Agenda item

The Integrated Care Director (ICD) at the North East London NHS Foundation Trust (NELFT) and Associate Director of Nursing & Quality (ADNQ) for Barking & Dagenham at NELFT delivered a progress update on the CQC Improvement Plan that it had developed to address the “Must Do” and “Should Do” findings, as a result of its CQC inspection in June 2019. The update also followed on from NELFT’s previous presentation to the Committee (minute 10, 21 October 2020 refers). The presentation highlighted actions undertaken so far to address the inspection findings, with only one “Must Do” and five “Should Do” actions remaining open, which related mainly to Essex and Kent services, and not to those in Barking and Dagenham.

In response to questions from Members, the ICD and ADNQ stated that:

• From a Barking and Dagenham service perspective, NELFT was working to embed all actions as core business as usual activity. NELFT had undertaken a thorough self-assessment in terms of where it felt that it stood against each of the five domains inspected and felt that there was now good evidence that it was able to demonstrate compliance against these, based against the work that it had undertaken to address any concerns; however, it was still awaiting the CQC’s determination on this as part of its next inspection.
• There were still some challenges, such as waiting times, which had been exacerbated by the pandemic in some areas. NELFT had seen particular surges in referrals in some areas and had redeployed a significant number of staff from some services at the height of the pandemic, which had led to decreased function in these particular services. One “Must Do” action was around addressing waiting lists in the Kent ASD pathway, with specific reasons pertaining to Kent as to this; however, NELFT was inspected by the CQC as a whole trust, with Barking and Dagenham only one part of this.
• Nationally, funding had been made available to address elective waiting lists, with acute hospitals and community trusts across the country having submitted plans and trajectories around reducing these, to get to a compliance standard of 18 weeks. This would require additional workforce for NELFT, who had submitted workforce plans as to this.
• Whilst some services had few vacancies, others such as district nursing, had higher vacancy levels. NELFT had partnered with a new recruitment supportive agency, Just R, to launch a new recruitment campaign across NELFT, and had spent a lot of time investing in staff networks. NELFT had also been recognised as a Working Families Top Ten Employer 2021, as well as nationally in terms of the work that it had undertaken in terms of workforce race equality and disability equality standards. As Barking and Dagenham had its challenges, such as increased complexity of needs and higher deprivation levels, NELFT acknowledged that it took special individuals to work within the area and that it needed to provide extensive training and development opportunities, to attract high quality employees.
• The NHS and NELFT both worked with the Agenda for Change payscale. Whilst NELFT acknowledged through its staff survey that staff wished to be paid more, there was finite resource within the Trust and it worked with a variety of different skill mix models, with both qualified and non-qualified staff and apprenticeship programmes to maximise opportunity. NELFT was also one of the biggest NHS Trusts to utilise the Kickstarter scheme, having recently employed 65 new starters through this programme. NELFT also had a very diverse workforce, which was reflective of the community that it worked with, with many staff who worked in the Borough, also living in the Borough.
• CQC inspections would very likely focus on ensuring that different trusts understood where their risks were, whether mitigations were in place, and whether actions were assigned around mitigating these risks.
• The CQC was commencing its NELFT stakeholder engagement, which it usually started six weeks before it came to inspect an organisation and meant that a NELFT inspection was likely imminent. As part of CQC scoping, it would ask NELFT to provide them with a list of partners, and would contact local authorities, the CCG and other partners of the organisation in question.
• A lot of positive work had been undertaken around developing the Executive Leadership team, as part of improving the ‘Well Led’ domain, which had been rated as ‘requires improvement’ previously.
• NELFT services were mostly back to normal, with a mixture of face-to-face, group and virtual activity. Under the arrangements, staff were still required to wear masks, PPE and socially distance, and none of the infection prevention control measures had been changed for health organisations. As part of this, patients and visitors were also expected to wear masks.

Following a question from a Member, Cllr Rice stated that as part of his role on the NELFT Governing Body, there had been lots of work around appointing a new Chief Executive and a new Chair of Governors; however, he would personally like to see more discussion around services and the CQC, and the ICD would relay this feedback. In response to a question, the ICD also stated that the new Chair of Governors could be in place in time for the next CQC inspection; however, this was not certain. Where there were any gaps in senior roles, there were mitigations in place, with acting positions to fill these vacancies during the interim, and an acting Chair of Governors would be in place if CQC did inspect within the next eight weeks.