Agenda item

Chelsea and Westminster Hospital NHS Foundation Trust has provided the attached report.

Professor Janice Sigsworth presented the update on Imperial College Healthcare NHS Trust’s (ICHT) implementation of the recommendations from the Francis Report. Of the 290 recommendations, some 50/60 had been applicable to ICHT.

There had been some quite fundamental changes arising from the Francis Inquiry, which had been embedded as part of the existing work streams. In addition, these  changes had been reflected in the recent CQC inspection.

In the first year, 44 actions had been completed. The report set out the four areas where ICHT wanted to do more work: feedback and learning from complaints; nurses/midwives to be in a supervisory capacity; clinical audit, mortality and efficacy of treatment; and feedback from students and trainees.

Ms Vanessa Sloane presented the update on Chelsea and Westminster Hospital NHS Foundation Trust, which set out the responses to the recommendations.

Councillor Carlebach considered that there had been a significant improvement in communications at ICHT but that there continued to be a lack of response from the executive team at Chelsea & Westminster Hospital. A response to correspondence initially sent on the 28 April in respect of a Changing Place remained outstanding, despite being chased.

Councillor Carlebach referred to the comments made by the CQC in respect of the Lead Nurse for Learning Disabilities not being  a specialist, and additional time not being allocated for this work. In addition there were issues in respect of easy to read leaflets; ‘Consent to Treatment’ leaflets not being available; and care for people with Learning Disabilities not being audited.  The web site did not name the Board Level Lead for Learning Disabilities.

Ms Sloane stated that work on the  Changing Place would begin that month and a Changing Place would be incorporated in the Accident & Emergency Department development.  

The Lead Nurse for Learning Disabilities now worked full time four days a week in this role, and was working with local police, GPs, families and the voluntary sector.

Ms Sloane stated that an IT solution was needed in respect of the patient audit and accepted the need for a patient leaflet.

300 staff had been recruited. 

There was ongoing work in respect of learning disabilities, around transition and support for young people and their families. There had been a stand at the Open Day, with families participating. Ms Sloane was the Lead Executive for Learning Disabilities

Councillor Brown queried staffing levels, the reliance on agency cover and nurse training across North West London.

Professor Sigsworth responded that ICHT currently had 170 vacancies. A senior nurse for recruitment and retention had been appointed. The Board had approved the recruitment of general nurses in Europe and neo-natal nurses in Australia, for which there was a national shortage. To encourage staff retention, rotation with other hospitals was being offered.

There were a reasonable number of nurses in training, but in North West London they were not coming through quickly enough and generally wanted to move around hospitals. 

Councillor Brown queried whether flexibility in pay was an option. Ms Sloane responded that this was possible for Chelsea and Westminster as a foundation trust, but would result in other hospitals being priced out of the market. Education, training and support were more effective retention measures.

Professor Sigsworth responded that there had been a pay freeze for a number of years, and the cost of living and housing was particularly high in London. The London supplement was in the region of £2/3,000. Whilst local staff were preferable, the Trust did recruit from the Philippines, the Commonwealth and Europe. 

Imperial had invested in midwives in preparation for the additional births consequent on the closure of Ealing maternity unit. There would be a recruitment day the following Saturday. 70/80 midwives had been recruited in the previous few months. There had been additional funding for the increased staffing.

Councillor Vaughan queried whether action had been taken to bring about a change in culture in respect of whistle blowing and incident reporting, and whether staff were confident to speak out.

Professor Sigsworth responded that there was a weekly review and annual report to the Trust Board. People were probably more confident to speak out, and it was hoped to reach the position where every member of staff felt confident to speak out.

Ms Sloane responded that in addition to the formal process, informal concerns were investigated and feedback given. Senior nurses were back on the floor in uniform every Friday.

Councillor Carlebach noted findings from the Chelsea and Westminster staff survey of bullying from members of the public, working additional hours and discrimination. Ms Sloane responded that staff were given the choice of working additional hours and might do so to support their colleagues. Bullying and violence was a real concern and the trust was working with the police and staff. Training was provided in conflict resolution to prevent escalation and a security system was in place.

Councillor Vaughan summarised the key issues from the discussion.

1.    There were concerns in respect of the responsiveness of Chelsea and Westminster to issues raised.

2.    There was a need for more nurses and overseas recruitment.

3.    London issues in respect of housing and salaries of nursing staff impacted on recruitment of nursing staff, and there needed to be a national strategy.

4.    There needed to be a culture change to encourage people to speak out.