Personal and Health Services Scrutiny Panel
Minutes of the Special Meeting held on 28 February 2012
Councillor Warrington (Chair)
Councillors Ambler, Bowerman, Middleton, Buckley, Cartwright, Shorrock, Bailey
Apologies for absence:
The Chair opened the meeting.
57. Tameside Hospital
The Panel welcomed Ms Christine Green, Chief Executive of Tameside Hospital and Mr Paul Connellan, Chairman of the Board for Tameside Hospital, to the panel meeting. The Panel welcomed Mr Connellan to his first Scrutiny Panel meeting representing the Hospital.
The Chair of the Panel introduced the subject of the meeting focussing on the reports published by the Care Quality Commission (CQC) and Tameside’s Local Involvement Network (LINk) following inspections and visits to Tameside Hospital. The Panel were extremely concerned following publication of these reports. The Panel were also concerned as some of the recommendations the Panel had made in February 2011, surrounding the Hospital, appeared not to have been adhered to.
Mr Connellan advised the Panel that the context of all of the issues could be summed up by a simple quote “whilst there are many good things happening at Tameside Hospital, there are things that need to be changed and other things which need to be improved. External reports such as the CQC’s identify what needs to be done and whilst we have not got there yet I believe that we are moving in the right direction”. Mr Connellan advised the Panel based on his fourteen weeks as Chair of Tameside Hospital that he is confident of the progress and the direction the hospital is travelling in.
LINk and CQC have identified specific areas where improvements have to be made at the Hospital, it is noted that although the same concerns raised by the CQC appear to have been around for quite some time. The Hospital aims to improve and develop by looking carefully at the findings and recommendations of both reports.
The CQC noted their report that in terms of Hospital care provided and the response towards Hospital staff, this has been very positive and Mr Connellan felt the Hospital should recognise this. The report identified two areas “people we spoke to were happy with the care that they were receiving at the Hospital. They told us that they were well looked after and that they didn’t have to wait for staff to help. Comments included, ‘the staff are lovely’, ‘the foods really nice’, ‘my care here has been excellent’, ‘staff are so very kind”. The report also notes “we observed care being delivered at the Hospital. All the nurses and support workers we observed talked to patients in a kind and professional manner. We noted spontaneous interaction occurring between staff and patients. All of the patients we saw were well groomed and their clothing was clean and appropriate”.
Ms Green and Mr Connellan acknowledged that the Hospital does have to address the concerns and the reasons behind the warning issued by the CQC. The warning originated due to concerns previously raised by the CQC not being fully addressed. The CQC found incomplete and erroneous documentation at ward level which was not identified on the Hospital’s own internal audits.
Ms Green and Mr Connellan are aiming to show the regulators positive changes and prove there has been improvement. Ms Green and Mr Connellan stated that they recognise there is a need for a cultural change and the ownership of ‘shop floor’ level issues needs, to be addressed. The CQC has no doubt the Executive Board expressed ownership and accountability, but that this accountability needed to be extended to shop floor level. Ms Green and Mr Connellan want to see greater professional pride and professional approaches to the management of risks.
The Executive Board of Tameside Hospital Foundation Trust are pushing for a culture of challenge within the Hospital where people must act on any concerns rather than turning a blind eye.
Ms Green advised the Panel that daily ward audits had been undertaken where patient’s records were scrutinised by ward managers on a daily basis. By utilising continued monitoring and development, it is planned that this will lead to the elimination of errors on patient records. Ms Green and Mr Connellan agreed that action needs to be taken whenever an error is found which may in some cases involve disciplinary action. Immediately following receipt of the CQC report a process of daily audits was implemented which was then changed to weekly audits following external peer advice.
Ms Green and Mr Connellan advised the Panel that back to basics education is being delivered to every ward leader with a clear understanding of the expected requirements. This is being rolled out to staff with on the job training in situ where a change has to occur. The CQC identified too much back room level responsibility being held with ward leaders and not enough with those colleagues who are hands on. Ms Green advised the Panel paperwork has been simplified to promote the most effective ways of working and achieving the correct assessments. The Board have always been proactive and completed walkabouts around the Hospital looking at issues. The Hospital requirements and standards have changed to reflect that of the requirements set out by the CQC.
The Hospital has been working in partnership with other Hospitals in order to provide support and challenge, as well as providing ideas for improvement. Representatives of South Manchester University Hospital(SMUH) were invited to walk the floor of the Hospital and they sent a team of four people for one day to look through the Hospital. This was conducted unannounced to staff and the Director of Nursing Philip Dylak was the only individual aware of the visit.
