Agenda item

To follow

Jacqui Scott, Chief Executive Officer – Bromley Healthcare (“Chief Executive Officer”) provided an update on the Bromley Healthcare CQC Action Plan.

The LBB Assistant Director for Integrated Commissioning advised that commissioner assurance arrangements had been presented to Members of the Adult Care and Health and Children, Education and Families Policy Development and Scrutiny Committees in March 2022, following a Care Quality Commission (CQC) inspection which had rated Bromley Healthcare overall as ‘Requiring Improvement’. The Integrated Commissioning Board had oversight of the assurance arrangements and were supporting Bromley Healthcare with their improvements. It was noted that Bromley Healthcare’s services were commissioned by a number of other Local Authorities, and that these authorities were taking part in the assurance arrangements. Meetings were held bi-monthly to receive updates in relation to the assurance arrangements. It was highlighted that, to date, the Integrated Commissioning Board were satisfied with the work being undertaken by Bromley Healthcare.

The Chief Executive Officer advised that Bromley Healthcare had regular engagement meetings with the CQC. The last meeting was held on 5^th April 2022, during which Bromley Healthcare had provided an update on the work being undertaken and the CQC had been content with the progress being made. It was noted that the second engagement meeting, scheduled to take place that week, had been postponed until 24^th August 2022.

The Chief Executive Officer advised that three Divisions had been established – Adults, Children and Young People and Urgent Community Response. Within each Division, the Divisional Directors were accountable for delivering performance targets, whilst the triumvirate of the Divisional Directors, Clinical Directors and Head of Nursing / Head of AHP were responsible for Divisional Governance. A cycle of assurance meetings had been established and the Executive Oversight Committee provided an opportunity for deep dives to be undertaken into areas for further review. In terms of recruitment, applicants for the Medical Director post had been shortlisted, and interviews would take place the following week.

The Bromley Healthcare Programme Management Office (PMO) system was the central repository for all projects and programmes within the organisation. All CQC related projects were identified within the tool – internally, these were  monitored weekly, and monthly via the CQC Sub-Committee. Progress at a programme, project and task level was visible and transparent, along with all project risks and issues. The tool worked on a linear basis, tracking percentage completion against target deadlines at a task level – any tasks potentially at risk were flagged early so that remedial action could be taken if required. Members were advised that an area currently not on track was around the reporting to the CQC – as Bromley Healthcare was a social enterprise it had a different reporting mechanism to that used by NHS Trusts. This had been raised at a meeting with the CQC and was included on Bromley Healthcare’s risk register – guidance was currently awaited from the CQC. It was highlighted that all other tasks were currently on track in terms of progress.

In response to a question, the Chief Executive Officer advised that the priority ratings were produced by the PMO system – each task had a deadline date, which were all on track to be met. During the internal Sub-Committee meetings, which the LBB Director of Children’s Services attended to provide assurance, deep dives were undertaken into each project to show the actions and work undertaken. The Portfolio Holder for Adult Care and Health noted concerns regarding the reporting process into the CQC, as they were the regulatory body, and asked what was being done to address this issue. The Chief Executive Officer advised that there were two areas for which they were required to report to the CQC. The reporting process around pressure ulcers had been put in place immediately, but the other required information to be entered on to the system in order for it to be progressed, which they were currently unable to do. This concern had been raised with the CQC, as well as SEL ICS who were providing this feedback to their engagement meetings. A further update could be provided once guidance was received.

The Chief Executive Officer informed Members that, as part of its long-term strategy, Bromley Healthcare had refreshed its values, which had involved gathering feedback from a staff survey; values focus groups; Employee Experience Collaboration Group; team meetings and leadership team meetings. The four new key values were Belonging; Health and Wellbeing; Continuous Learning and Compassion, and a formal launch would be completed shortly.

Members were advised that there were two levels of audit within Bromley Healthcare – an internal programme conducted by the quality team, and an external programme conducted by KPMG to provide additional assurance. Since the last report, three audits had been completed by KPMG – risk management; HR business processes; and estates health and safety. There was an internal programme of 50 planned audits, plus further spot checks relating to records and compliance with standard operating policies and procedures. The following KPMG audits were planned for 2022/23: Accessible Information Standards; Record Keeping Audit Hotspots; previous recommendations reaudit; review of governance and divisional structure; and deferred visit audit.

A Member enquired if improvements were being seen by patients following the recommendations made by the CQC inspection report. The Chief Executive Officer advised that the key area highlighted during the CQC inspection related to the timeliness and quality of record keeping. Both of these had been strengthened and underpinned some of the other issues raised. The organisation was readying itself for patients to view their own records – they wanted them to be of a standard that they would be happy to receive, and external assurance was also provided by KPMG. It was noted that with regards to record keeping in the District Nursing Services, the response rate to the survey had been very low. However, since the introduction of roving iPads, the number of responses had improved as well as the richness of the information fed back from patients, which would be used to improve services. The Place Based Director noted that a key focus of the CQC was to look at quality and the processes of how things were undertaken, rather than outcomes which were for the commissioners to consider. The CQC wanted assurance around what was being done well and that the right policies and procedures were in place. Outcomes in any service were crucial – if the right processes and procedures were in place this would lead to improved outcomes. The Chairman asked the Place Based Director if she was reassured by the progress being made by Bromley Healthcare. The Place Based Director confirmed that she was, and noted that they had been monitoring performance. The LBB Assistant Director for Integrated Commissioning oversaw the performance management framework for all contract providers. During the pandemic a number of the usual contract monitoring and performance mechanisms were stood down to enable a focus on addressing the response to the pandemic. However during this time a close eye had been kept on outcomes – including friends and family test  to gather feedback following the implementation of the Single Point of Access (SPA), and monitoring admissions to hospital.

The Chairman thanked the Chief Executive Officer and LBB Assistant Director for Integrated Commissioning for their update to the Sub-Committee. It was highlighted that careful attention was being paid to the recommendations made in the CQC inspection report, particularly around the audit process and recruitment, and work was being taken forward in a thorough manner.

RESOLVED that the update be noted.