Briefing for CQC inspection to RBCH

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CQCbriefing

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The Care Quality Commission (CQC) will be undertaking an announced inspection of our hospitals from Tuesday 20 to Friday 23 October 2105. An unannounced inspection will then take place between Friday 23 October and Thursday 5 November.

The last inspection in 2014 found we had improved in the areas of concern highlighted during the initial CQC inspection back in 2013. The inspectors will be looking to confirm we have continued to improve in these areas and others across the Trust.

The inspection will involve a team of inspectors (50+) visiting all areas and the services we provide at both hospitals.

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Tony Spotswood, Chief Executive RBCH and Jane Stichbury, Chairperson

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What will the CQC inspectors be looking for? When the CQC inspect a hospital they are looking to answer five questions:l are services safe?l are services effective?l are services caring?l are services responsive to people’s needs?l are services well led?

The CQC use current information about us to decide their initial key lines of enquiry. This information has been gathered from a variety of data sources including the national patient survey, staff surveys and audits, the General Medical Council (GMC) Survey 2015, the Friends and Family Test, serious incidents and never events. They have also reviewed our performance against national targets and objectives such as Referral to Treatment Times (RTT), cancer waiting times and Emergency Department performance.

What will happen during the inspection?Inspectors will talk to staff, patients, carers, visitors and other key stakeholders such as the Clinical Commissioning Groups, Healthwatch and patient forums. The CQC hosted public listening events on 7 October and will host staff focus groups during the inspection period. They will look at any comments and concerns people have about our services.

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What will happen after the inspection? Using all the data and the inspection findings the CQC will award a rating to each service across each of the five domains (Safe, Effective, Caring, Responsive and Well-led). The CQC will apply one of the following ratings:l outstandingl goodl requires improvementl inadequate

The results will be displayed at the entrance to our hospitals, on our websites and in the individual service areas that have been inspected.

It is proposed that we will receive a first draft of the CQC report in mid/late December. There will then be a quality summit with external stakeholders to agree the Trust’s actions on Thursday 21 January next year, with the final report scheduled to be published at the end of January 2016.

How should I prepare?The CQC inspection is an opportunity for us to showcase what we have done at the Trust to continually improve the quality of the services we provide. It is an opportunity to demonstrate the work that we have undertaken since the previous inspections in 2013 and 2014 and showcase our areas of best practice.

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Self assessment As part of the preparation for the inspection, the CQC asked the Trust to self-assess our main core services against the five CQC domains (Safe, Effective, Caring, Responsive and Well-led). A summary of what we said is provided below.

The CQC asked: which services or areas of the Trust do you consider to be good or outstanding?We said: l Critical care, with outstanding care

and leadership, ICNARC track recordl Radiology, with enhanced seven day

provision and an outstanding interventional radiology service

l Clinical haematology which is JACIE accredited and includes a district-wide specialist integrated haematology malignancy diagnostic service

l Nationally renowned diabetes servicel Specialist endocrinology service offering

specialist regional clinicsl Specialist inpatient gastroenterology

service offering a Trust-wide daily review of patients and specialist IR and EUS

l Older People’s Medicine interim care service, GP led unit and excellent integrated therapy service and Wards 26

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and 4 are dementia-friendly environmentsl Seven-day cardiology, acute medicine OPM,

GI bleeding, radiology and surgical servicesl Ophthalmic servicesl Hip surgical outcomes and PROMS

within orthopaedicsl Colorectal surgery with mortality within

the upper quartile and specialist oesophago-gastric cancer services serving the whole of Dorset

l Excellent cardiology service, including provision of elective and PPCI, electrophysiology and complex pacing service

l Robotic assisted prostate surgery offering services across Dorset

l Orthodontic servicesl Revalidation process for medical staff l Anaesthetics - high quality medical,

nursing, AHP workforce, out of hours predominantly consultant delivered service

l Additionally we have a developing “Quality Improvement” Programme to drive our work around continuous improvement and learning. Specific areas we highlight include: improvement in the management of sepsis; improvements in the flow of patients through the hospital, although the hospital remains at times very busy; significant improvements in the cancer pathway; the use of checklists and the safe management of patients requiring emergency laparotomy.

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The CQC asked: which services or areas of the Trust do you feel are our weaker areas?We also had to describe what actions we are taking to address these weaker areas. We said:

While good progress has been made to improve patient flow through our hospital and absorb a 10% increase in emergency admissions, the Royal Bournemouth Hospital at times remains very busy. This allied to a doubling in the number of delayed transfers of care and a 50% increase in the number of patients awaiting continuing healthcare (CHC) placement, continues to create pressures within the Trust and lead to some outlying of medical and elderly care patients as well as impairing the achievement of the four hour target.

