Verbal update.

CQC Inspection documentation may be found here.

Paul Moore, Director of Quality and Assurance at Wirral University Teaching Hospital (WUTH) provided a verbal update on tha actions arising following the Care Quality Commission (CQC) inspection of urgent and emergency services at WUTH Arrowe Park in March 2019. Services had been rated as ‘Required Improvement’.

Mr Moore informed that it had been helpful to receive the CQC inspection in March which had followed on from and earlier inspection in May 2018. He further informed that there had been positive movements in some service areas and others had demonstrated outstanding practice. He concurred that of a number of issues identified, concerns remained e.g. responsiveness to initial assessment and triage where a combination of high occupancy, demand, patient flow i.e. nowhere to go, had resulted in unacceptable waiting times for both assessment and triage.

The Adult Care and Health Overview and Scrutiny Committee were apprised that at time of inspection this was the case, and this operational dilemma was being addressed i.e. where to place people. He added that it was clear that in order to reduce risk to patients, centralisation of Urgent Care in and around A&E where a variety of professional care services were available would provide the most appropriate solution. He agreed that even if used for shortest possible time, ‘corridor care’ was not compliant care or acceptable practice.

Mr Moore explained that as a result of the CQC inspection procedures for escalation measures had been made clear to all staff.

Members were informed that the WUTH did not agree with the CQC’s comment regarding paediatric staffing levels and inter collegiate guidelines. He informed that it was not clear if this comment was accepted by NHS as a whole, believing the recommendation regarding staffing levels may not be achievable, given there was an insufficient number of registered child nurses available in the country. The WUTH had accepted the advice but had asked for comment on the guidelines.

Mr Moore provided reassurance on the control of infection – particularly clostridium difficile – an extremely difficult infection to eradicate. He stated that WUTH was making progress in this regard and doing everything possible to address this bacterial infection, generally only using antibiotics where absolutely necessary.

Members questioned the Director of Quality and Assurance WUTH on a number of points relating to his verbal report and matters raised as a result of the CQC inspection. These included:

·  Staffing Levels;

·  WUTH leadership style;

·  Number of people held awaiting treatment, or being treated on trolleys (max 12);

·  Cost of temporary workforce (£60k per month);

·  Time patients to spend in A&E (no recorded data, but no more than 12hours); and

·  Current time taken for triage (15 minutes, down from 23 minutes).

Members stated that all future reports should be submitted in written format, noting that although verbal reports were helpful, it was not good practice.

Mr Moore provided explanation of a CQC comment that staff could not demonstrate what to do in the case of a fire and although this was challenged, the WUTH NHS Trust was unable to persuade the CQC. He advised the Committee that staff understood fire alarms procedures, but some were not aware of assembly points. Staff were undertaking training again and had subsequently performed actions correctly in practice tests.

A further round of questioning took place, with the Director of Quality and Assurance WUTH providing responses on the subjects relating to:

·  Staff in ACU feeling pressured to take patients, and demoralised as a result;

·  Relationship with Managers in the Walk-In Centre;

·  Teams working under pressure day in day out (symptom of bigger problem i.e. people spending too long in hospital resulting in congestion);

·  The need to enhance discharge and avoid admission in the first place;

·  Infection prevention and control i.e. the condition of the building (different floorings in different areas e.g. wood block flooring, sealing of floors against the walls, mould in silicon – all of which being difficult to clean); and

·  Increased number of equipment and devices now on wheels for easy access but hindered by a lack of storage resulting in ‘spread’ to other areas, the need to de-clutter had been acknowledged.

The Director of Quality and Assurance WUTH concluded his report stating that the hospital had been working to address these matters and the Chief Operating Officer had undertaken an examination of ‘stranded patients’ through multi-disciplinary consultations in an effort to encourage consultants to take into account consideration of early discharge dates.

Resolved - That

1)  the report be noted; and

2)  a further update report on this matter be brought back to this committee.