Agenda item

This report to the Health, Inclusion and Social Care Policy and Accountability Committee from Chelsea & Westminster Hospital NHS Foundation Trust (the Trust) provides a position update. The report includes current Trust and London benchmarking performance reporting and an indication of action and interventions planned for further support.

A presentation was given by Professor Tim Orchard and Professor Janice Sigsworth.  Professor Orchard acknowledged that recruitment and retention of staff had been a primary focus for a significant period. Imperial was a large organisation with over 7500 staff working across several sites, responsible for delivering high quality care.  Imperial was ranked in the top three Trusts nationally with one of the lowest mortality rates in the UK, and had worked hard at staff engagement across a large workforce.  Staff engagement was a challenge and the organisation had struggled with some key issues, particularly how senior staff were seen.  Measures to address this included rotating meetings and increased frequency of ward visits.  Professor Orchard acknowledged that they also needed to use tools such as social media more effectively to develop a presence with staff.

Staff turnover was a national challenge and in terms of metrics vacancy rates for London were 2.9%, with voluntary turnover rates at 9%, although they were aiming for 10%.  Additional challenges also included how the organisation dealt with poor behaviour and performance.  A premium for recruitment had been introduced, for example, for care of the elderly wards and acute, and the Trust recruited internationally where necessary. Recruiting well was key to achieving deliverables and to move forward from the Requires Improvement rating for CQC (Care Quality Commission).  Focusing on people and culture, the Trust had three years previously engaged with 4000 staff, to better understand the values and manage expectations.

Professor Orchard stated for the record his deep regret regarding Staff Nurse Amin Abdullah who had ended his life, following a formal disciplinary hearing which had resulted in his dismissal.  Professor Orchard acknowledged that Mr Abdullah should not have been dismissed and hoped that the experience would help the Trust to change its procedures for the benefit and protection of staff. He expressed concern that the use of less informal processes to address poor performance had declined and that there was a reactive response to deal with matters more formally.  Professor Orchard introduced Kevin Croft, who had recently been employed by the Trust as an interim measure.  A new protocol had been introduced so that a senior manager from another site would review cases prior to a decision being reached, to ensure consistency, objectivity and impartiality.  To date, 31 cases had been reviewed, eight had been returned for either more information to be obtained or for informal action to be taken.

Professor Orchard assured Councillor Richardson that Mr Abdullah’s case should not have been the subject of a formal disciplinary hearing.  Mr Croft’s investigation and performance framework protocols had been implemented and there were now the tools in place for dealing with all forms of poor performance.  There was a need to train staff in how to deal with some performance issues informally and for the performance evaluation processes to align for both doctors and other medical professionals.  Finally, it was important to take full account of equality and diversity issues, and it was acknowledged that there were notably higher rates of BAME (black and minority ethnic) staff subjected to disciplinary procedures.  Councillor Richardson commended Professor Orchard for the open and transparent way that the Trust had responded.

Dominic Conlin provided a perspective from Chelsea and Westminster NHS Trust Hospital (ChelWest), extrapolating key points from the report.  The age of the workforce was significantly younger (although this had slightly increased, following the merger with West Middlesex), by comparison to Imperial or University College London (Hospitals NHS Foundation Trust), with a higher proportion being new to the work, looking to specialise once they had completed their critical care work.  Many of the younger staff were not on the traditional career track of education, job, house, marriage.  They had different priorities, highlighting the prohibitive cost of housing in London. The Trust aimed to improve the culture and wellbeing of staff with initiatives such as the healthy workforce charter, recognising that there was a duty of care toward staff and the wider population, with the aim of making a healthier workplace. 

Staff engagement represented a linear link to better patient health outcomes. The data set out in the report provided a sense of the Trusts metrics and whether there were any wider incentives that could be considered such as housing, transport and key worker accommodation which were some of the root causes for the Trust.

With reference to the report (page 19 of the Agenda), Councillor Caleb-Landy expressed his concern regarding the reported 29% of staff who experienced abuse or harassment (staff survey).  Professor Orchard acknowledged that this figure was high but expected it to reduce.  He reported that such incidences usually arose during critical periods such as patient handovers.  The Trust aimed to stamp out bullying behaviours and to ensure that all staff understood what was expected in terms of accepted values and behaviours.  He explained that the way to avoid a “knee-jerk reaction resorting to formal disciplinary action was to create a more supportive environment and to equip staff with the tools to make this possible.  Trust had also taken steps to ensure that there was an increased of amount of security in Accident & Emergency (A&E), to ensure the safety of staff and patients safety.

Professor Sigsworth added that the staff survey was anonymous and although harassment was a grave issue, this was a challenging concern throughout any organisation.  Regarding cases that she had been involved in, she had taken care to listen and acknowledge a complaint as a valid concern and not deny it.  As a corollary, she added that it was important to be seen to take action.  If the behaviour continued, a way should be found to feedback and to address a concern, without breaking confidentiality and that this was a critical matter of trust. 