The representatives of SMUH provided feedback to Philip Dylak and staff. They recommended reducing the daily audits to weekly audits as there was the threat they could actually become counterproductive. The Strategic Health Authority (SHA) were asked for support and they suggested contacting Liverpool Heart and Chest Hospital who had developed their own audit tool that was proving successful. The audit tool has been adopted as a new method of monitoring and has been helpful in achieving consistency within Tameside Hospital.
Following Ms Green and Mr Connellan’s presentation to the Panel, Ms Green raised the issue of the health wide economy issues which have been having an impact on staffing at the Hospital. The Hospital is faced with the problem of having medically fit patients in Hospital who are unable to be released from Hospitals care. As of Friday 24 February 2012 there were 73 medically fit patients within Tameside Hospital. In the majority of circumstances these patients do not meet the criteria to relocate them or no assessment had been undertaken. Ms Green advised that unlike care homes and other services the Hospital is not able to close their doors to patients.
The Panel were invited by the Chair to ask questions of Ms Green and Mr Connellan.
The Panel asked how confident the Hospital was that the longstanding issues raised would be addressed. Ms Green and Mr Connellan stated that, when they submitted the evidence to the CQC that they had ward level compliance with audits and felt they had addressed the issues at hand. The CQC advised the Hospital they were not looking for perfect audits to be completed but evidence of actions being taken to address the issues the audits had identified. Sometimes an entry that was made on a patient’s records was not good enough or there was limited thought behind the entry.
Ms Green and Mr Connellan acknowledged that there are many changes that need to be made but the actions the Hospital have taken so far are important steps to change the culture of the Hospital, and there needs to be recognition that the Hospital has responded to try and improve.
The Panel asked how the Hospital will maintain robust monitoring processes. Ms Green advised the Panel the Hospital had acted in good faith previously and the working process is being challenged and changed, although the majority were doing good work it was a small minority that were causing issues. There had been good overall performance for the Hospital which regrettably served to mask underlying issues.
The Panel asked whether the change from daily to weekly audits, has had an impact on outcome 16 (assessing and monitoring the quality of service provision), which the Hospital received a warning for. The report identified issues with nutrition and falls, and the monitoring of these falls. The Hospital was concerned that the CQC looked at only a handful of patient’s records and found so many errors that had not previously been identified by the Hospital’s own auditing methods.
The Panel sought guarantees that the minority of staff who are not conforming to the required procedures are monitored and dealt with appropriately. Ms Green advised the Panel that the Hospital’s objective is to raise overall standards and ensure a good service is provided. The message has gone out to all members of staff at all levels and all departments. The amount of scrutiny taking place in the Hospital at present is unprecedented.
Ms Green advised that the CQC had not imposed any sanctions on the Hospital. Ms Green advised the Panel the CQC recognise there are no systematic failings and the majority of staff are very aware of risks and health and safety regarding incidents.
Ms Green raised the issue of disciplinary action being taken against staff as identified within the Hospital’s action plan. During the CQC visit a nurse was witnessed leaving a drugs trolley unlocked. Ms Green advised the Panel this was a fundamental clinical error, as well as being in the Hospital code of conduct, disciplinary action was therefore required in that circumstance.
The Panel asked whether the changes had resulted in additional workloads and what pressure this was putting on staff and whether they were able to cope. Ms Green advised the Panel that the changes taking place, and the addressing of the concerns is not an additional workload but work that should have been undertaken previously.
The Panel asked to what degree the finances and resources have been restricted and whether future discussion with the local authority would be beneficial. Ms Green and Mr Connellan feel there is no immediate shortage of resources but the constant methods of resourcing at the Trust make long term sustainable planning extremely difficult.
Ms Green advised the Panel that senior professionals from the Hospital, PCT and Local Authority are due to have a meeting regarding how the Hospital develops models of care that are sustainable for longer periods and for future development.
The Panel thanked the Chief Executive and Chairman of the Board from the Hospital for attending the panel meeting and advised they would be monitoring the situation closely.
The information provided by the Hospital to the CQC and LINk reports is noted
That increased accountability is necessary at the Hospital amongst all staff at all levels and a change in culture is necessary
The PCT and Hospital need to look at freeing up more beds and a systematic approach made to discharge patients who are medically fit.
58. Local Government Act 2000- Urgent Items
The Chair reported that there were no urgent items for consideration at this meeting.