Actions: To improve patient flow through the hospital, we have introduced Five Daily Actions, additional beds, a cardiology assessment area, more ambulatory care, Bournemouth Rapid Evaluation and Treatment (BREATH) hub in ED and improved discharge processes with partner organisations.

The pressures generated on staff as a result of how busy the Trust is

Actions: Developing Organisational Development and leadership strategy to implement a collective leadership model addressing issues such as staff wellbeing.

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Increased waiting times for endoscopy leading to loss of JAG accreditation.

Actions: Expanded endoscopy capacity, new booking system being implemented, complete revision of existing listing processes. Six-week wait to be achieved by March 2016.

The Trust has previously struggled to maintain performance against key cancer standards owing to increased demand.

Actions: More capacity for cancer patients, pathway redesign, in Q1 (from April to June 2015) all cancer standards were met and projected Q2 full compliance.

The responsiveness of aspects of the stroke service illustrated by the historic D level rating in the Sentinel Stroke National Audit Programme) SSNAP data.

Actions: Improved stroke pathway, new leadership, additional scanning provision to be introduced later this year. Performance for the first quarter of 2015 was at level B, the best in Wessex.

Despite significant progress, the recruitment of qualified nursing staff remains a challenge to Acute Medical Unit, Older People’s Medicine (OPM) and ED.

Actions: Newly qualified nurses have started in post and we are focusing on nurse staffing, use of mitigation templates combined with new role development for Bands 2, 3 and 4, continued overseas and local recruitment, increased commissions, increased return to practice focus, new bank rates of pay, external review of skill mix focus on retention.

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The Trust’s financial position deteriorated from a historic surplus to forecasting a deficit of £12.9m for 2015-16.

Actions: Deficit is being reduced to £10.9 million through improvement programme.

The Trust declared non-compliance on the national information governance toolkit at the March 2015 submission.

Actions: Work is underway to address non-compliance for information governance, with a full action plan available on request.

Some temporary risks were created through the transition to implementing EDM and replacing the paper clinical record.

Actions: There is intense clinical, operational and IT input to address the risks and speed of transition to full implementation of EDM. This will involved allocating additional resource to ensure sufficient support and allocating additional staff to implement bespoke solutions, as well as further training to help prepare and customise clinical notes.

Consultant medical staff vacancies remain difficult to fill in Elderly Care, Medicine and non-training grade posts similarly remain difficult to fill in ED.

Actions: Filling medical vacancies: Elderly Care - new leadership team, four middle-grade doctor appointments and three additional nurse practitioners to support senior decision making on wards. ED - a further consultant appointment in September 2015 and ongoing recruitment.

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Jo Maple-RobertsEndoscopy SisterHow are you and your department preparing for the CQC inspection?

Ensuring all the team are aware of the governance data that is available and discussing the visit at weekly team meetings. I have developed a ‘Governance board’ showing highlights of complaints, AIRS, RCA’s, risk register, saving lives, performance and compliments. I also used the Trust CQC questionnaire to run a session at our training afternoon in September.

What will you be highlighting about your service if asked by the inspectors?

That the last year in endoscopy has been challenging from a demand and capacity perspective but the support we have received from our management team with regards to admin, staffing has been excellent.

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Any advice for colleagues who have never been through an inspection?

Be prepared... but also be proud of what you and your team have achieved and promote the quality of service you deliver.

What improvements have there been at RBCH that you would hope the inspection will highlight?

Endoscopy did not receive a visit last time, but I have been fortunate enough to attend the Trust’s “Time To Lead” course to develop leadership within all areas.

What are you most proud of at RBCH at the moment?

My team and the great feedback we receive from patients about the care they received whilst with us.

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Kathy BlustonRehabilitation Lead Christchurch Day Hospital How are you and your department preparing for the CQC inspection?

We have prepared for the CQC inspection by doing our own peer inspection and putting in place measures to address anything we identified as not to the standard we would wish.

We have briefed our staff on what to expect during the inspection and have ensured that all our current information on display is up to date.


We will be highlighting our work to achieve Practice Development Unit Accreditation. This includes many projects to improve quality and communication.

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We are becoming a focus point for the “better together” community initiative to improve our communication with community services. We are very committed to this and see this as one of the most important things we have ever done.

We will also highlight our patient newsletter, and how we listen to patients with our “you said we did” initiatives and our patient focus groups.


Improvements at Christchurch Hospital we will highlight are the new refurbishments and our friendly community hospital approach. The improvements at RBCH are the amazing efforts everyone is making to improve quality and safety.


We are most proud of our staff on both sites.

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Kevin HousePortering SupervisorHow are you and your department preparing for the CQC inspection?

