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.