Agenda item

This item includes the compliance plan produced by North West London Hospitals Trust in response to the Care Quality Commission’s recent inspection of the Trust. The Trust, with covers Northwick Park hospital, was the subject of a Care Quality Commission inspection in May 2014 and was found ‘to require improvement.’

Chris Pocklington (Deputy Chief Executive, North West London Hospitals Trust) presented the report which set out the action plan that had been produced as a result of the Care Quality Commission’s (CQC) inspection in May 2014.  Members heard that a Quality Summit at Northwick Park Hospital (NPH) had taken place in August 2014 between the Trust and partner organisations and had been chaired by the CQC in order to identify what suitable measures should be included in the action plan.  The action plan had been presented to the Trust’s Board the previous week and had been approved.  Against each recommendation made by the CQC, details of the action to address this were included and with a deadline for completion.  Chris Pockington advised that progress on the action plan would be regularly reported to the Board and it was anticipated that there would be a follow up inspection from the CQC to see what action had been taken to address the issues raised in the first inspection. 

During discussion by members, it was queried whether a more detailed report on the action plan would be produced in future.  A member expressed concern about risks to the health of local residents and asked whether there had been a reduction in the number of nurses at NPH when the inspection had taken place in May.  She sought confirmation as to whether there had been a freeze in staffing numbers at the Accident and Emergency Unit (A&E) at NPH and if so for what length of time.  The current number of nurses and GPs in A&E at NHP and the vacancy rate was requested.  The member referred to a £3 million reduction in staff budgeting for doctors in nurses and the impact in terms of safety this would have in respect of the CQC inspection report.  The member sought clarification that there were in fact ten less beds overall within the North West London Hospitals Trust (NWLHT) than there were a month ago.  She also referred to the duty of candour the Trust was required to provide to the committee in respect of members being told that the modelling for patient numbers for NPH after the A&E closure at CMH was apparently inaccurate and she emphasised the need for the committee to receive accurate information. 

A member referred to the action plan and asked what steps were being explored in helping to retain existing staff and had the reasons for staff leaving been identified.  He also enquired whether retention of staff was a performance indicator for NPH.  Another member remarked that waiting times at NPH had risen to crisis levels since the closure of the A&E at CMH and asked what measures were planned to address this, particularly as winter would shortly arrive.  A member asked for further information on plans in respect of major emergencies and emphasised the importance of ensuring key roads were open as is this had been an issue, for example, during the 7 July 2005 London bombing incidents. He also asked whether the planned additional beds at NPH had happened and if so how many. The committee sort views with regard to the progress made since the CQC inspection and how confident was the Trust that the action plan would achieve the objectives and within the timescales set. 

With the approval of the Chair, Councillor Hector addressed the committee.  Councillor Hector stated that she had been provided with conflicting information on the number of beds at NPH and she asked that the number be clarified.

In reply to the issues raised, Chris Pockington informed members that a more detailed report on the action plan would be reported to the Trust’s Board in October and this could also be provided to the committee.  He stated that he would seek information on numbers of staff at NPH, including it’s A&E, since the closure of the A&E at CMH, however he confirmed that the number of nurse vacancies at NPH had reduced significantly.  He was unaware of any decision to freeze the number of staff at NPH A&E and of a £3 million reduction in budget for doctors and nurses and there had been ongoing recruitment at the NPH, including its A&E, since the CMH A&E closure.  Members heard that the Board’s Trust regularly reviewed the rate of staff turnover and a high rate was one of the challenges the NPH faced and it indicated that not all was as it should be.  Chris Pockington stated that increasing the number of established staff would make it more attractive for them to remain and there had also been a recent successful recruitment drive for appointing full time medical consultants.  He confirmed that staff turnover was a performance indicator and the Board was provided information on this as part of the employment data that they regularly received. 

Chris Pockington advised that the Board was fully aware of issues regarding patient waiting times at NPH.  He informed members that this was attributable to a number of reasons, including the fact that there were more ambulances visiting NPH since the A&E closure at CMH than the modelling exercise had anticipated.  NPH was also not able to discharge patients as quickly as would be desirable and there were also less staff available for diagnosis at weekends, although the Trust would be taking steps to address this.  NHP faced additional pressures in the growing number of older people in the population and patients who required greater attention.  However, steps were being taken to address these issues and changes to the system in respect of ambulance arrivals had produced noticeable improvements in the last four days, with less arrivals and a reduction in the number of delayed transfers.  Senior staff were involved in daily conference calls to discuss solutions to the problems identified and a concerted effort was being made by all staff to put together actions to address the issues identified.  Chris Pockington added that NPH did not currently have sufficient beds to deal with the volume of patients it was receiving and a business case was being put together for increasing capacity in acute wards by autumn 2015.  Once this could be achieved, NPH would be able to operate at a lower level of occupation and would be better equipped to provide services.  Chris Pockington confirmed that 20 new beds had opened at NPH on 10 September and there were now a total of 760 beds occupied at 94% rate, whilst beds in the A&E department were close to 100% occupancy.  Patient capacity outside of hospitals was similarly important and would help facilitate a more effective and efficient system of healthcare.  Chris Pockington stated that he could not clarify whether there were less beds overall within the Trust than had been the month before, however patients at CMH tended to stay longer than others within the Trust and the hospital had seen a net increase of 20 beds.  He advised that the issue of bed capacity was complex and could not be based purely on numbers, however he indicated that he could present the modelling in respect of bed provision to members.  He added that whilst he would be happy to provide a greater level of detail to members on particular issues at future meetings providing he was sent substantive queries in advance of the meeting. 

Professor Ursula Gallagher (Brent Clinical Commissioning Group) confirmed that all but two of the nurses who had worked at CMH A&E were now at NPH, with the other two remaining at CMH and there had been little external recruitment to protect existing staff who had worked at CMH A&E.  She explained that the purpose of expanding the healthcare hubs was to ensure appropriate community provision and overall there were more beds now than there were within the Trust the previous year.  Professor Ursula Gallagher emphasised the need for rigorous decision-making to ensure patients were dealt with promptly.  In respect of major emergencies, she advised that the CCG’s System Resilience Group were responsible for creating a system resilience plan.  All hospitals trusts in London were working hard to ensure there was appropriate flexibility and capacity in major emergencies.  In addition, NHS England coordinates plans for wide scale emergencies and undertook ‘dry runs’ using various scenarios and a multi-agency approach was taken to manage such situations. 

Dr Ethie Kong (Chair, Brent CCG) added that organisations working in isolation was not the answer to responding to major emergencies and this is why the System Resilience Group involved both acute, primary and community healthcare providers and London ambulances.  She was also confident that targets in the action plan would be achieved in the timescales set. 

Councillor Daly emphasised that all Brent CCG papers for Scrutiny Committee members should be publically available and she requested that a representative from the Care Quality Commission be in attendance the next time this item was discussed.

The Chair requested that a report be presented to the committee in about two months’ time updating them on progress with the action plan, including whether the measures listed were on target to be achieved within deadlines set.  In addition, any members who had questions requiring specific details were to submit these to Cathy Tyson (Head of Policy and Scrutiny, Assistant Chief Executive Service) who coordinate responses from NWLHT.