By making sure that all staff are aware of the upcoming visit by the inspectors. We always ensure the corridors are monitored and any portering equipment is stored appropriately, and all our current procedures are up to date.


That we are continuously looking at ways to improve our efficiency by working more cost effectively.


To be yourself and do your job to the best of your ability, and if asked questions by the inspectors to answer them honestly.

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I feel the staff levels on wards have improved, I believe there are more nurses per patient and I feel that their standards of work have im-proved somewhat too.


I am most proud of the care given to patients on the wards, all nurses and health care assistants are exceptional in the work they do. I feel the nurses and HCA’s don’t get enough credit for the hard work they have to do day in day out. They are a credit to our hospitals. My department also works extremely hard and I’m very proud of the team around me.

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Martin Schuster-BruceConsultant in Critical Care and Anaesthesia, Clinical Director Anaesthesia How are you and your department preparing for the CQC inspection?

We have reviewed our Trust’s previous CQC report from November 2014 to ensure any recommendations relevant to our service have been implemented. We have particularly focussed on our governance arrangements and worked to ensure staff understand and can interact with our governance systems.

This process has included ensuring our policies and procedures are up to date and our staff know how to access these documents.


We provide a high quality and safe service that continues to evolve in response to the needs of the local population. We have instigated a 24/7 CEPOD theatre and are working on reducing the number of patients operated on out of hours. We have embedded the principles of enhanced recovery for our surgical population and worked on standardising our anaesthesia techniques for our core surgical procedures. Our critical care service has delivered a consistent high-quality service with lower than expected mortality and infection rates.16

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This should not be a stressful or intimidating experience. The inspectors are simply trying to establish how our hospitals works and how we perform. You should be open and honest when answering any questions the inspectors may ask.


I believe there has been a genuine improvement in the basic nursing care provided within the Trust and a real attempt to ensure that we have sufficient nurses working on our wards to care for our patients at all times.


Our staff are our most precious asset and I am most proud of the care and professionalism of staff who work within our directorate. The outcomes for our patients are dependent on all the staff who support and deliver our services, ranging from our senior consultants and nurses to our non-clinical staff who maintain our equipment or clean our theatres.

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Michelle RichardsWard 26How are you and your department preparing for the CQC inspection?

The team on Ward 26 is discuss what we do well, remembering what we are proud of. We are also discussing the CQC assessment sheet, thinking of examples demonstrating the criteria they set. It is our job to reassure them we are providing the care expected by our patients, their families and by ourselves as health care professionals.

The directorate is being open and honest about where we have come from and where we are going. In relation to staff recruitment and retention, and quality of care. I feel the directorate is developing a holistic approach by working from the ground up, assuring standards are set correctly from the beginning, creating an opportunity for the directorate to evolve and remain committed to delivering high quality care in an ever changing and challenging NHS.


I will be highlighting our five Pride Award nominations from last year and the award we won for “patient safety”. I will also want to discuss the hard work needed to sustain a team after they have been recognised for doing well. Making sure complacency does not set in and allowing the team to take ownership of their ward and the direction it takes. 18

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Our team dynamics: Multidisciplinary team working is at the heart off what we do. The processes we have in place clarify the expectations of the team, and ensures efficiency is maintained even when challenges arise, for example, short-term sickness.


Be proud of what you do, if there are pitfalls, try and be honest with yourself, pre-empt what needs working on and have a plan in place.


Trust-wide investment into the ward sisters’ development, sisters attended a compulsory leadership programme. This was based outside the Trust, giving a greater learning opportunity for the ward sisters who passed this new approach on to our teams.

Matrons are very supportive and they listen to how we are. We have regular meetings where we can talk about anything affecting us, as well as talking through ward safety and any issues which need resolving.


Resilience, teamwork, leadership and compassion.

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RBCH contactsAdult Safeguarding LeadEllen Bull and Jenny House, ext 6439

Named Nurse for Safeguarding ChildrenPippa Knight, ext 4235

Clinical Lead for Clinical AuditJulius Cranshaw, ext 4193

Clinical Effectiveness ManagerWendy Greenhalgh, ext 4985

Senior Nurse - Clinical RiskKate Rowlinson, ext 4958 bleep 2083

Complaint Manager and Clinical Claims OfficerJennie Moffat, ext 4301

Non Clinical Claims AdministratorDee Page, ext 4014

Dementia Nurse SpecialistRachael Davies, bleep 2681

Falls LeadDebbie Fortune, ext 4021

Fire OfficerStuart Leece, ext 4293

Health and Safety OfficerGeorgina Cullum, ext 4039

Senior Infection Prevention and Control NursePaul Bolton, ext 4842

Information Governance Officer Camilla Axtell, ext 4461

Learning Disability LeadDebbie Hopper, ext 4227

Medical Director and Caldicott GuardianBasil Fozard, ext 4614

Consultant MicrobiologistLayth Alsaffar, ext 4849

PALs AdvisorMichelle Lynch, ext 4886

PALs AdvisorCarolyn Polden, ext 4886

Head of Patient EngagementSue Mellor, ext 4253

Associate Director of Quality and RiskJoanne Sims, ext 491020

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Senior Information Risk Officer(Board Lead for Information Governance)Peter Gill, ext 4058

