Agenda item

Members may have seen reports in the local media and be aware that the Care Quality Commission (CQC) made an unannounced inspection at the Royal United Hospital (RUH) in February 2013.

The CQC looked at two different parts of the hospital, the older people's wards and the day surgery unit.  It found that the RUH was not meeting the required standard in the following four categories:

·         Respecting and involving people who use services

·         Care and welfare of people who use services

·         Cooperating with other providers

·         Records.

The CQC has provided the following comment.

‘Following inspection at the RUH Bath in early February the Trust sent an action plan to CQC outlining how the trust intends to achieve compliance with the areas of concern identified in our inspection report .  CQC have accepted the action plan and will return to the hospital to check compliance again when the dates in the action plan have passed.  The inspection will be unannounced so we are unable to confirm when the inspection will occur.

‘The inspection in February was a responsive inspection following local information raised with CQC raising concerns about the manner in which patients had been discharged during a period of 'black alert' in January.  Upon arrival at the hospital the scope of the inspection was extended to review the care of patients accommodated in 'escalation' areas at the hospital.  Shortly after the inspection we were informed that the Trust had stopped using the day surgery unit (DSU) as an escalation area.  Due to continued high levels of urgent admissions the trust was unable to maintain that position.  We have been in touch with the trust since the inspection and been informed of the immediate actions taken by the trust to ensure care quality and safety had been improved for patients accommodated in the DSU. ’

Both the CQC inspection report and the RUH action plan in response to the report are attached.  Members are asked to note these reports.  The Committee will be kept informed of developments and a further update provided following the CQC follow-up inspection.

Jocelyn Foster, Commercial Director, RUH was in attendance to answer questions from the Committee.

The Committee discussed the Care Quality Commission (CQC) report and agreed that the report findings were distressing.  Disappointment was expressed that the CQC was not present at the meeting.  The Committee asked Ms Foster to summarise the headlines of the report and the actions against them.

Ms Foster did so and also clarified the instances of ‘black escalation’ at the Hospital.  She explained that this occurred when there were no spare beds in the hospital, all areas were in use and ambulances were not able to ‘off-load’ the patients they carried. She confirmed that there were currently no empty wards that could be used during a black escalation period. 

The Committee addressed some of the grading awarded to the RUH and stated it believed some of the categories to have been far too generous considering the seriousness of some of the findings. The Committee asked Ms Foster how the RUH planned to improve performance and how this would be followed up by the CQC in future.

Ms Foster explained that a future follow up inspection would be unannounced to test the integrity of any completed actions. The RUH was currently in the process of implementing changes to processes and systems as a result of the CQC inspection.

The Committee stated that it would have like to have challenged the CQC on its report findings, as there was a belief that it echoed the findings of a similar report in 2010.

The Committee then scrutinised the supplementation of ward staff and the role of agency nurses.  The Committee were concerned over staff resources in nursing.

Ms Foster commented that one of the problems with escalations was matching ward staff to reflect patient needs across the hospital. The report had highlighted problems in this area.

A councillor stated that one of the key Safeguarding issues from the report was around co-operating with partners, and asked what was being done to improve performance in this area.

Ms Foster stated that the RUH believed this to be an area of concern, and had been working with other providers to identify how this could be enhanced.

The committee also expressed concern around the use of agency nurses and their potential contribution to the findings in the report.

Ms Foster stated that RUH operated with a full complement of nursing staff, but would return with the figures to address any concerns the Committee had.

The Committee also requested that the Chief Executive of the RUH be asked to attend the next meeting to address some of the points raised by the Committee.

Deborah Fielding, Accountable Officer, CCG  stated that the CCG would be working with the RUH and the Bath and North East Somerset CCG at Board level to address the areas of concern in the report.

The Committee wanted it noted that, whilst it had concerns, it remained supportive of the RUH. 

The Committee requested the following data from the RUH for their next meeting:

• Trend data, over a meaningful period of time on nursing resources.

In addition, the committee raised a number of issues to which they required a response. This included:

·       To what extent the RUH considered agency nurses contributed to the problems identified by the CQC in February;

·       the issues identified in the report that were similar to those issues identified in a report in 2010.

·       Why the RUH was not reaching the required standard for ‘cooperating with partners’, as the Committee was very concerned about this, particularly from a safeguarding perspective.

Resolved

That the Chief Executive of the RUH be asked to attend the next meeting of the Committee;

That the information requested above be provided by RUH for presentation at the next meeting of the Committee.