Agenda item

Purpose: To provide an update on the response to the Care Quality Commission report.

Jo Sherman, Hospital Director, Elysium Healthcare and Michele Paley, Elysium Healthcare, presented the report on Thornford Park Hospital (Agenda Item 5).

Ms Sherman gave an overview on Elysium Healthcare and Thornford Park Hospital. This included the Operational Board, background of Elysium Healthcare and geographical coverage. The Strategic Plan for 2022 was explained with a number of aims highlighted.

Councillor Tony Linden asked for clarification around how Thornford Park Hospital was regulated. It was confirmed that the regulatory requirements were not affected by Australian ownership and they were regulated by the Care Quality Commission (CQC).

Ms Sherman continued the presentation including an overview of the organisational structure of Thornford Park Hospital, how it had developed over recent years and the beds and wards that they had. They explained that had mostly male wards and two female wards. They clarified that PICU stood for Psychiatric Intensive Care Unit where high risk patients were for six to eight weeks. They were commissioned by NHS England and the Clinical Commissioning Group (CCG).

Jo Sherman then explained the action plan in response to the CQC report (slides 10 – 12). Ms Sherman advised an example of restrictive practices was stopping takeaways after 10pm. They ensured that they did not have blanket rules for everyone and that everything was individually risk assessed. There were risks and so they ensured that they evidenced their decision making process and that service users were part of that process. It was clarified that ‘leave’ was time outside of the hospital which was individually risk assessed. Data was submitted to Provider Collaborative and other stakeholders.

Ms Sherman explained the external audit and governance of Thornford Park Hospital. In addition to the CQC and internal governance, they were audited by NHS England, Provider Collaborative, NHS Wales, CCGs, Local Authorities and Advocacy. The Provider Collaborative was external NHS input involving specialised commissioning. This included independent sector and NHS groups. There was a lead Trust. These Provider Collaboratives helped to minimise out of area placements and also bring consistency of treatment, care and outcomes. They also came on site and reviewed their data. The Advocacy was a large presence in the hospital from two providers attending weekly to support patients with their voice.

Jo Sherman moved on to advise the Committee of areas of achievement which included enhanced access to leave into the community, grounds and home. Ongoing collaborative working with external stakeholders was another area of achievement highlighted. This had meant working with NHS England in developing services locally and the development of specialist services for autism and learning disability. Finally they explained that their management of Covid was very good and they had no deaths within the hospital. They also managed to increase levels of leave despite Covid. Finally Jo Sherman advised they were keen to reduce the length of stay for people at hospital.

Councillor Jeff Brooks commended the hospital for their management of Covid but noted concern in elements of the CQC report. Councillor Brooks highlighted the actions in the CQC report that must be taken and those that should be taken and requested assurance that action had been taken. He noted general care planning. Jo Sherman responded to confirm that there has been lots of coaching around care planning and ensuring the service user voice was within the care plans. They were monitored internally and by external stakeholders. The whole action plan was reviewed internally and externally by Provider Collaborative. These assurance processes ensured they provided evidence to show how they were moving along the action plan. They were also continuing the coaching and care planning which was ongoing. The same was for NEWS2 training which was in the induction and in update training for all staff.

Councillor Brooks requested further assurance that they would ensure emergency equipment audits were put in place and more detail around the action plan and steps being taken. Jo Sherman advised the emergency equipment issue was identified on one ward last year and was actioned on that day. Subsequently they have done regular audits and additional audits to prevent this from happening again. Michele Paley advised that she had commissioned audits across Elysium Healthcare last year and in April 2022 to ensure medical equipment was in place.

Councillor Jeff Beck highlighted that there was an over reliance on agency staff and that permanent staff were reported to have said that made them feel undervalued. It took time to become confident with agency staff. He noted that agency staff were more expensive and it would be more economical to have permanent staff. Michele Paley agreed they would prefer to employ their own staff rather than have agency staff. However there were significant shortages of registered nurses across the country. They had increased their focus on international recruitment. This week their 400th international nurse had just arrived. They had a strong focus to get them through their training and register with the Nursing and Midwifery Council. They had a significant programme around preceptorship which was encouraging newly qualified nurses to join them. They had an academy with ring fenced training time to make them a more attractive option for people to be employed by them. It was a challenging environment to retain staff. They had recruitment campaigns, a dedicated international nurse academy and international nurses arriving every three to four weeks. Thornford Park operated an assistant practitioner programme and a nurses’ associate programme. These were to recruit to different levels and disciplines to support the nursing team. Councillor Beck asked whether the concern about insufficient female staff for washing and dressing had been addressed. Jo Sherman advised that when allocating staff to wards they looked at skill mix and gender mix. They had two female wards and the workforce within those wards was predominantly female.

Councillor Linden referred to the CQC report for his questions. Firstly he asked about the concern of patients of Hermitage and Bucklebury Wards who did not feel safe due to patients assaulting other patients. Jo Sherman responded that at the time there were difficult relationships between some patients on those wards. That had been addressed and they had worked closely with commissioners to ensure patients were moved on to alternative placements. Bucklebury Ward was an acute admission medium secure ward and they had a number of patients who transferred from prison. They had done a lot of work around how they could improve the experience for individuals. Concerns were not currently being reported in community patient forums.

Councillor Linden asked about regular supervision of staff and recordings of that supervision. Jo Sherman advised that was particularly for PICU wards during the pandemic. They were struggling with staffing and had high levels of sickness due to Covid. They had a reduction in their compliance with supervision. This was shared with the CQC and with all other external stakeholders. That supervision compliance continued to be monitored. They contractually had to submit monthly supervision data and it had improved. Michele Paley advised they had undertaken a review of their supervision policy and had much clearer algorithms on how they measured and recorded it. This meant they had clearer data ensuring all staff were included.

Councillor Linden asked about the management of patient risk on Bucklebury Ward. Jo Sherman advised that had been addressed through their coaching and care planning. That was then reviewed through their ward rounds by the multidisciplinary team.

Councillor Linden asked for confirmation that the issue with observing patients had been addressed. Jo Sherman advised that the blindspot identified in the inspection had been addressed through additional mirrors. Councillor Linden asked for confirmation that the requirement notices had all been addressed. It was confirmed that they had been.

Councillor Alan Macro asked how Thornford Park Hospital compared with the other hospitals in the group when it came to CQC ratings. Michele Paley advised that Thornford Park Hospital was not an outlier. They had varying types of services and they tended to look not just at the overall rating but also dug down in terms of the service type and the wards.

Councillor Macro raised concern that the blind spot was not picked up internally and asked if there were internal processes to prevent this. Jo Sherman advised they had an annual ligature audit that took place. This was updated by Michele Paley last year. Michele Paley confirmed this was a learning point that had led to a review of the ligature risk management policy and procedures, and brought in a revised ligature audit tool as a result. They had not been strong enough in including blind spots in their audits previously. Michele Paley advised the CQC guidance on ligatures had been withdrawn and that work to review national guidance / standards on how ligature audits were reviewed had been delayed. This was a co-produced piece of work that would be launched on 25th June 2022. There would be a subsequent review internally following that to meet national guidance. Councillor Macro asked if audits would occur after refurbishments also. Michele Paley confirmed that any changes to configuration (decoration, moving things around, change in a service user profile) would trigger a repeat of the ligature audit.

Councillor Claire Rowles asked if the CQC report came as a shock or if it was anticipated. Jo Sherman advised that for some parts of the report they were not surprised, but other areas they did challenge. In particular the facilitation of leave and so they submitted further evidence to the CQC around that.