Head of Risk ManagementCaroline Clark, ext 4966

Security OfficerMalcolm Keith, ext 4731

Tissue Viability NurseLouisa Way, ext 5672

Trust Secretary Sarah Anderson, ext 4777

Volunteers ManagerJackie Taylor, ext 4161

Clinical Directors David BennettSurgery, ext 4256

Martin Schuster-BruceAnaesthetics, ext 4193

Richard HartleyOrthopaedics, ext 4926

Tristan RichardsonMedicine, ext 4868

Andrew WilliamsElderly Care, ext 4539

Mark SopherCardiology, ext 6140

Ellie ThickettSpecialist Services, ext 4705

Non MatthewsOphthalmology, ext 4362

Rachel HallCancer Care and Pathology, ext 4790/4792

Arnie DruryRadiology, ext 4115/4984

Directorate Managers Jane BurnsSurgery, ext 4241

Corrina JordanAnaesthetics, ext 4198

Jo Clothier Orthopaedics, ext 4481

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Alex ListerMedicine, ext 4982

Vanessa MasonElderly Care, ext 4386

Jo BlackwellCardiology, ext 6231

Tracey Hall Specialist Services, ext 4580

Louise Neville Ophthalmology, ext 6055

Paul MasseyCancer Care and Pathology, ext 4780

Sarah Oliver Radiology, ext 4491

MatronsSue DaviesSurgery, ext 5801, bleep 2260

Andy GyngellITU, ext 4057, bleep 2129

Carmen CrossMaternity, ext 5880

Sue LangloisAnaesthetics, ext 4168, bleep 2759

Belinda HewettOrthopaedics, ext 4481, bleep 2493

Nicola BowersElderly Care, ext 4539

Troy WelchMedicine, ext 4642

Claire Liggins ED, ext 4170, bleep 2610

Kelly SpavenAmbulatory Care, ext 4025

Paula RaysonCardiology, ext 6151

Alison PressageSpecialist Services and Ophthalmology, ext 4352, bleep 2487

Marie MillerCancer Care, ext 5197, bleep 2053

Trudi EllisElderly Care, ext 4949, bleep 2712

Nicola BowersElderly Care, ext 4949, bleep 246222

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Heads of nursing and qualityMartin SmithMedical Care Group, ext 4612Kate HorsefieldSurgical Care Group, ext 4503/4451Sue ReedSpecialities Care Group, ext 4325

Directors of OperationsFrancis WisemanMedical Care Group, ext 4273Mark TitcombSurgical Care Group, ext 4451Abigail DaughtersSpecialities Care Group, ext 4325

Quality and Risk Committee LeadsDr Sean WeaverAssociate Medical Director and Chair of (QARC) ext 4605Dr Jehinger DinCardiology, ext 6136Dr Farhad IslamED, ext 4370Dr Earl WilliamsMedicine, ext 4563Dr Khaled AmarOlder Peoples Medicines, ext 4538Mr Robert HowellSurgery, ext 4881Mr Heath Taylor/Mr Simon Richards Orthopaedics, ext 4928Dr David ParhamPathology, ext 4832Dr Joseph ChackoOncology, ext 4797Miss Anne DenningOphthalmology, ext 4353Dr Andy PopeRadiology, ext 4984Tom GreenAnaesthetics, ext 4194Dr Andy PopeRadiology, ext 4984

Helen Martin/Alison PressageSpecialist Services, ext 6085/4352

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VisionTo be the

most improved hospital by 2017

MissionProviding the excellent care

we would expect for our families

Values

Communicate- say it, hear it, do it!

Improve- change it!

Teamwork- share it!

Pride- show it!

Our strategic plan forpatient care 2015/20

Strategic Themes

People To attract and develop

the best team

Quality Safe Effective

High quality experience

Improvement Relentlessly

improving our care and outcomes

Leadership A collective, values based

leadership culture

Strategic ObjectivesContinue to

improve the quality of care we provide

to our patients

To continue to drive improvements

in patient experience,

outcomes and care

To support and develop our staff

engagement, welcomes feedback,

is open and transparent

Developing our services as the main

emergency care hospital for Dorset

and west Hampshire residents

Ensuring patients have rapid access to all of our

services

Ensuring our services

remain financially

sustainable

Documents

Briefing for CQC inspection to RBCH