Agenda item

6.1

The Committee received a presentation from Sheffield Teaching Hospitals regarding the CQC Inspection and Maternity Services. 

6.2

Present for this item were Dr. Jennifer Hill, Medical Director (Operations), Professor Chris Morley, Chief Nurse, Mr. Andrea Galimberti, Deputy Medical Director/Interim Clinical Director for Obstetrics, Gynaecology and Neonatology, Laura Rumsey, Interim Midwifery Director, Sandi Carman, Assistant Chief Executive, (Sheffield Teaching Hospitals) and Alexis Chappell, Director of Adult Health and Social Care (Sheffield City Council) and Dani Hydes, Deputy Director of Quality, (NHS South Yorkshire ICB).

6.3

Dani Hydes gave a brief overview of the quality assurance framework and the new governance arrangements following the transition to the South Yorkshire Integrated Care Board (ICB).  She reported that the changes had not diluted the role of Sheffield as a ‘place’ in Quality Assurance, that ‘place’ is an active member of the Quality Assurance Board.

6.4

Alexis Chappell said that the Health and Care Act introduced an assurance system for Integrated Care Systems which the Care Quality Commission (CQC) have been charged to implement. The CQC will look at how systems are working together and integrating to improve population health.  A working group was in place in Sheffield to ensure preparedness for this new framework. Alexis Chappell agreed to bring a report to a future meeting of the Committee on the new CQC assurance framework.

6.5

Dr. Jennifer Hill gave a presentation outlining what had happened after the CQC inspection of Sheffield Teaching Hospitals had taken place, the action plan that had been formulated from that and the progress made so far.  Dr. Hill said that during the inspection the CQC talk to staff and patients, observe practices and review documents including patient records, staff records, and training records. Then individual services were rated.  Dr. Hill said that an inspection of maternity services had been carried out in March 2021, during the period that the pandemic had severely impacted services and resulted in a rating change from Outstanding to Inadequate.  Following this, further inspections were carried out over a number of different services including urgent and emergency care, medical, surgical and community inpatient services and maternity services and this had resulted in a further report which identified 85 “must do” requirements and 26 “should do” recommendations requiring improvements by the 17^th July, 2022.  She said that these concerns were taken very seriously, and immediate action was taken to address them. Dr. Hill then outlined 17 improvement actions and their progress to date.  She reported that a team had been established to undertake quality support visits, and a Compliance Oversight Group established to oversee the progress of the action plan.

6.6

Professor Chris Morley referred to the presentation and outlined particular areas where improvements had been made. He referred to safety huddles on wards which looked at any concerns on wards, the introduction of ‘Ward Boards’ which gave helpful information for visitors, and also for staff to be able to see what was happening on their wards.  He said that there had been additional nursing staff and midwives recruited and more was expected during September.  He referred to the Maternity Improvement Plan which would be implemented to drive the improvements required going forward. Professor Morley outlined the systems and training that had been put in place on mental health wards and training in risk assessment on those wards.

6.7

Members made various comments and asked a number of questions, to which responses were provided as follows:-

·                With regard to staffing, retaining staff was a key aim.  The Trust is the eighth best Trust at retaining staff, but more was needed.  There was a programme for the first year to 18 months to ensure that each new starter had a mentor to help with their early career.  Secondly, there were a number of opportunities on offer, such as acting up, diversity of roles etc. and finally a transfer register so that someone could transfer across areas should they so wish.  Flexible retirement was often offered, and support given to midwives and nurses at the end of their career. 

·                A review was being undertaken which was giving advice and recommendations on how to staff areas and be able to skill mix the maternity workforce.  Midwives should do what they were trained to do.  Registered Nurses are not a substitute for midwives, but can add value and promote safe care. The Trust was looking at how to capitalise further on that. Nurses could be used to enhance the safety of mothers and babies and some post-natal care can be delivered by a non-midwife worker.  Nationally, there was a shortage of midwives, but it was hoped to make the Jessop Wing an attractive place to work to recruit more staff to it. Plans to support staff to work as a team were in place by listening and hearing what staff were saying from the bottom up.

·                Receiving feedback from patients was not easy. The Directorate Teams had tried many ways to regularly engage and listen to the feedback at all levels.  Out and about visits had commenced and they would go to many different areas and get feedback from staff.  On maternity wards, there were monthly “walkrounds”, to find staff, talk to them and get their feedback. There was a refreshing approach to patient experience generally, but there was more that could be built on.  There were many opportunities for patients to feedback and the Trust was looking to build on this as it goes forward.

·                With regard to diversity, and inclusion, the Trust has a very clear EDI Strategy and works with staff groups on this. The Trust is keen to effectively represent the community it serves and work is ongoing to improve diversity at Board level.

·                With regard to the “falls pack”, the first step in the process was to risk assess a patient as they entered the ward to ascertain whether they were at risk of falling, and there were a number of checks carried out by staff when completing a falls risk assessment and the patient would be given a leaflet with advice on how to prevent them from falling.

·                In terms of patient feedback from maternity services, the Trust has in place a Maternity Voices Partnership which collaborates and co-produces improvements to services, as well as traditional mechanisms such as the NHS ‘Friends and Family Test’. The Trust was confident that women and families had a say in services provided to them through their feedback and also had a right for reply.  There was also now better oversight of complaints as this was being managed at Trust level.

·                The Trust was procuring an electronic patient record, but this wouldn’t be in place until 2024.  The current system did not always make it easy for nursing teams to identify patient needs so they have been encouraging teams to ask what matters to patients and include any issues raised in their care plans,  ensuring that all elements of care were addressed by the right professional.

·                No advance notice was given of the CQC inspections.  The Chief Executive was phoned at 6.00 a.m. on the day it was to be carried out and the inspectors arrived two hours later.  Some issues highlighted in the inspection didn’t come as a surprise and it was recognised that there was a lot of work that needed to be done to get processes back up to speed following the pandemic.

·                There were a number of mechanisms in place to achieve best practice.  The Medical Directors and Chief Nurses meet on a regularly basis to share best practice.  On a national stage, there was a Shared Hospital Trust to which met to share its experiences, which was particularly useful during the pandemic. With regard to benchmarking, the Trust used a range of data sets and carried out comparisons with other organisations to pick up best practice. 

·                Work had been carried out with regard to inequality in outcomes in maternity services for BAME communities, and the Trust was in the process of benchmarking against national reports. The Yorkshire and Humber quality dashboard did not include ethnicity, but the Trust had recently developed an inequalities dashboard, and this was a focus of the organisation. If a woman or her baby was found to be at risk, the Service was keen to reduce risks and focus on meeting needs.

·                The Trust recognised the issue of transparency, and that it is important that members of the public are able to easily access information about Trust performance and action being taken on the CQC outcomes.

·                For the past 10 years, there had been a lot of work carried out in maternity services and many initiatives to improve quality of care. However when the pandemic hit, many areas of the NHS changed but maternity had to keep going and redesign its pathways. There was a constant amount of working then reworking which disrupted a lot of improvement work.  Going forward, a lot has been learned and particularly the value of the quality support team and the governance which was in place but was disrupted.

·                The reporting of incidents was done by all levels of staff and were monitored quickly.  Each Head of Department would go through quality of measures in place and there were a number of mechanisms in place to deal with incidents.

·                Each Directorate had a management team and monthly or quarterly meetings were held to flag up any issues that had arisen and offer support.

6.9

The Chair thanked Dr. Jennifer Hill, Professor Chris Morley, Andrea Galimberti, Laura Rumsey and Sandi Carman  for their presentation and their valued contribution to the meeting.