lead for Clinical Governance, who was in contact with the CQC, had been invited to sit on the Medical Equipment Board. New criteria for prioritising medical equipment had been adopted so that the ‘should do’s’ could be prioritised. A Member asked about testing equipment and whether an Action Plan was in place. Dr Streather did not have details at the meeting but offered to respond afterwards.

Action: Dr Streather

A Member enquired about the impact that high staff turnover has on mandatory training. Dr Streather noted that the pressures were greatest in nursing and this could be difficult. The Trust was looking creatively at recruitment, but he said it did not have problems attracting staff. Due to the competitive market, retention of staff was a problem particularly in the first year of employment, whereas longer term staff tended to be loyal. The Trust had begun some initiatives to welcome staff and to provide some subsidised accommodation. It was working in partnership with the Institute for Health Improvement on improving staff morale and retention.

Dr Streather reported that the Trust had had discussions with the CQC about the behaviour of surgeons in operating theatres at the Royal Free Hospital. The Trust had taken action regarding unacceptable behaviour. The Staff Survey had shown an improvement over the last year, with staff reporting improvements in how they felt they were being treated. A review of the behaviour of surgeons had also formed part of the response to the Never Events and none of the recent Never Events had taken place in operating theatres. The Trust has a comprehensive program of training videos showing scenarios where behaviour might cross a line and the CEO had attended meetings with over 30 staff groups to show the videos and discuss these. It was too early to see their impact on the reporting of bullying and harassment but early indications showed improvements.

A Member asked what the reasons were for the failure of all staff to complete mandatory training and was concerned about the impact on patient care. Dr Streather noted that the CQC report showed that staff were aware of the essential things they needed to know. He suggested the following reasons for non-completion of mandatory training by all staff: the leadership team needed to take training more seriously and communicate this to staff and also staff struggling to meet their targets should not neglect their own training.In the past, there had not been enough access to PCs for online training. This had been corrected. He noted that Chase Farm had performed better than Barnet and the Royal Free in this respect as they had new computers.

Dr Streather reported that there continued to be a growing number of patients attending A&E. The Trust had been receptive and learnt from best practice such as triaging patients. The Hampstead site was slightly ahead of the London average for A&E targets. Barnet Hospital was more difficult with often over 400 patients a day attending A&E whereas it was only designed for 3/5 of this number. It was hoped that some investment could be made ahead of the winter and discussions were ongoing with Barnet CCG. Attempts to get patients not to turn up at A&E when their condition did not warrant urgent treatment had not been successful so far. Sufficient capacity was needed in urgent Primary Care in the medium term.

Dr Streather also commented on the Cancer 62 Day Referral to Treatment Target not being met. He said that a Cancer Clinical Practice Group had been set up which he hoped would improve this.

The Chairman thanked Dr Streather for his open responses and invited him to attend the HOSC meeting on 12 December for an update on progress so far on the Quality Account and on the CQC. Dr Streather agreed to attend.

Action: Dr Streather

RESOLVED that the Committee noted the verbal report.