It was explained that it was critical to have a two-way relationship of trust. Monitoring and support for staff experiencing these issues was important and could sometimes affect more than one staff member, in any given situation.  Professor Orchard stated that staff would be able to confide in designated ‘guardians”, one based on each of the Trusts sites and who would be able to report to the Trust’s Board.   

Jim Grealy welcomed the report but noted that 35% of staff had experienced bullying.  He asked what had been done to counteract and address this, particularly in cases of abuse by members of the public.  Additionally, he enquired about any causal factors as to why BAME staff found it difficult to pass appraisals and how these could be identified.  Professor Orchard explained that dealing professionally with patients who were vulnerable and ill, was at times difficult and a necessary part of the job. There had been an increase in number of very disturbed patients held in A&E for extended periods, usually following Saturday night excess. It was important that staff felt safe in the workplace and the department was small for the number of patients treated.  With regard to BAME staff appraisals. Professor Orchard recognised that while the organisation reflected the diversity of the local community, this decreased significantly at the top of the organisation. Professor Sigsworth explained that there were BAME midwives who had not accessed training opportunities and could be encouraged and better supported in managing their careers. An offer to support the Trust in its to efforts to recruitment overseas by writing to government was welcomed.

ACTION: PAC to write a letter of support to the Home Office (UK Visas and Immigration) on the issue of recruitment visas for overseas staff

Councillor Lloyd-Harris described the report as impressive, honest and brave and asked about the qualifications of the senior investigator and the process of appointing them; and, the human resources review, considering the high number of failings highlighted by the case of Amin Abdullah. Professor Orchard reported that having trained staff was essential, with a duty to ensure that investigators received training and support commensurate with the challenging requirements of undertaking investigations.  He accepted failings had occurred and explained that the Trust had implemented proposals as to how future investigations would be conducted and supported. The Trust had plans to restructure Human resources, with staff being trained or retrained.

Victoria Brignell observed that there was no mention of affordable childcare for staff.  Professor Sigsworth that there were nursery facilities accessible for staff, utilised and accessed as suitable around varying shift patterns.  The provision was convenient and staff had reported positive feedback. The Trust was also considering improvements to a voucher scheme.

Bryan Naylor highlighted the issue of clinical staff performing administrative duties, with particular emphasis on discharge planning such as arrangements for patient transport.  Professor Orchard explained that they had experienced difficulties with the patient transport contract.  He concurred that this was partly an issue of discharge planning. Patient turnover was vast, with the length of stay reducing.  Discharge planning was a concern, the shorter the length of admission, the harder it was to plan.  The Trust was currently engaged in rolling out a series of interventions at ward level to better understand the estimated discharge time.  Each time a patient was seen, staff should be thinking of when that patient could be discharged.  He agreed that Imperial had not been as good in doing this as other trusts.  It was necessary to consider practical elements: did the patient have clothes, keys etc; information to help forward plan for example, to book transport or support at home.  Most problems arose when patient transport was booked on the day it was required. An external person had been asked to liaise with external organisations to ensure that care packages were in place.  For this to work, confidence was required that if a patient was sent home, they would be assessed within two hours and a care package put in place.

Councillor Ben Coleman welcomed both reports which he felt addressed the issues differently, welcoming the breadth of the report of the Imperial report. Mr Conlin clarified that a broader perspective could be provided, with similar figure allowing for further comparisons. As part of the general ethos and culture of the organisation, staff must perceive that responsible and assured action was being taken on their behalf. ChelWest had an initiative which allowed senior managers to spend one day on a ward, once a month.  This allowed greater dialogue and engagement with staff, to get the bigger picture rather than patient simply symptoms.

Councillor Coleman (on behalf of Councillor Patricia Quigley) asked why there was of no reference to ancillary staff, and if they had been included in the survey. In addition, Councillor Coleman asked if any staff with disabilities (according to a breakdown by gender) had been included in the survey. If not, how would ChelWest ensure that their needs were being met appropriately. Mr Conlin responded that ancillary staff were not directly employed by ChelWest.  He acknowledged that this did not help unify staff culture and the Trust would consider how to be more inclusive of staff employed by Sodexo. The importance of this was recognised, particularly in terms of the positive impact all staff could have on patient care by encouraging greater inclusivity.

Mr Conlin observed that the contracted out ancillary staff bought into the culture of the organisation more than medical staff.  They were also included staff award to celebrate this.  The percentage of staff with disabilities led staff, were below national levels and it was acknowledged that most disabled awareness training was directed at patients rather than staff. It was explained that this was undertaken with a more implicit focus on patients, rather than staff and, always undertaken by new staff as part of their induction process, in accordance with the organisations equal opportunities policy.

Professor Sigsworth explained that the Trust had data on self-declared disabled staff, although the number was low.  There were staff for whom reasonable adaptations had been made and all staff received disability awareness training. 

She acknowledged however that Imperial could be quicker in resolving some staff issues and conceded that they were not always as sensitive as they could be. Professor concurred with Mr Conlin, much of the focus was in how staff should engage with patients and about making reasonable adjustments within the work place.