Agenda item

Members of the Children, Education and Families PDS Committee are invited to attend the meeting for consideration of this item.

The Chairman welcomed Members of the Children, Education and Families Policy Development and Scrutiny Committee, and the Portfolio Holder for Children, Education and Families, to the meeting for consideration of this item. A copy of the presentations received from the Assistant Director for Integrated Commissioning and Jacqui Scott – Chief Executive Officer, Bromley Healthcare (“CEO – BHC”) and Michael Nutt – Chairman, Bromley Healthcare (“Chairman – BHC”) had been provided in the published agenda pack for the meeting.

The Assistant Director for Integrated Commissioning provided an update in relation to commissioner assurance arrangements. Members were advised that the Care Quality Commission (CQC) had published a report on 4^th February 2022 stating that Bromley Healthcare (BHC) had been rated overall as ‘Requiring Improvement’ following an inspection between August and September 2021. Three service areas had been inspected: Inpatient (‘Good’), Adults (‘Requires Improvement’) and Children, young people and families (‘Requires Improvement’). Across the five inspection domains BHC had been rated as ‘Requires Improvement’ for being Safe, Effective, Responsive and Well led, and rated as ‘Good’ for Caring.

BHC had held initial discussions with key stakeholders regarding their response to the CQC report and a high-level presentation and action plan had been shared with the Clinical Commissioning Group (CCG), along with a more detailed list of actions. BHC had produced a CQC Action Plan, which had been submitted, and responded directly to the CQC directions ‘must do’ and ‘should do’.

Members were informed that BHC had established additional Governance around the action plan, including a CQC Assurance Board sub group, which would include representatives from the SEL CCG and Local Authority. As other neighbouring local authorities also commissioned services from BHC, they would have representation on the Commissioner Assurance Board in order to agree a single assurance process, which would be led by Bromley. It was noted that the Board would be time limited and would report on a quarterly basis to the Bromley Local Care Partnership Board and, as part of the CCG reporting, the Council’s Health Scrutiny Sub-Committee. There would be a link between the oversight Board and BHC CQC Assurance Board via the CCG representative.

In relation to the Commissioner Assurance Board, a Member enquired if it was intended for there to be a single point of contact across the named local authorities, of if various issues would be split across the group. The Assistant Director for Integrated Commissioning said that the finer details were still being worked through with the neighbouring local authorities. There were common themes across the organisation, and in order for services to focus on making improvements they wanted to avoid having lots of individual meetings. It was anticipated that the finalised scheme would be in place from April 2022 – the Board would be time limited but would remain in place until they were satisfied that BHC was meeting all requirements.

The CEO – BHC informed Members that the CQC Inspection had consisted of on-site visits across community bases and the bedded rehabilitation unit; staff, senior leaders, patients and families were spoken to; records and feedback cards were reviewed, along with a range of documents, policies and procedures; adult and child consultations were observed, along with handovers, clinics and MDT meetings; and an online staff survey across BHC was also conducted. It was noted that this had been BHC's first inspection conducted under the NHS Trust regime. Several areas of good practice had been identified and it was highlighted that the CQC had not taken any enforcement action. BHC would continue to meet with the CQC every two months to confirm the work undertaken. The Portfolio Holder for Children, Education and Families asked that the outcomes of these meeting be relayed to the Portfolio Holder for Adult Care and Health and Director of Adult Social Care in order for them to be aware of how the progress being made by BHC was deemed by the CQC.

The CEO – BHC advised that in response to the CQC Inspection, governance across the organisation had been strengthened by the appointment of two new non-executive directors with backgrounds in community services integration and clinical immunovirology. They had also looked to strengthen the governance levels below, with three divisions established (UCR, Adults and Children) with triumvirate leadership teams in place (Clinical, Nursing and General Management). In response to a question, the CEO – BHC advised that this would allow more scrutiny of the leadership team and would separate the operational and quality elements. More meetings with service and operational level leads would take place to allow them to discuss the support required. It was noted that a Head of Safeguarding, combining adults and children, had been appointed. In response to questions from a visiting Member, the CEO – BHC advised that this was a new role, in addition to the Head of Adults Safeguarding and Head of Children Safeguarding roles, which would be involved with other agencies. It was highlighted that the CQC had not raised safeguarding as an area of concern, however they had taken the opportunity to strengthen it further.

Members were advised that BHC had moved to Committee and Board arrangements – all actions would be signed off by the relevant Committee and regular updates would be presented to the Council’s Health Scrutiny Sub-Committee. There would also be internal scrutiny and challenge in relation to performance and the ‘deep dive’ process. The BHC Programme Management Office (PMO) ensured that there was a standardised, repeatable, defined and measurable process for all projects and programmes. As the sole repository of information relating to the projects being undertaken, or considered within BHC, it gave oversight, visibility and assurance that projects were being managed, delivered on time, on budget and achieved their goals.

