Agenda item

The Associate Director of Nursing and Quality (ADNQ) at the North East London NHS Foundation Trust (NELFT) and the Integrated Care Director (ICD) for Barking & Dagenham at NELFT presented an update on the NELFT Care Quality Commission (CQC) Inspection as of March 2023. This provided context as to:

·  The CQC Well-Led inspection of NELFT between April to June 2022, with NELFT subsequently being issued with a new rating of “Good”;

·  Overall Well-Led feedback that NELFT had received from the inspection;

·  Positive feedback that had been received as to safeguarding at NELFT;

·  The Well-Led Improvement Plan, including the nine “Should Do” recommendations that had the CQC had made following the Well-Led review, and the monitoring and progressing of the Improvement Plan; and

·  The Quality Support Visit programme at NELFT.

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

·  During the Covid-19 pandemic, complaint response times had decreased, as well as investigations around the most serious incidents; as such, there had been some delays and some increased 90-day responses for complaints and increases around the 45-day response for serious incidents being completed.

·  Since the pandemic, this response backlog had improved. NELFT had a very robust process in terms of incidents being reviewed on a daily basis through Datex, which was an electronic system used by NELFT for incident reporting and complaints monitoring. NELFT’s acknowledgement rate of complaints within three days was now at 90%, with the close-down of complaints in terms of the 28-day framework being dependent as to the complexity of the complaints themselves.

·  Some of the Inspectorate team that had inspected NELFT in 2022, had also inspected NELFT in 2019. The Lead Inspector had praised NELFT for its cultural and behavioural changes, with many of the challenges previously identified in the 2019 inspection, such as around senior leadership, having been addressed, such as through different Chief Executive arrangements and embedding a more just and compassionate culture.

·  NELFT aspired to become an “Outstanding” Trust; the Trust would use its CQC action plan and the number of quality improvement workstreams within this, to meet the requirements in order to achieve this “Outstanding” rating.

·  NELFT faced a number of challenges, such as operating in an area of significant population growth and the continued impact of the Covid-19 pandemic. The new place-based arrangements would present a different opportunity around how NELFT planned and organised health provision to help address some of these challenges.

·  NELFT had a number of staff recruitment and retention programmes, with the recruitment process having an induction and speed-dating for new recruits. NELFT also had one of the best staff survey results in London. It had a number of accolades in terms of its work around recruiting staff from Black Asian Minority Ethnic (BAME) backgrounds; in Barking and Dagenham, 60% of its workforce came from a BAME background.

·  NELFT’s staff had voiced that they came to work for NELFT due to its inclusivity, agile working and flexibility, having won awards around family friendly practices, workforce race equality standards and disability standards.

·  There was a national workforce shortage; whilst some disciplines were harder to recruit to, NELFT was working to recruit in these specialisms. NELFT had also recruited over 240 internally educated nurses this year and was working to nurture this staff group.

·  The diversity of NELFT’s senior leadership team was increasing. In terms of the local leadership team of 14 colleagues, 11 were from a BAME background. The NHS was composed of more females than males, with the Senior Leadership team reflective of this.

·  There were no 18-week breaches in terms of people accessing community learning disability services in Barking and Dagenham; however, there were 18-week breaches in the Adult’s Autism, Paediatric Autism and Paediatric Speech and Language pathways. During the pandemic, Autism assessments were suspended as the physical assessment had to be completed without a mask; NELFT was currently addressing the backlog through a new pathway around Paediatric Autism, autism assessments and diagnostic services.

·  In terms of managing waiting lists, this depended on the service; in some services, staff had been refocused to provide assessment and initial treatment, as opposed to longer-term treatment. The amount of one-to-one service provision had decreased and group provision had been increased, so that more people were able to be seen by NELFT in a shorter time frame. Whilst group treatment worked well for some individuals, it did not for others; digital applications were also being employed to enable people to undertake one-to-one work.

·  NELFT had also looked at different skill mix models, such as through utilising Assistant Psychologists to provide lower intensity programmes, to ensure that service users were not left without treatment. Clinical Harm reviews had also been introduced for waits of over 18 weeks, to ensure that service users were not declining whilst waiting for treatment.

·  Whilst NELFT had received a small amount of funding to help address backlog waiting lists due to the pandemic, this funding would not be recurring.

·  The Governance structure was to be restructured following a recommendation from the CQC and from Deloitte, who NELFT had commissioned to undertake an internal well-led review; this would enable NELFT to better support the delivery of organisational objectives and to free up more capacity to support the emerging collaborative agenda.

·  An area for future improvement was around Quality Improvement (QI) and being able to evidence the involvement of QI and quality improvement projects within the organisation, reviewing data and ensuring that NELFT’s projects and improvements made were evidenced in this data. This would help to pinpoint the areas for improvement going forward.

·  There was a QI team at NELFT, with a dedicated director for this, and there was also a dedicated QI Advisor for each locality. All staff were also able to undertake QI training.