Agenda item

In February 2013, the Care Quality Commission (CQC) made an unannounced inspection of the Royal United Hospital (RUH).  James Scott Chief Executive, RUH, attended the Committee in July 2013 to present the RUH’s Action Plan in response to the February inspection report.

The CQC returned to the RUH in June 2013 to undertake a follow-up inspection and produced their report in October 2013 (copy attached).  James Scott will be in attendance to present the Action Plan in response to the June inspection and answer members’ questions.

James Scott, Chief Executive of Royal United Hospital (RUH), Bath, was in attendance to present the RUH action plan in response to the Care Quality Commission (CQC) Audit that highlighted a number of concerning findings. James Scott introduced Helen Blanchard, Director of Nursing at RUH who was also in attendance to answer questions from the committee.

James Scott outlined the upcoming inspection of the RUH on 4 December, which will be conducted under the new inspection regime. He went on to detail the new inspection arrangements including the membership of the inspectorate and their new powers. Following this, James Scott discussed public listening events that were being conducted to engage with users and members of the public as part of the inspection process. Events will be held on 5 December 2013 at Bath Race Course and County Hall in Trowbridge. Both events will start at 6.30pm.

Helen Blanchard discussed the action plan and reaffirmed that the RUH was concentrating on taking ownership of the issues and findings, with a focus on making the necessary sustainable changes. The importance of accurate record keeping was discussed with a focus on both professional, CQC and regulatory compliance. The recording of patient risk assessments on admission were also discussed, alongside discharge information. Helen Blanchard commented that, measures had been taken to improve both areas, and was confident that this would be reflected in the outcomes of future inspections. Patient dignity was also discussed, with changes made to staff training, practice and awareness. The monitoring arrangements were discussed, and it was confirmed that the Trust Quality Board continues to monitor the progress of the action plan on a fortnightly basis.

Cllr John Noeken expressed disappointment with the CQC findings, stating historic findings from previous reports and inspections had again been replicated in the most recent report. Cllr Noeken expressed concern over the action plan and the findings from the CQC, and stated that the effectiveness of the actions, findings and recommendations would be tested in full over the winter period.

Cllr Helena McKeown stated concern at the findings in the report and stated that the RUH appeared to be overloaded with policy and internal meetings. Cllr McKeown questioned the hospitals recruitment policy, and in particular the number of nurses appointed by the RUH. A number of examples of patient treatment were cited and the role of record keeping in these examples was questioned. James Scott stated that £750k had been spent on frontline nursing staff, and that the nursing ratios were adequate to manage the patient flow at the RUH. James Scott noted the changes that had been made at operational level to support the handover between shifts.

The role of agency staff was discussed and it was confirmed that agency staff are not used on night shifts. Cllr Gordon King expressed concern from personal experience at the hospital’s operational level, where it was stated that there was a lack of senior vision across the wards. Cllr King also stressed concern at the number of junior nursing staff functioning without senior supervision and support. Helen Blanchard confirmed that nurse sisters were available to provide an overview across wards, and that the nursing ratios were sufficient.

Cllr Mary Douglas expressed concern at adequacy of Nursing levels at the RUH. Cllr Douglas also questioned the national guidance for nursing levels, and suggested that the recommended staffing levels were not capable of providing the correct level of care.

Brian Warwick stated his concern at the report findings and stressed concern that the content and findings of the report seemed to have been diluted. The Committee noted concern at the CQC report in general, noting particular concern at the categorisation and continued replication of findings.

James Scott then outlined the internal monitoring arrangements to scrutinise the action plan and frontline performance. This included the clinical governance group reporting to the Board on key performance indicators including patient experience, safety and clinical outcomes (including mortality rates). It was confirmed that mortality rates at RUH were 25% lower than the national average, with this figure falling to 50% below the national average for elective surgery. Helen Blanchard also discussed the role of dignity champions and public engagement.

James Scott then proposed a meeting between the senior staff at RUH and the members of the Health Select Committee to address some of the concerns that had been raised.

Resolved:

1)    To note grave disappointment and concern at the findings of the CQC report.

2)    To meet with the Chief Executive, and senior staff at the RUH to address the concerns with the findings of the CQC report.

3)    To arrange a meeting between the Chair, Vice Chair (HSC) and Chief Executive (RUH) shortly after the publication of the report into the CQC Inspection, scheduled for December 2013.

4)    To note concern at the current staffing levels at RUH, and the need for accurate record keeping in supporting operational staff at RUH.