A summary of the CQC Action plan ‘must do’ and ‘should do’ themes was provided, which contained background on the recommendation and an update on the work that had been undertaken. An example related to the ‘must do’ theme of ‘oversight of 2-year checks and deferred visits’ – there was a live dashboard for the 0 to 4 mandated checks, which highlighted if any of the required information was missing. The Chairman – BHC reemphasised that they would address the issues honestly and transparently. The dashboard process had been developed during the COVID-19 pandemic to demonstrate that work was being carried out effectively and was constantly being refined. It was noted that several of the key issues raised by the CQC had been on the BHC Risk Register – they were disappointed with the outcome of the CQC Inspection but took it seriously and needed to respond.

A visiting Member considered that the plan was excellent and demonstrated that systems were in place to internally audit processes and methods to ensure that the same situation would not happen again. In response to a question, the CEO – BHC advised that a plan had been in place, which they had been working through, to address the key issues on their Risk Register. This had included the health visiting dashboard being made available and KPMG undertaking an internal audit to give external assurance. It was noted that the governance changes implemented would also be subject to an external review.

A Member noted that one of the ‘should do’ themes was for BHC to continue to work towards a medium- to long-term strategy and asked for clarification of the refresh of values that was underway with staff. The CEO – BHC said that the organisations three key values were no longer felt to be representative and therefore work had been undertaken via surveys and focus groups to consider a refresh. The ‘top five’ suggestions had been identified and further work was underway to finesse and embed them into everything the organisation did.

A visiting Member enquired as to how the tangible impact on frontline services would be measured. The CEO – BHC advised that they were currently reviewing how to best obtain patient feedback and were also looking to use more text messaging and surveys, where appropriate. BHC were considering how feedback relating to district nursing could be collated and services were also reviewed through Healthwatch Bromley. It was hoped that opportunities for public and patient engagement across the One Bromley system may also be possible. The Member noted that there were lots of active families and groups across the borough who would be able to provide insight on the improvement being made.

In response to a question, the CEO – BHC said that the district nursing team had been on the frontline throughout the pandemic and had continued to see patients face-to-face. A number of staff from other services had been redeployed into this team, and strategies had been put in place for the future. It was noted that during this time, the Rapid Access Therapy Team (RATT) and other specialist services had been established, which had fared well. With regards to the community health services for children and young people it was highlighted that BHC had taken on an additional service just 8 weeks prior to the inspection, which would have impacted the inspection.

A Member noted that the organisation had reported higher than usual sickness/absence levels and enquired if the right systems were in place to get staff to return to work. The CEO – BHC said that the organisation’s sickness levels pre-pandemic had consistently been at around 3%. Since the pandemic this figure had risen, however staff had reported COVID-19 infections via a specialist COVID line which provided advice around isolation and had returned to work as soon as they were well enough to do so. During the first wave of the pandemic, staff had been referred into the BHC COVID Management Service to receive further support. The organisation also had a strong HR team which supported services in relation to sickness and an e-rostering system was in place to monitor periods of absence. In response to a question from another Member, the CEO – BHC said that during the first wave of the pandemic there had been many unknowns – national guidance had been followed and around 30% of staff had been redeployed into different roles. Virtual meetings had been held with all services to gain an understanding of what had, and had not, worked to help inform the response to the second wave. External assurance had also been provided by KPMG reviewing the organisation’s response to the pandemic. There was a clear plan for how services would continue to recover and well as escalation plans, if required. The Member further noted the vacancies within the district nursing service and enquired if it was an issue to attract staff into this area. The CEO – BHC acknowledged that this had been an issue, however it was hoped that the revisions to the career pathway would offer more opportunities and the acquisition of the care agency would provide another route for staff to move into this role.

A Co-opted Member highlighted that the CQC Inspection had taken place in the midst of the COVID-19 pandemic. From personal experience he was aware how stretched health care staff had been and considered that leniency and understanding should be shown. Staff had worked hard to continue to provide services. The Chairman – BHC noted that the report was a snap shot of a certain point in time and was not a reflection of the team’s performance across the pandemic. A Member expressed that they had been surprised to see the outcome of the CQC Inspection as they were aware of the high standards that BHC held their staff to. The organisation’s mission statement appeared to have slipped and it was important for BHC to return to where they had been previously. These comments were echoed by another Member who considered that the organisation needed to bring the culture back to where it had been before – a shining example of health care provision. The CEO – BHC said that within district nursing, Band 7 leads had been appointed for each team – they would spend lots of time with their team and provide support. When Band 5 nurses joined the team, expectations would be set out and signed-off once they were met. Record keeping would be part of the probationary period, and during 1-2-1 sessions managers could see who was completing their updates on time. The leadership team were determined to turn the recommendations around and deliver the best service. The Chairman – BHC said that he was proud of the work undertaken by staff, particularly over the last two years – it was testament to the culture of the organisation and staff were fully engaged with the improvements to be made going forward.

RESOLVED that the presentations be noted.

Reverend Roger Bristow and Councillors Nicky Dykes, Kate Lymer and Stephen Wells left the meeting after consideration of this item.