Agenda item

Ms Patricia Wright advised that she had started as Chief Executive of The Hillingdon Hospitals NHS Foundation Trust (THH) in December 2020.  She had previously been Chief Executive of Hounslow and Richmond Community Healthcare Trust, Chief Executive of Kensington and Chelsea PCT and Director of Strategic Commissioning across the eight PCTs in NWL.  Ms Wright noted that, following the CQC inspection in 2015, THH had been rated overall as ‘Requires improvement’ but that the Trust had been rated as ‘Good’ in the caring domain.  Following the 2018 CQC inspection, Hillingdon Hospital had been rated overall as ‘Inadequate’ but maternity services had been rated as ‘Good’. 

The CQC and Health and Safety Executive had undertaken inspections in August/September 2020 following a Covid outbreak in July which had affected staff and found failings in relation to adequate infection prevention and control measures.  NHS England / Improvement (NHSE/I) had subsequently asked Lesley Watts to provide specialist advice to the Board and identify support for the organisation as a whole.  This work had resulted in the implementation of a comprehensive improvement plan. 

Work that was being undertaken in response to the enforcement notices included: a new changing area in A&E; new signage; work around staff protection; and risk assessments around the hospital and in relation to vulnerable staff.  Tighter controls around managing infections had been introduced at Hillingdon Hospital which had resulted the previous week in the Trust being clear of all nosocomial infections for 28 days. 

Ms Wright noted that the improvement plan needed to respond to the issues raised by the CQC but that it also needed to be aspirational.  At a service level, the Trust had been systematically looking at the key lines of enquiry identified by the CQC and picking off quick wins whilst also undertaking more focussed actions.  Staff currently had low morale and would not recommend THH as a place to work.  As such, work needed to be undertaken with staff to get them to identify ways in which their morale could be improved.  Ms Wright advised that THH had not yet requested that the CQC take off the improvement notices as it was recognised that there was still more to do to embed the improvements that had been made.  It was hoped that a lot of the issues raised in the CQC inspection report would have been addressed by September 2021. 

When the Trust had achieved Foundation Trust status in 2011, it had been aspirational.  However, there had been some long standing performance issues and issues around emergency access.  A comprehensive action plan had been put in place, action had been taken in 2018/19 and 2019/20 and big changes had been made to the leadership of the Trust. 

One of the criticisms of the 2018 CQC report had been in relation to the leadership and culture at THH.  In terms of the type of leadership that she would like to embed at the Trust, Ms Wright advised that she had trained as a pharmacist where precision was important.  Her approach would be to create a governance framework for staff to work within and then let staff take the lead to ensure that they took ownership of the process. 

Ms Wright recognised that the churn in the leadership team had not been helpful and that staff had not been clear about the vision for the organisation.  Although the pandemic had impacted on the improvement progress made by the Trust, the outbreak at Hillingdon Hospital in July had resulted in improvements and the Trust was now being used as an exemplar for infection prevention and control checks and processes. 

Between March 2020 and July 2020, the Trust had still been fragile so had been hit hard by the pandemic.  For example, although there would usually be 9 ITU beds funded at Hillingdon Hospital, this had increased to 15 in the first and second wave of the pandemic.  There had been high levels of staff sickness and Government guidance had been changed on a regular basis.  The ability to segregate at the hospital had been impacted by the lack of space and crowding at the entrance. 

Although A&E performance had improved when patients stayed away from the hospital, this performance had again declined when patients had started to return.  Emergency performance continued to be below standard which had been impacted by space constraints and the need to keep patients who were infected away from those who were not infected.  The current number of presentations at A&E had been similar to those during a busy winter’s day and this would need to be managed very carefully going forward. 

Ms Wright stated that the staff were the Trust’s biggest asset.  She paid tribute to the dedication and hard work of all staff throughout the pandemic, especially those in A&E and ITU, who had had to work incredibly hard to manage the demand on services.  She noted that staff had also been affected by Covid in their personal lives as well as at work and that some of them had been anxious about taking Covid home to their families.  Around 83% of THH staff had received their Covid vaccination, although it was hoped that this would reach 90%. 

There had been fewer vacancies during the pandemic than had been seen prior to Covid and the high level staff sickness absence rates had started to reduce.  Although the vacancy rate had continued to drop, work had been undertaken to recruit around 65 overseas nurses who would arrive over the next twelve months as well as 70 new HCAs who were already in post.  Staffing in A&E continued to vary and vacancies continued to be difficult to fill.  A new Clinical Manager would be starting in May 2021 and would need to set themselves a realistic improvement trajectory which would be supported by the senior management team.  Ms Wright advised that there was still more to do. 

The 52 week patient waiting list numbers had increased from very low numbers up to around 1,000.  However, work was underway with partners locally, as well as with other Trusts in North West London, to reduce these numbers.  A recovery plan was now in place so that elective work could be restarted.  In the second phase of the pandemic, Mount Vernon Hospital had been retained as a ‘green’ site so staff who were shielding could work in a protected environment and had been able to keep on top of day case work.  Ms Wright advised that, with regard to cancer, THH had been meeting the majority of its targets.  This was particularly true of those targets where the Trust had more control.  

During the second wave of the pandemic (from December 2020), there had been an increase in the number of patients presenting with Covid, putting additional pressure on capacity.  At the peak of the first wave in April 2020, there had been around 100 patients diagnosed with Covid in inpatient beds at any one time.  In December 2020/January 2021, the peak was around 160-180 but staff and the sector had been more prepared and able to provide mutual aid to each other. 

Although the Covid had affected the quality of care provided by the Trust, quality around pressure ulcers and falls had been maintained.  Communication had also been more challenging as carers were not permitted to go into the hospital during the pandemic.  Ms Wright acknowledged that the Trust’s communication had not been as good as it could have been and consideration would need to be given to how this could be improved for the future.  Response times in relation to complaints had also been poor during the pandemic but had been brought back to 100% compliance in March 2021. 

Ms Wright advised that, as some facilities at Hillingdon Hospital were not fit for purpose, and in preparation for the new hospital development, two modular units were being established on the site.  ITU and respiratory facilities were due to move into Modular North during April 2021.  Following an enforcement notice from the London Fire Brigade, a planned refurbishment of the tower wards would also be undertaken. 

Although a lot of the issues faced by the Trust resulted from the poor state of the estate, there had been issues with a lack of emphasis on tight governance processes.  Covid had exacerbated the impact of the poor estate, for example the narrow corridors, but had also prompted different ways of managing infection control which would be used in the future.  It was hoped that the Trust would be back to a CQC rating of ‘Requires improvement’, if not ‘Good’, by 2022.

Financially, the Trust had ended the year in a balanced position.  That said, there was still a significant underlying deficit that would need to be addressed as part of the Outline Business Case for the development of the new hospital.  Going forward, the Trust’s focus would need to be on quality whilst also keeping an eye on the money. 

The Chairman thanked Ms Wright for attending the meeting and providing an honest and open update.  The Committee recognised that improvement would take time and looked forward to receiving another update on performance improvements in twelve months. 

RESOLVED:  That:

1.    THH be invited to provide a further update on performance improvements in twelve months; and

2.    the presentation and discussion be noted.