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Agenda item

Great Western Hospital (GWH): Inspection Report

The CQC completed an unannounced inspection at GWH at the end of October 2013, the findings of which were published in December 2013. A copy of this report will be made available to view online.

 

The action plan compiled by the hospital in response to the inspection report is attached with a letter from the Chief Executive to the Committee.  Nerissa Vaughan, Chief Executive of GWH will be in attendance to discuss the outcomes of the recent CQC inspection, and to present the accompanying action plan.

Minutes:

Hilary Walker, Chief Nurse, and Kevin McNamara, Director of Strategy at Great Western Hospital (GWH) were in attendance to discuss the outcome of the CQC inspection and to outline the Hospital’s action plan.

 

Hilary Walker outlined the key areas of concern highlighted by the report and presented the action plan to address the concerns indentified. This included cleanliness issues, staffing concerns, governance and monitoring problems and concerns surrounding patient record keeping practices.

 

Ms Walker identified changes made by the Hospital to target the findings of the CQC report and highlighted the appointment of new nursing staff and practice development nurses to support the development of the existing nursing teams.

 

The Committee questioned the dispute between GMB members and Carillion, and wanted to know if the dispute had directly impacted the findings in the report. Earlier in the dispute there had been reported strike action but there had not been strike action this year, although a number of ongoing tribunals were said to be having an impact on operations within GWH.

 

The Committee discussed the current nursing arrangements and queried the ratio of nurses to patients at GWH. Hilary Walker stated that GWH recognised that staffing levels were not where they should be to support 1:7 nursing care, but that £1.2m investment in extra staffing was going some way to address this issue. An effort had been made to recruit additional staff but there were still gaps and more work was needed to be able to reduce reliance on agency staff.

 

The Committee questioned the medicinal practices at GWH and asked if this had been a result of governance failings or a cultural problem within GWH. It was confirmed that governance processes were in place to monitor such practices and welcomed the suggestion that other areas of governance might be audited.

 

The Committee expressed concern at the findings of the CQC report and suggested that findings were a ‘wake up call’ to the leadership team. The Committee also noted that the findings identified were made under the old inspection regime, and stated that a better picture of the Hospital might be achieved following an inspection under the new regime.

 

The Committee discussed the appointment of overseas nurses and queried if this had an impact on some of the concerns raised in the CQC report. The Committee also questioned the role of agency nurses in the findings. It was confirmed that GWH worked with TTM Healthcare when recruiting overseas nurses. One of the requirements of the recruitment programme was an adequate understanding of the English language. However some difficulties were to be expected such as dealing with patients with strong accents or over the telephone. GWH stated that these concerns were minor issues and would not have negatively impacted the CQC findings.

 

The Committee discussed the use of whiteboards on wards to document patient activity. It was confirmed that GWH had applied for funding to support a digital whiteboard installation that would provide greater security to patient information due to its screen saver function.

 

The Committee expressed concerns over medication and the operational hours of the Pharmacy. GWH confirmed that the national review on hospital operational hours was starting to lean towards 7 day openings and that GWH was reviewing how this could be implemented in future.

 

The Chair then allowed Cllr John Hubbard to address the Committee. Cllr Hubbard expressed concern at the governance practices within the Hospital, and highlighted the link between culture and governance failings. It was confirmed that the failings identified in the administration of medicine was linked to a policy lapse. A policy audit was suggested and would be considered by GWH.

 

The Committee raised concern over possible communication issues due to language between housekeeping staff and patients, and suggested this could be a potential cause for concern. GWH stated that a response to this question would be provided in writing as the data for this was not readily available.

 

Resolved:

To note the GWH action plan for the CQC inspection, and to document concern at the findings of the report.

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