Agenda item
Central and North West London NHS Foundation Trust - Care Quality Commission report and action plan
The Care Quality Commission (CQC) has published a report on the quality of services provided by Central North West London NHS Foundation Trust and an action plan has been developed by the Trust to respond to the findings of the inspection.
Minutes:
The committee had before it the report published by the Care Quality Commission (CQC) on the quality of services provided by Central North West London NHS Foundation Trust (CNWL) and the action plan developed to respond to the findings of the inspection.
The committee welcomed to the meeting Natalie Fox (Borough Director for Brent, CNWL Trust), Robyn Doran (Chief Operating Officer, CNWL Trust), Dorothy Griffiths (Chair CNWL Trust), Dr Aunpam Kishore (Clinical Director) and Sarah Mansuralli (Chief Operating Officer, Brent CCG).
Dorothy Griffiths stated that the Trust welcomed the report and recognised the findings of the inspection. On behalf of the Trust, she was proud to point out that it had been graded as outstanding for caring and other areas had been rated as good. However, she recognised that the concern of the committee was over the acute services for adults and core mental health services which had been rated as requiring improvement for which she apologised on behalf of the Trust.
With the aid of a presentation, Natalie Fox informed the committee of the work already undertaken or planned to be done in order to bring standards into line with the recommendations from the inspection. She outlined the ‘must do’ actions which comprised addressing blind spots on the wards at Park Royal, making sure there were adequate numbers of staff and that they were suitably trained, improving monitoring and record keeping, better bed management, reducing the time patients were moved around, providing private telephone facilities for patients, reducing the risk of AWOLS and ensuring adequate contingency plans. Natalie Fox explained to the committee the actions that had already been taken to address some of the required actions and the plans for ensuring all of them were implemented within an agreed timescale.
In answer to questions from the committee, it was explained that the effect of the financial cuts had not been disproportionately applied to mental health services but they did have an effect on the ability to deliver the service. The Trust was required to achieve a higher level of efficiency and the CCG and Social Care services were working to ensure redesigned pathways did not disadvantage any groups. Sarah Mansuralli stated that the Trust was taking a more transformational approach to delivering mental health services. It was stated that few other Trusts had received outstanding for caring and the majority of them had received a similar level of ‘must do’ actions.
Questions were asked about the level of absconding and it was reported that during 2013/14 there had been 40 recorded incidents but this had dropped to 26 in 2014/15 and 6 during the first quarter of 2015/16. However there were different classifications for recording patients who had absented themselves and the request was made for figures for all forms of recorded absences since May 2015. This would include the number returned by the police, which it was reported had significantly reduced. Questions were asked about the numbers of restraining incidents, how many took place at Park Royal which was of particular concern and how many were recorded as being supine restraint. Reference was also made to the use of rapid tranquilisation restraint. The request was made for figures covering June to date to be supplied on the number of restraining incidents, those involving rapid tranquilisation restraint and where they took place.
It was reported that the staff vacancy rate at the time of the inspection stood at 21%. This level remained despite many staff having been recruited because many had also moved on to pursue other opportunities. It was agreed that a better staff retention rate was needed. Vacancies for care co-ordinators were currently running at a high level because of the impending transformation of the service. There were also other vacancies in the health and social care services.
Natalie Fox explained the work with carers that took place to get feedback from them and provide the support needed and she accepted that this was another area where more still needed to be done.
In answer to a question, Robyn Doran undertook supply figures on the length of time between being referred for an appointment and getting the appointment.
It was explained to the committee that monthly meetings with the CQC took place to review implementation of the 'must do' actions and it was expected that this work would be completed by the end of December 2015.
The Chair thanked the Trust officers for facilitating a visit he and Councillor Farah had made to see the work of the Trust which had been very informative and he hoped similar visits could be arranged in the future. The committee thanked all the staff of the Trust for their hard work often in difficult circumstances. Representatives of the Trust were thanked for their attendance. It was agreed that the committee would receive a progress report in six months on implementation of the action plan and compliance with the CQC recommendations. It was also agreed that a report would be submitted in three months on the proposed redesign of mental health services in the context of having to make 20% financial savings.
The committee had requested the following information:
· the number of unauthorised absences occurring since May 2015 broken down by all types
· the number and type of restraining incidents during the previous three months
· How long patients had to wait from being referred to getting an appointment.
Supporting documents: