Update from CEO Robert Morton: CQC inspection – the story so far…(14th April)

Last week we completed the formal inspection phase of the CQC inspection process. This follows previous stages including the submission of a portfolio of evidence (some 19,506 pages), regional focus groups, and stakeholder engagement. Part of the latter phase included engagement with bodies such as the Trust Development Authority, the clinical commissioning groups (CCG)s, NHS England, Health Education England (HEE), College of Emergency Medicine, NHS Litigation Authority, Parliamentary and Health Service Ombudsman, and the local Healthwatch.

We are now in the unannounced inspection period until Monday, 25^th April; the inspection then moves into the reporting and reviewing phases when the report is drafted and the Trust has an opportunity to check the draft for factual errors. The key take home message is that we have completed some of this journey but have much more to do.

On behalf of the Trust, I want to thank everyone for all of their hard work which has brought us to this point.  In particular, I want to thank Lewis Andrews and the Quality Development Team who have put in extraordinary effort to bring our Trust to a point where we can all proudly say, “Nothing to hide and lots to be proud of”.

The CQC inspection team has taken the opportunity to provide us with some high-level written feedback. In this week’s message I am providing you all with the feedback we have received in writing from the CQC regarding what they describe as “Areas of Good Practice” as well as “Areas of Concern”.

It is important to stress that this is INITIAL FEEDBACK and should not be interpreted as representing the final report. It is given to us in order to highlight areas we need to celebrate and share as best practice, as well as areas we need to take action on immediately. Basically, the CQC will expect us to act on those “Areas of Concern” immediately, even before any draft report is produced. These “Areas of Concern” will also be a key area of focus for CQC inspectors during the unannounced inspection phase. Essentially, if we fail to address these “Areas of Concern” immediately, this is likely to significantly influence the final report.

On a positive note, it appears that on balance, the CQC inspector’s preliminary feedback is predominantly positive. The following bullet points are COPIED VERBATIM from the letter we have received from the CQC. The language used is frank, as we’d expect from a rigorous inspection, and certainly gives a very strong perspective:

Areas of Good Practice: 

• Attitude of staff: All staff were helpful, open and dynamic.
• We received extremely positive feedback from patients, their family and carers.
• We saw some examples of excellent compassionate care. These included but is not limited to: 

- The call handler who did not panic when the system went down but continued to provide advice and support to the person resuscitating a member of the public. The team around this person demonstrated their compassion and support following the call ending.

- The crew who dealt with a patient who was not willing to go into hospital until their elderly dog was cared for. The team located a dog sitter and ensured that the patient was reassured and willing to go into hospital for treatment they required.

- The call handler who maintained contact and supported a woman and her carer through giving birth in a layby. The resulting baby boy and mother were both transported to hospital in a safe condition.

- The crew who dealt with a palliative care patient who did not want to be transported to hospital. The crew contacted other health specialists, her GP and organised appropriate care and treatment. They sat with her and her husband patiently explaining her condition and treatment options. They only left when the patient and her husband were fully reassured and felt able to cope with the next stage of their end of life care journey.

•  We saw some examples of initiatives from the staff working at stations including newsletters and local initiatives
• Some examples of excellent leadership especially at the EOC centers and at Kempston and West Suffolk stations.
• Our team wanted to highlight two people who demonstrated outstanding leadership and enthusiasm. Sandra Treacher and Tony Peck were just two of the good leaders we met during the inspection.
• The trust demonstrated how to transfer to a new CAD system with minimal disruption and great commitment from staff.
• We were impressed by the equipment the trust had and the ease of access to equipment. 

 

Areas for Concern:

• Inconsistencies of leadership and role modeling leading to sloppy practice.
• We found good practice there were also areas of concern these included: 

- Examples included, CD keys placed in the ambulances rather than on the person, records left on dashboards, unkempt vehicles etc.

- Lack of people management in that training records were not kept or staff were not given opportunities to develop, appraisals were not done, competency checks were not undertaken.

- Poor governance throughout the trust. Issues included staff reporting a lack of policies, poor MCA and DoLS awareness, lack of understanding of safeguarding reporting, lack of feedback to staff regarding incidents and lack of consistency in audits.

• There was a permafrost at the band 7/8 level. So good practices were not collected and shared and poorer practices not addressed on a trust wide level. Staff were aware of senior team but understandably getting around 90+ stations takes time.
• The turnaround times and response times are not at target. However the CEO is proactive in engaging NHSE and NHSI to drive system wide improvement.
• The impact of union representation on both personnel and trust time.
• The management of patient records and the potential impact on key performance target reporting and outcome reporting for patients due to missing records/ poor recording. 

 

As I’ve outlined, we need to take action on these matters in the next two weeks and I have provided all Trust managers with a copy of the CQC’s letter of initial feedback on Wednesday.

The CQC inspection represents a significant milestone on our journey to become a more clinically-focussed organisation. The work we have had to do over the last eight months demonstrates there is much ground to recover before we can consider ourselves “Outstanding” across every domain.  We need to have the capacity to drive this work forward and continue to ensure we uphold the professional standards expected of us by the people we serve.

In the coming months, our Quality Development Team will transition to be our ongoing Quality Improvement and Professional Standards Team, further evidence the Trust is committed to the highest standards of services to our patients.

While this team will lead the implementation of any action plan that may emerge in due course from the final report from the CQC inspection, they will also continue to drive forward our overall agenda to become a quality focussed ambulance service. This is a good time for the rest of us to really get behind team EEAST and push this on for both our staff and our patients.

Away from the CQC inspection, discussions on the late finish proposals to balance patient safety and staff wellbeing are continuing with our staffside colleagues, and I will provide more detail in next week’s update.

Have a good week

Robert

Published 14th April, 2016