Janelle Holmes, Chief Executive Officer Wirral University Teaching Hospitals NHS Foundation Trust presented her report that informed that the CQC inspected the Trust between 13th March and 3rd May 2018. The report stated that the Trust was rated as ‘Requires Improvement’ overall due to a combination of a range of observations, that included:

• instability in the Executive Team and turnover of senior leaders;
• compliance with Fit & Proper Persons Requirement;
• ineffective governance (including risk management, quality monitoring, quality of information, concerns around culture, assessment of competence and skills, incident handling arrangements);
• environmental cleanliness;
• assessment of falls and pressure ulcer risk;
• access to Children’s Emergency Department 24 hours per day;
• transfer of patients out of hours; and
• use of Deprivation of Liberty Safeguards.

Having recently taken up her post, Ms Holmes informed that the rating had not been unexpected, but the Trust was clear in its aim to draw a line under the report and implement a number of key recommendations and actions agreed by the Trust’ s Board. Plans to address the requirements identified by CQC had been submitted to the Chief Inspector of Hospitals, NHS Improvement (NHSI) and NHS England (via Wirral Health & Care Commissioning). The immediate steps initiated by the Board involved:

• action to stabilise and transition rapidly towards a substantive leadership team and Board of Directors;
• the appointment of an executive lead for quality & governance. Paul Moore joined the Board on 9th July 2018. He will provide the leadership to transform quality governance, and drive on behalf of the CEO and Board the Quality Improvement Plan in concert with the Executive Medical Director and Executive Director of Nursing;
• allocation of dedicated PMO support to accelerate and manage delivery of quality improvement actions;
• the Board refreshing its strategy, vision and organisational priorities to reflect more directly its ambition of safe, high quality and sustainable clinical services for patients, and its dedication towards providing outstanding care;
• initiation of a wide-ranging organisational development programme to strengthen and promote effective leadership at all levels – intended to continue to drive the programme to develop organisational culture;
• the executive lead for quality & governance has undertaken a initial review of quality governance capacity and capability within the Trust. He has put forward a series of recommended immediate improvements, which have been wholly supported by the Board, to simplify, rationalise and strengthen oversight and control of quality, safety and risk management. Over the coming months, the executive lead for quality & governance will lead on behalf of the Board the delivery of the CAC action plan, changes to the Board’s committee structure, the approach to risk management and learning, and specifically target improvements in serious incident handling. This will focus on addressing better internal control, assurance and accountability for quality, risk management and exemplary corporate governance; and
• the Trust’s full participation in enhanced monitoring by NHS Improvement and Wirral Health & Care Commissioning. The Trust is committed to working closely with all stakeholders to achieve system level improvement that will enable and support safe, high quality and sustainable clinical services now and in the future.

Members questioned Ms Holmes on a number of key points of concern, primarily those surrounding reported issues of leadership failings and bullying culture. Members also highlighted concerns regarding the recruitment of staff, general vacancies and how certain areas of the Trust had been labelled as ‘not fit for purpose’. Members further highlighted concerns that the proposals for leadership training and investment in staff development did not appear to cascade through the entire organisation and staff morale remained low. The Chair identified that the Overview and Scrutiny Committee would be keen to hear from staff, RCN and/or Union Representatives to seek reassurance and hard evidence that these particular issues were being satisfactorily addressed.

The Chief Executive Officer Wirral University Teaching Hospitals NHS Foundation Trust re-affirmed that the Trust had a zero tolerance attitude to bullying and was happy to share the organisational development plan and that there was a general view that the above mentioned issues were getting better. She added that Members would see the changes and Members of the Overview and Scrutiny Committee were invited to view, first hand, some of the plans in action. The Chair suggested that such visits be arranged through Healthwatch Wirral.

Further questioning took place on CQC areas of concern and the Wirral University Teaching Hospital NHS Trust’s Improvement Plan. Members requested that the Improvement Plan be forwarded to the Health and Care Performance Panel for ongoing review.

Resolved – That

(1)  the report be noted;

(2)  a copy of the CQC inspection report and the Wirral University Teaching Hospital (WUTH) NHS Trust’s Improvement Plan be provided to the Health and Care Performance Panel for review; and

(3)  Overview and Scrutiny Members wishing to visit the WUTH NHS Trust liaise with Healthwatch Wirral to assist with the planning of such visits.