Agenda item

Dr Smith delivered a presentation explaining the findings of Health Education England (HEE) in relation to the standards of staff training and medical education, and the actions taken by the Trust in response to HEE’s report.

Members noted from the presentation that;

·  BHRUT hosted a large number of doctors in training. As part of the monitoring service for feedback from trainees, HEE, along with the General Medical Council (GMC), undertook reviews on the quality of the trainee experience. In addition, HEE undertook a risk-based trainee focus group visit to the Trust on the 2 April 2019, which was planned following the release of the GMC National Training Survey 2018 results. During this visit, some concerns were raised in relation to the acute medical on-call rota, clinical supervision, the relationships between the higher medical trainees and the Emergency Medicine department;

·  As a result of the visit, HEE issued nine mandatory improvement requirements to the Trust and this led to the GMC placing Acute Medicine into enhanced monitoring, due to the potential for patient harm (no harm had actually occurred); and

·  Dr Smith and the Director of Medical Education took these concerns very seriously and were leading the improvement work plan. The Trust continued to work the HEE and GMC and had provided evidence of progress in line with the HEE Quality Visit Action Plan.

Dr Smith took members through the nine mandatory improvement actions the Trust was progressing in detail.

Whilst members were pleased that there were now more individuals that trainees could report issues to, they expressed concern that it had taken a HEE visit for the Trust to become aware that it had a problem. Members also expressed concern that the problems faced by doctors in training could be similar to those faced by other professionals in the Trust, such as nurses. The Trust’s ICE assured members that it was confident that trainees in other professions did not face a similar experience as the management and accountability structure was clearer and the supervision requirements were more developed. The ICE accepted that the Trust needed to work very hard with regards to the culture around doctors in training to ensure all colleagues knew the value of working together. It had already started this work, using the PRIDE way’s ‘Respect for People’ framework to establish high standards; however, it would take a number of years to achieve this.

Members expressed concern that some of the required actions identified by the HEE were basic, such as providing evidence that the consultant on-call was clearly identified and providing supervision and support to medical trainees. Dr Smith accepted that this was the case and added that sometimes organisations needed a mirror held up to them to see where poor practice was occurring. The Trust had a long journey ahead to get to the standards required and telling all staff to listen first would be her ‘mantra’ going forward.

Members asked how consultants were held accountable in terms of their management of staff.  Dr Smith stated that over the last few months, it had worked hard to get recognition amongst consultants that there were significant issues in the management of trainees, which had to be overcome. Its next steps were to get to a point where it was tackling all incidents of poor behaviour by building capacity to do this. It had, for example, developed its clinical leadership, appointed clinical leads, and clarified structures and expectations.

Members commented that addressing HEE’s concerns and going even further to provide an excellent training experience for trainees was crucial to the Trust’s future, otherwise trainees would not return to work for the Trust once they qualified. The ICE assured the Committee that the Trust’s Board was absolutely determined to address all the actions and build on them to create a positive culture in the long term. Dr Smith assured members that there were now clearly identified leads whom trainee doctors could talk and report to regarding any problems they were facing. In addition, all trainees had access to a ‘Guardian of Safe Working’, an internal consultant who was separate to the Trust’s Board to whom they could raise concerns anonymously. The Trust had also carried out workshops to help with problem solving in the context of team working.

Members asked whether the Trust had arrangements in place to support trainee doctors who had ambitions to become future leaders, such as opportunities to shadow consultant leaders. Dr Smith stated that all trainees had to demonstrate elements of leadership training as part of their ‘sign-off’ and there were opportunities to shadow board directors. Senior trainees could apply for Chief Registrar posts, which had protected leadership and management time. The Trust also had a number of staff undertaking a Darzi Fellowship, (a one-year programme aimed at those at the start of their leadership journey, undertaking one main project for the Trust as their sponsor).  However, the Trust could do more on this aspect, and she would take this back as a recommendation for the Trust to reflect further on.

The Chair thanked the Trust’s representatives for attending the meeting and taking the time to answer its questions.