Agenda item

Report of the Vice Chairman of the Joint City and County Health Scrutiny Committee

The Committee considered a wide-ranging report and presentation from Peter Homa, Chief Executive of Nottingham University Hospitals (NUH) NHS Trust, covering the following issues:

NUH response to the Care Quality Commission (CQC) report and rating

(a)  the CQC involved a team of over 60 inspectors on both planned and unannounced visits in September 2015. 8 pathways were inspected:

o  urgent and emergency care;

o  medical care;

o  surgery;

o  critical care;

o  children and young people;

o  maternity and gynaecology;

o  outpatients and diagnostic imaging, and

o  end of life care.

  Inspectors engaged staff and patient focus groups, as well as Executive and Directorate management teams and specialist leads;

(b)  NUH was rated overall ‘good’ by the CQC, with a ‘good’ rating for being ‘effective’, ‘caring’ and ‘responsive’. No major concerns were identified, the Trust received an ‘outstanding’ rating for being ‘well-led’ and a ‘requires improvement’ rating was awarded for being ‘safe’;

(c)  the report highlighted a number of examples of outstanding practice, including in the strong ethos of learning and training, strong partnership working with local schools and public health, elements of dementia care, governance and innovative use of technology, such as the ‘Pocket Midwife’ initiative;

(d)  areas identified for improvement included improving End of Life care, specific staffing issues around children’s provision, specialist training issues around midwifery, critical care, neonates and eye casualty and greater consistency in the application of the Mental Capacity Act, and in documenting emergency equipment checks and do Not Attempt Resuscitation decisions.

The Committee congratulated Mr Homa on the report’s positive outcomes, and noted actions identified to address the issues needing improvement. Mr Homa explained that improving the ‘Safe’ rating was less about safety of patients and more to do with consistency of recording and embedding actions already taken across the Trust. He also confirmed that parts of NUH already operated on a 7-day basis, and that the Trust’s plans to meet 7-day requirements were progressing well.

Partnership with Sherwood Forest Hospitals Trust (SFH)

(e)  NUH had been successful in securing a partnership with SFH following a competitive tendering process, also involving Sheffield and Derby Hospital Trusts. The NUH approach to partnership was respectful, humble and supportive, with an immediate focus on addressing CQC issues and longer term focus on developing a new vision and values for the unified organisation;

(f)  the union between NUH and SFH benefitted both patients and staff. Patients would experience improved clinical outcomes, safety and access to services, while staff would experience greater career, development and education opportunities, stable experienced leadership and enhanced research opportunities;

(g)  union also brought benefits to the wider health infrastructure of Nottinghamshire. Existing joint working would be enhanced, health and social care would be more easily integrated and financial and estate efficiencies could be made;

(h)  work was ongoing to develop governance arrangements, agree timelines for integration, ensure strong and consistent communications and engagement and develop plans.

The following issues were raised during discussion:

(i)  Mr Homa confirmed that the SFH structural debt arising from historic Private Finance Initiative (PFI) investment is an entirely separate issue to the union of NUH and SFH. The mechanisms to deal with the PFI issue have not yet been agreed, but will involve additional central Department of Health (DH) resourcing;

(j)  Mr Homa confirmed that NUH would not have proceeded with union with SFH if PFI had not been disaggregated from the process, and agreed to provide further information to a future meeting;

(k)  Mr Homa was confident that there was sufficient leadership, management and staffing capacity within both NUH and SFH to deliver union. Clinical colleagues in particular were positive about meeting the challenges and taking up the opportunities offered by the organisations coming together;

(l)  possibilities were being explored to extend the Medilink bus service across Nottinghamshire. Mr Homa recognised the difficulties with services between Mansfield and Newark and Newark to Nottingham, and work was ongoing to overcome these issues;

(m)  It is expected that Bassetlaw and Doncaster Hospital Trust will more likely align services with South Yorkshire;

(n)  Mr Homa explained that the process of NUH/SFH union was both informed and driven by very high levels of staff engagement, and he expressed the view that positive culture and performance shifts should be evident within 12 months.

NUH Long Term Strategy Development

(o)  NUH is developing a Strategy for the period 2016-2020, engaging with patients, partners and staff to take forward 9 clinically-led workstreams:

o  ambulatory and diagnostics;

o  cancer services;

o  Nottingham Children’s Hospital;

o  Elective services;

o  Emergency and acute services;

o  Long-term conditions;

o  Obstetrics, gynaecology and neonatology;

o  Regional specialities and

o  Technology and IT;

(p)  The Strategy will be developed in the wider context of union with SFH, the Sustainability and Transformation Plans for Nottinghamshire and Lord Carter’s national NHS efficiency recommendations;

(q)  NUH priorities for 2016/17 were arranged under 4 headings – ‘Quality’, Finance’, ‘Our people’ and ‘Strategic’, and included:

o  Responding to CQC inspection report ‘must do’s’

o  Improving and maintaining emergency access and 62 day cancer performance;

o  Delivering financial recovery plan milestones and financial efficiencies;

o  Addressing key workforce risks (fewer agency/locum staff);

o  Embedding new organisational structure/SFH partnership;

o  Developing an Estates Strategy;

(r)  The Strategy is being delivered in the context of the tightest financial constraints under which the NHS has ever operated.

Mr Homa confirmed that patients will have the opportunity to inform both the development of the Long Term Strategy and Improvement Plan in response to the CQC Inspection Report. NUH continues to run the ’15 Step Challenge’ programme, and hundreds of patients’ and partners’ views will be taken into account.

RESOLVED to thank Mr Homa for his report and presentation, and to request a further update, incorporating information on future arrangements to address Sherwood Forest Hospital Trust’s PFI issues, to a future meeting of the Committee.