Agenda item

The recent inspection report is attached for the Select Committee to read. Officers from the CQC and RUH will attend the meeting.

Catherine Campbell, CQC Inspection Manager gave a presentation to the Select Committee regarding this item. A copy of the presentation can be found on their Minute Book and as an online appendix to these minutes, a summary of the presentation is set out below.

CQC Inspection: 15-18 and 29 March 2016

The range of services provided by Royal United Hospital Bath NHS Foundation Trust, including the Royal National Hospital for Rheumatic Diseases and the community maternity services required a diverse inspection team:

• 22 inspectors
• 29 specialist advisors
• plus support staff

11 services were inspected:

• 8 acute services at the Royal United Hospital Bath site
• 2 acute services at the Royal National Hospital for Rheumatic Diseases
• The community maternity service (including midwifery led birthing centres)

CQC’s 5 key questions

Safe? Are people protected from abuse and avoidable harm?

Effective? Does people’s care and treatment achieve good outcomes and promote a good quality of life, and is it evidence-based where possible?

Caring? Do staff involve and treat people with compassion, kindness, dignity and respect?

Responsive?  Are services organised so that they meet people’s needs?

Well-led? Does the leadership, management and governance of the organisation assure the delivery of high-quality patient-centred care, support learning and innovation and promote an open and fair culture?

Overall ratings

The trust was rated as outstanding for caring, which is a notable achievement, reflecting high compassion, support and patient involvement in delivering care.

The effective and well-led domains were rated as good and the safety and responsive domains as requires improvement

There was a wide range in the ratings given to individual services:

•  1 Outstanding

•  6 Good

•  4 Requires Improvement

Inspection Findings

Safety: Requires improvement

Effective: Good

Caring: Outstanding

Responsive: Requires Improvement

Well-led: Good

There were many areas of excellent and innovative practice. Risk reporting and safety were largely well managed and the governance systems ensured ownership at an appropriate level. Care and treatment were effective and evidence based. There was very good multi-disciplinary working and programmes that prevented hospital admission. Training was generally good. Staff were caring and compassionate and true dedication to the patients shone through. Services were flexible and responsive. Clinical and overall leadership was strong throughout and there was effective staff engagement.

Outstanding Practice

•  We saw numerous examples of outstanding practice in the care and compassion shown to patients as well as involvement in their care and treatment, particularly in services for children and young people and in end of life care.

•  The Conversation Project: an initiative to improve communication between staff and patients and relatives about care for the dying patient.

•  We saw some outstanding practice within the outpatients department, in how staff treated and supported patients living with learning difficulties.

•  The Royal National Hospital for Rheumatic Disease was a centre of excellence for lupus care and treatment.

•  The Fibromyalgia service had been developed in response to patient need and was now being set up to become a franchised model to share the programme with other trusts.

Next Steps

•  Our inspection has identified many areas of good and outstanding practice as well as areas for improvement. We will monitor the trust’s plans for improvement.

•  The inspection process has focused attention on topics which impact the wider health and social care system – these were considered further during the Quality Summit held after inspection.

Councillor Paul May commented that the impact of the inspection was positive and confirmed what he had seen in person. He added that he felt very reassured.

Councillor Vic Pritchard, Cabinet Member for Adult Social Care & Health praised the excellent work of the hospital. He said however that he was not comfortable with the rating terms used by the CQC as the hospital had achieved a ‘good’ rating across many areas, but the overall rating was given as ‘requires improvement’.

Catherine Campbell replied that they do have a standard to which they have to assess against. She added that she was not aware of anywhere in the country that provides this level of end of life care.

Dr Ian Orpen commented that the final rating does not tell the whole story and suggested that a further rating of ‘satisfactory’ could be added in between ‘good’ and ‘requires improvement’.

Dr Bruce Laurence said that he agreed with the comments made by Councillor Pritchard and Dr Orpen.

Councillor Eleanor Jackson said that she was impressed with the consistency of approach of the officers involved in the inspection. She stated she was concerned at the lack of a Critical Care Matron for 16 months and asked if some areas of the building were fit for purpose. She said that she had been reassured on the whole by the report, especially with regard to patients with learning difficulties.

Catherine Campbell replied that the estate was not a focus for the inspection, although she was aware that the Trust has a plan for site development.

Councillor Bryan Organ asked for an explanation of lupus care and Fibromyalgia.

Helen Rawlings, CQC replied that Fibromyalgia is a medical condition characterised by chronic widespread pain and a disorder of pain processing due to abnormalities in how pain signals are processed in the central nervous system. She added that lupus is an autoimmune disease in which the body’s immune system mistakenly attacks healthy tissue in many parts of the body.

Helen Blanchard, Director of Nursing and Midwifery, RUH gave a presentation to the Select Committee in response to the inspection report. A copy of the presentation can be found on their Minute Book and as an online appendix to these minutes, a summary of the presentation is set out below.

Summary of ratings

Inspection report highlights many areas of good and outstanding practice:

•  End of life care and the caring domain rated as ‘outstanding’

•  Leadership, governance and safety culture promoting high quality person-centred care

•  Good coordination of care

Of the 53 indicators represented by the core services and CQC domains:

•  3 rated as ‘outstanding’

•  36 rated as ‘good’

•  14 rated as ‘requires improvement’

Areas for improvement

Some areas for improvement identified including:

•  Staffing levels

•  Pressures in urgent and emergency care

•  Patient flow

The main areas for improvement relate to Urgent and Emergency Services, Medical Care and Critical Care.

An improvement plan is being implemented to address the areas of concern identified by the CQC.

In response to the point raised by Councillor Jackson she said that a Critical Care Matron has now been appointed and commenced in post.

Councillor Paul May reiterated his point that the report was positive and that the Select Committee should support the RUH in its actions for improvement.

The Chair thanked Catherine Campbell, Helen Rawlings and Helen Blanchard for attending the meeting on behalf of the Select Committee.